[Future directions of stroke rehabilitation]

Recently, in the field of stroke rehabilitation, some novel concepts and therapeutic interventions have been proposed. It seems that earlier mobilization for acute stroke patients could lead to better functional outcome. In addition, neural plasticity during acute phase of stroke is enhanced, which means that this phase of stroke could be the period when the patients are likely to respond to rehabilitation training. In the future, acute rehabilitation should be aggressively provided in stroke centers in Japan. Some interventions such as non-invasive brain stimulation, centrally-acting drugs and vagus nerve stimulation have been reported to enhance neural plasticity. If these interventions are introduced combined with rehabilitation training, compensatory mechanism for impaired neurological function could be facilitated, leading to further functional recovery. Some robotic devices to support joint movements of the limbs externally have been developed. Robot-assisted rehabilitation can improve the efficacy of rehabilitation training, especially when applied for gait training. Neurofeedback is a sophisticated training system applying real-time monitoring of brain activity with the use of functional neuroimaging. Neurofeedback can be introduced in order to remedy motor imagery of stroke patients even if motor function is severely impaired. Regenerative therapy is a promising therapeutic intervention and some institutions in Japan have already started to introduce this therapy for stroke patients. It is proposed that rehabilitation training should be provided following the introduction of regenerative therapy so that structural reorganization caused by the therapy could lead to beneficial functional reorganization of the damaged brain. With the aim of improving active motor functions of hemiparetic limbs, botulinum toxin injection for limb spasticity after stroke should be combined with rehabilitation training. If these concepts and interventions are introduced aggressively and more widely for stroke patients, it is expected that functional outcome of such patients could be generally improved.