Some factors influencing the outcome of stroke rehabilitation

The eventual outcome of a stroke patient's rehabilitation may depend as much upon his experiences following the stroke as upon the actual brain damage. Positive factorsinfluencing rehabilitation include the early stimulation of the body orienting mechanism in upright positions; the prevention of the development of spasticity; the therapist's understanding of the factors involved in learning a motor skill; the ability to analyse an everyday activity and find its missing or abnormal components an understanding of the current hypotheses about the effect of stimution upon the recovering brain. Negative factorsinclude a tendency to be obsessed with techniques of treatment rather than with a detailed analysis of the patient's problems; the perpetuation of certain 'myths' such as proximal to distal recovery of function, and practising movement in a neuro-developmental sequence despite the maturity of the adult patient's brain; a failure to understand the different physiological and behavioural mechanisms underlying apparently similar problems which leads to lack of cortical drive being confused with muscle weakness; the expectations of the therapist who expects a stroke patient will become spastic, will not recover functional use of his upper limb, and will need a quadripod stick in order not to fall over.