Rehabilitation in Subacute and Chronic Stage After Stroke

Abstract

Despite advancing rehabilitation programs, stroke is the most prevalent disease to cause disablement. With the increase of the elderly population, the number of stroke patients increases as well. Although stroke patients at an early stage depend on a stroke unit in the acute hospital, their functional recovery and long-term health status are more affected by subacute rehabilitation hospital. Moreover, a stroke patient’s initial evaluation is crucial for prognosis and establishment of rehabilitation training strategies. The earlier stroke patients start their rehabilitation treatment, the better results they can attain; the recovery from stroke occurs within 3 months after the onset of stroke. Similarly, while neurological and functional recovery occurs in the acute and subacute stages, sometimes, it occurs 6 months after the onset of stroke or in the chronic stage. There are two main mechanisms of neurological recovery. The first is activity-dependent neuroplasticity in the injured cortical representation area, and second is vicariation, which is an operating mechanism as a substitute for the injured brain function in the remnant cortical area, outside of the damaged brain area. This stroke recovery is affected by many factors that influence reorganization of the damaged brain and early rehabilitation; furthermore, intensive rehabilitation and organized enriched environments also significantly affect recovery. In addition, there are substantial researches about new rehabilitation treatment, likely rTMS, tDCT, robotic therapies, mirror therapy, virtual reality, and drug augmentation; therefore, the results of these studies are expected to highlight promising rehabilitation treatments for stroke in the future.