title: Dose and timing in neurorehabilitation: prescribing motor therapy after stroke.
abstract: OBJECTIVE
  Prescribing the most appropriate dose of motor therapy for individual patients is a challenge because minimal data are available and a large number of factors are unknown. This review explores the concept of dose and reviews the most recent findings in the field of neurorehabilitation, with a focus on relearning motor skills after stroke.
  
  
  RESULTS
  Appropriate dosing involves the prescription of a specific amount of an active ingredient, at a specific frequency and duration. Dosing parameters, particularly amount, are not well defined or quantified in most studies. Compiling data across studies indicates a positive, moderate dose-response relationship, indicating that more movement practice results in better outcomes. This relationship is confounded by time after stroke, however, wherein longer durations of scheduled therapy may not be beneficial in the first few hours, days, and/or weeks.
  
  
  CONCLUSIONS
  These findings suggest that substantially more movement practice may be necessary to achieve better outcomes for people living with the disabling consequences of stroke. Preclinical investigations are needed to elucidate many of the unknowns and allow for a more biologically driven rehabilitation prescription process. Likewise, clinical investigations are needed to determine the dose-response relationships and examine the potential dose-timing interaction in humans.
authors.affiliation: aProgram in Physical Therapy bProgram in Occupational Therapy, Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri cSchool of Kinesiology, Auburn University, Auburn, Alabama, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Lang
authors.forename: Keith R
authors.initials: KR
authors.lastname: Lohse
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Birkenmeier
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D000066530:Neurological Rehabilitation / Q000379:methods*; D000071939:Stroke Rehabilitation