Affiliations: [a] Department of Neurology, Johns Hopkins University, Baltimore, MD, USA | [b] Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA | [c] Neuroscience, Johns Hopkins University, Baltimore, MD, USA
Correspondence:
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Address for correspondence John W. Krakauer, Johns Hopkins University School of Medicine, 207 Carnegie, 559 North Wolfe Street, Baltimore, MD 21287, USA. Tel.: +1 410 955 9320; E-mail: [email protected].
Abstract: BACKGROUND:Stroke is one of the leading causes of disability in the world, with the upper limb being affected up to 80% of the time. Current rehabilitative therapies for the upper limb, primarily centered on task-oriented training, are ineffective at boosting recovery from motor impairment beyond what is expected from spontaneous biological recovery and instead promote compensatory strategies in order to perform specific activities of daily living. PURPOSE:To give a critical overview of animal and clinical literature that support the idea that a non-task-oriented approach may be more fruitful for recovery from motor impairment, and to propose a novel therapeutic paradigm designed to bolster spontaneous biological recovery early after stroke. CONCLUSIONS:A focus on movement quality, rather than task completion, practiced at high intensity and dosage in an enriching environment may be the training approach that best exploits the sensitive period early after stroke in order to amplify the generalized gains seen with spontaneous biological recovery.
