Rehabilitation for Cerebrovascular Disease: Current and new methods in Japan

Rehabilitation is treated as an independent subject in Japanese Guidelines for the Management of Stroke 2009, formulated primarily by 5 academic societies, namely The Japan Stroke Society, The Japan Neurosurgical Society, Societas Neurologica Japonica, Japanese Society of Neurological Therapeutics, and The Japanese Association of Rehabilitation Medicine. Rehabilitation is discussed in terms of "procedures for stroke rehabilitation" and "rehabilitation for main disorders and problems." Rehabilitation should be carried out based on these criteria. As one approach that should be pursued in stroke rehabilitation, we recommend the treatment concept of incorporating intensive rehabilitation intervention simultaneously to the extent possible to encourage functional compensation ability, which we call intensive neurorehabilitation. For example, the patient receives preconditioning to improve the brain's plasticity, followed by intensive and active rehabilitation. Following this approach, positive results have been achieved in pioneering and systematic tests, which focused on using low-frequency rTMS (repetitive transcranial magnetic stimulation) and intensive training with patients who are paralyzed in the upper limbs.