Post Stroke Exercise Training Intensity, Dosage, and Timing of Therapy

Although the exact intensity and timing of rehabilitation post stroke varies from study to study, in general, more intense, earlier rehabilitation results in improve motor outcomes. This is consistent with our understanding of the influence of repetitive taskspecific exercises on neuroplasticity. There are pragmatic difficulties implementing more intense and earlier rehabilitation, but there are also innovative approaches including new technologies. As time goes by post stroke, the dosage of therapy required to result in improved outcomes increases. Very early rehabilitation exercises therefore offer the greatest opportunity, although rehabilitation should be carefully limited for the first 24 hours and longer for more severe strokes. Some recent data have shown that augmented rehabilitation in the subacute phase results in greater recovery in the upper extremity, when compared with recovery in the chronic phase, with a suggestion it may be as good or perhaps better than the same augmented therapy delivered in the acute phase. Therapy in the form of task-specific exercises in the chronic phase requires higher doses to produce improved motor outcomes.