Intensity versus task-specificity after stroke: how important is intensity?

Recent evidence suggests that intense training regimens can increase the use and function of the more affected limbs of stroke patients. The efficacy of these intense regimens has led some to conclude that intense training regimens should be more widely applied clinically and has caused some physicians to attempt implementation of more intense training regimens with stroke patients. However, intense protocols may not be needed to produce positive motor changes in some patients and may not be plausible in some environments or with some patients. In this commentary, we review the evidence supporting the efficacy of less intense, task-specific training regimens emphasizing the use of the more affected limb. We submit that intensity does not need to be altered to induce substantial clinical improvements, as some have suggested. Rather, the results of the studies suggest that the nature of stroke motor therapy itself can be altered to be more task-specific while remaining within the typical contact time parameters (i.e., 30-45 min/session), yet can be more efficacious than more traditional motor rehabilitative approaches.