From Qualitative to Quantitative Functional Assessment in Stroke Rehabilitation with a Focus on Ultrasound Role

Stroke-surviving patients may present a wide range of neurological deficits affecting both sensory and motor functions as well as the cognitive and the emotional domains, with an impact on independence on daily activities and quality of life in general. Assessment scales are essential tools for evaluating all these aspects of a patient's condition and for monitoring their evolution in time, attempting to provide a quantitative index to complex and sometimes indirectly observable parameters. In fact, the use of these scales entails methodological and interpretative challenges that can limit their applicability and effectiveness. This narrative review explores the current state and limitations of assessment scales used in the rehabilitative evaluation of post-stroke patients. Common neurorehabilitation techniques and traditionally used assessment scales for measuring patient progress are reviewed, highlighting their main limitations. As an alternative to the observational approach, direct assessment of the effect of the ongoing rehabilitative process on the functional recovery of the damaged neurological network, based on the recording of their electric signaling or on the modification in regional cerebral blood flow, have been recently proposed. Innovative rehabilitation assessment methods based on quantitative data are reviewed, with a special focus on ultrasound-based techniques, aiming to improve accuracy and sensitivity in clinical assessment.