Current Concepts and Controversies in Stroke Recovery: Rehabilitation Implications

Abstract

This paper summarises the stroke incidence crude rate as 3.02 per 1000 people of 25 years and over and that of ‘mini-strokes’ as 2.89 per 1000 people. Many people with a mini-stroke may develop a full stroke within one year. Occupational therapists therefore need to shift their attention first to primary prevention to alter original organic pathology and then to restitution of hemiplegia. A number of issues in neurological recovery following hemiplegia are then highlighted. These include ‘penumbra’, a metabolic disorder, the understanding of which helps to know if a hemiplegic lesion is able to tolerate the loss of oxygen and whether it can adapt to the ischaemia, early mortality and implications of regional cerebral circulation changes for treatment of hemiplegia and for prognosis. In the treatment of hemiplegia, there is a need to understand the role of ipsilateral brain, that is, brain plasticity in stroke recovery, the role of uncrossed pyramidal fibres, the parallel versus hierarchical operation of the descending cortical influences, and the interactions of the pre-motor systems with the primary cortex. In treatment, the paper explains the implications of the use of Bobath-type therapeutic procedures, the use of unilateral or bilateral tasks in occupational therapy and the learned non-use of the hemiplegic side.