Affiliations: Rehabilitation Centre 'De Hoogstraat', Rudolf Magnus
Institute of Neuroscience, UMC Utrecht, The Netherlands | Department of Physical Therapy, VU University Medical
Center (VUmc), Amsterdam, The Netherlands | Deparement of Physiotherapy, Isala Clinics, Zwolle,
The Netherlands
Note: [] Corresponding author: G. Kwakkel (PhD), Physical Therapist,
Human Movement Scientist, Senior Researcher, Rehabilitation Centre 'De
Hoogstraat', Rembrandtkade 10, NL-3583 TM Utrecht, The Netherlands. E-mail:
g.kwakkel@azu.nl
Abstract: Longitudinal studies show that almost all stroke patients experience
at least some predictable degree of functional recovery in the first six months
post stroke. However, the non-linear pattern as a function of time is not well
understood. Several mechanisms are presumed to be involved, such as recovery of
penumbral tissues, neural plasticity, resolution of diaschisis and behavioural
compensation strategies. Rehabilitation is believed to modulate this logistic
pattern of recovery, probably by interacting with these underlying processes.
However, prediction models that are adjusted for the effects of time after
stroke onset suggest that outcome is largely defined within the first weeks
post stroke, although functional improvement has been found to extend beyond
six months post stroke. In addition, kinematic studies show that functional
improvement is more than recovery from impairments alone, suggesting that
patients are able to improve in terms of gait or dexterity deficits using
behavioural compensation strategies. Therefore, understanding the impact of
task-dependent cortical activation patterns in non-invasive methods requires
not only information derived from longitudinal studies pertaining to functional
outcomes, but also a better understanding of what is kinematically learned
during the acquisition of new skills.
