Impact of intensity of practice after stroke: issues for consideration.
OBJECTIVE
The present debate paper addresses four relevant issues related to the impact of intensity of practice after stroke. First, the best way to define intensity of practice is discussed. Second, the paper describes the evidence that exists for a dose-response relationship in stroke rehabilitation. Third, the relevance of an appropriate patient selection for a meaningful intensive practice is explored. Finally, the paper raises the question of what it is that patients actually learn when they improve their functional skills. Search strategy. For this purpose articles from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE and PiCarta and references presented in relevant publications were examined.


CONCLUSIONS
Although, there is strong evidence that early augmented exercise therapy time (expressed as time dedicated to practice) may enhance functional recovery, there is a discrepancy between the evidence for the benefits of intensive practice, on the one hand, and, the implementation of intensive rehabilitation treatment programmes in the current healthcare system on the other. Further emphasis should be given on a better understanding of the time-dependency of prognostic factors that determine the effectiveness of intensive practice in patients with stroke. In addition, a better understanding is needed of the neurophysiological and biomechanical mechanisms that underlie compensation-related learning of functional tasks after stroke.
Kwakkel
Gert
G
De Hoogstraat Center of Excellence for Rehabilitation, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, and VU University Medical Center, Amsterdam, The Netherlands. g.kwakkel@vumc.nl
D000203:Activities of Daily Living; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D009043:Motor Activity / Q000502:physiology; D026741:Physical Therapy Modalities / Q000145:classification* / Q000191:economics; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function / Q000502:physiology*; D012046:Rehabilitation / Q000379:methods*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome