Functional recovery after stroke: a review of current developments in stroke rehabilitation research

This review article discusses current research developments in functional recovery after stroke. With the institutionalization of stroke services across health care facilities, a reduction in mortality rates, length of inpatient stay and improved independence in activities of daily living has been reported. Several systematic reviews show that traditional treatment approaches induce improvements that are confined to impairment level only and do not generalize to a functional improvement level. More recently developed treatment strategies that incorporate compensation strategies with a strong emphasis on functional training, may hold the key to optimal stroke rehabilitation. Intensity and task-specific exercise therapy are important components of such an approach. Guidelines may assist the clinician in this responsibility. However, due to marked heterogeneity of the stroke population and poor methodological quality of many studies, results are uncertain. Several options are discussed to overcome the problem of stroke heterogeneity in research designs. Longitudinal repeated measurements designs are required to study the effects of non-linearity and time dependency of functional recovery in stroke. Furthermore, prognostic research based on sound clinimetric data generates relevant information that may guide the clinician in clinical decision making and in determining optimal treatment strategies.