Recovery from stroke

Recovery in stroke is reviewed. Motor recovery occurs mainly within 6 months after onset of stroke. However, improvement may occur even after 12 months from onset in patients who are severely paralyzed but retain some ability for movement. Rehabilitation, such as repetitive training or biofeedback, significantly enhances recovery; however, the effect of neurodevelopmental exercise is still controversial. Neurotrophic factors that prevent or slow the death of neurons have been induced by exercise and further developments are expected in this field. Mechanism of recovery consists of recovery of the damaged cells themselves, substitution, reorganization of the cerebral cortex, or utilization of another pathway, such as the ipsilateral route. The first trials to predict prognosis of stroke were made many years ago, and new trials are still being undertaken because no reliable prediction method has been developed. Although correlation coefficients, regression analysis, neural network, tree analysis, or Rasch conversion have been employed, there are as yet no satisfactory equations. Predictive equations formulated using one group of patients should be applied to other patients to evaluate their accuracy. Neurophysiological parameters, such as central motor conduction time or extent of Wallerian degeneration, are expected to be effective for prediction of recovery from stroke.