Rinsho Shinkeigaku (Clinical Neurology)

Symposium 21

Fundamental theory and practice in stroke rehabilitation from acute stage to chronic stage

Hiroyoshi Hara, M.D.

Department of Rehabilitation Medicine, Aizawa Hospital, Stroke-Neurological Center

One of the most important objects of stroke rehabilitation is motor recovery from acute stage to chronic stage. Reorganization theory of motor circuits in the cerebral cortex contributing to recovery following stroke is proposed. In acute stage motor recovery depends on residual corticospinal tract excitability from onset to 3 months (1st stage recovery). In next stage alternative output system is used according to intracortical excitability depending on intracortical disinhibition at the peak of 3 months (2nd stage recovery). At 6 months and beyond training-induced synaptic strengthening becomes better established, and new networks are better reorganized (3rd stage recovery). Stroke rehabilitation programs from acute stage are required depending on this stage theory. With each stage to select and perform the most effective rehabilitation programs are necessary. Two obstruction factors of motor recovery are indicated. One of them is Wallerian degeneration of corticospinal tract. Early Wallerian degeneration of the corticospinal tract that is seen on diffusion weighted MRI was reported. The appearance of Wallerian degeneration at acute stage should be directed to more attention as motor recovery inhibition. Next obstruction factor is development of spasticity from acute stage. Spastic paresis is subjected over time to immobilization of the paretic body part and chronic disuse of the paretic body part, which are avoidable through early rehabilitation intervention. Recently various interventions were proposed for motor recovery. The combination of repetitive transcranial magnetic stimulation and intensive occupational therapy by Abo (2010) are recommended to recovery hand function at chronic stage as 3rd stage recovery.
Full Text of this Article in Japanese PDF (558K)

(CLINICA NEUROL, 51: 1059|1062, 2011)
key words: acute stroke rehabilitation, stages of motor output reorganization, spasticity, Wallerian degeneration

(Received: 20-May-11)