Clinical observations on recovery from stroke.

Recovery from stroke occurs in a similar pattern in most patients, but the final functional status is difficult to predict. This recovery is most rapid in the first few months, but it may continue for years. The factors facilitating prolonged and more complete recovery are unclear and multiple. The neurophysiologic mechanisms of synaptic sprouting, unmasking, and redevelopment of inhibition may underlie recovery and provide the basis for developing therapeutic interventions in an attempt to promote return of function. Although the impact of current rehabilitation strategies on stroke recovery is uncertain, review suggests that it is beneficial in selected groups of patients. Further research is needed to answer the many questions surrounding recovery from stroke (a) to address the mechanisms of stroke recovery in human subjects with imaging or pathologic correlation, (b) to design therapeutic techniques based on neurophysiology and assess their effectiveness in groups of patients, (c) to determine if intensive rehabilitation reduces functional dependency resulting in decreased long-term social and economic costs, (d) to determine when rehabilitation should begin, where rehabilitation should take place, and how rehabilitation programs should be organized, and (e) to enable selection of patients most likely to succeed in rehabilitation programs. Although difficult to design, studies addressing these areas will provide much useful information that will further the development and delivery of rehabilitation services, resulting in improved patient care and reduced costs.