[Review Article] Neuroplasticity in action post-stroke: Challenges for physiotherapists

Published in: European Journal of Physiotherapy, 2015

Neuroplasticity in action post-stroke: Challenges for physiotherapists

Gunilla Frykberg & Rajul Vasa

Department of Neuroscience/Rehabilitation Medicine, Uppsala University, Sweden, and  Rajul Vasa Foundation, Center for Brain and Spinal Injury Rehab, Mumbai, India

Abstract

Knowledge regarding neuroplasticity post-stroke is increasingly expanding. In spite of this, only a few physiotherapy interventions have been able to demonstrate effectiveness in achieving recovery of lost sensorimotor control. The aims of this review article are to highlight and discuss challenges for physiotherapists working with patients post-stroke, to question some current assessment methods and treatment approaches, and to pose critical questions indicating a possible new direc­tion for physiotherapists in stroke rehabilitation. Differentiation between recovery and compensation post-stroke is increas­ingly being emphasized. Implementation of this goal in the clinic is insufficient, with a lack of assessment tools with potential to discriminate between the concepts. Large-scale reviews are performed without considering whether functional gains are achieved through “more effective” compensatory strategies or through recovery. Cortical plasticity in neuroreha­bilitation research and voluntary control in contemporary treatment methods are in focus. Challenges for physiotherapists in stroke rehabilitation consist of rethinking, including looking upon the body under the influence of gravity, focusing on implicit factors that impact movement control and developing new assessment tools. The introduction of a new assessment and treatment concept aiming at expanding the boundaries of center of mass movements towards the paretic side is pro­posed. In conclusion, we need to assume our responsibilities and step forward as the experts in movement science that we have the potential to be.

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