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Training and exercise to drive poststroke recovery

Nature Clinical Practice Neurology volume 4, pages 76–85 (2008)Cite this article

Abstract

To make practical recommendations regarding therapeutic strategies for the rehabilitation of patients with hemiparetic stroke, it is important to have a general understanding of the fundamental mechanisms underlying the neuroplasticity that is induced by skills training and by exercise programs designed to increase muscle strength and cardiovascular fitness. Recent clinical trials have provided insights into methods that promote adaptations within the nervous system that correlate with improved walking and upper extremity function, and that can be instigated at any time after stroke onset. Data obtained to date indicate that patients who have mild to moderate levels of impairment and disability can benefit from interventions that depend on repetitive task-oriented practice at the intensity and duration necessary to reach a plateau in a reacquired skill. Studies are underway to lessen the consequences of more-severe motor deficits by drawing on medications that augment plasticity, biological interventions that promote neural repair, and strategies that employ electrical stimulation and robotics.

Key Points

  • Within several days after the onset of a stroke, clinicians can begin to promote functional recovery in their patients

  • An understanding of the mechanisms underlying the neuroplasticity induced by skills training might help us to devise ways to enhance gains

  • Task-specific training seems to benefit stroke patients more than general exercise in terms of improving daily functioning

  • Task-oriented learning should be supplemented by exercises to build muscle strength and increase endurance

  • A number of randomized clinical trials have highlighted the value of exercise programs in individuals living in the community after stroke

  • Patients with severe motor deficits might benefit from medications that augment plasticity, biological interventions that promote neural repair, and strategies that employ electrical stimulation and robotics

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Figure 1: Functional MRI studies performed before and after locomotor training in a 12-year-old who had undergone hemispherectomy.

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Acknowledgements

The author's work is funded by the Dr Miriam and Sheldon G Adelson Medical Research Foundation, the Larry L Hillblom Foundation, and NIH grants RO1 HD046740 and RO1 NS050506.

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Author notes

  1. University of California, Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA bdobkin@mednet.ucla.edu

Authors and Affiliations

  1. BH Dobkin is a Professor in the Department of Neurology at the University of California, Los Angeles, CA, USA.,

    Bruce H Dobkin

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The author declares no competing financial interests.

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Dobkin, B. Training and exercise to drive poststroke recovery. Nat Rev Neurol 4, 76–85 (2008). https://doi.org/10.1038/ncpneuro0709

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