Expanding Rehabilitation Beyond the Clinic—Strategies to Increase Total Restorative Therapy Time for Adults with Hemiplegia

Abstract

Background: Positive neuroplastic changes involving cortical reorganization after stroke are experience dependent and are facilitated more effectively when rehabilitation occurs with high volume. Structured experiences to promote adaptive changes can be implemented during scheduled therapies in any rehabilitation setting. However, time spent in supervised restorative therapy is limited regardless of setting. Time spent in therapeutic activity can be extended by a variety of options that patients can engage in independently, that are low-cost, and that have evidence to support their use as a supplement to physical and occupational therapy. Purpose: The purpose of this paper is to present four such options for supplemental therapeutic activities to support restorative rehabilitation, including mental practice, mirror therapy, low cost virtual reality, and community group exercise classes. A sample of the evidence supporting their feasibility and effectiveness is presented. Practical guidelines for implementation are provided based on the evidence. Recommendations: Evidence based interventions can be used to extend total restorative rehabilitation time as an extension of therapy activities performed in the clinic. They are feasible and effective and can support positive neuroplastic changes in individuals with hemiplegia. These strategies can and should be implemented across practice settings by physical therapists, occupational therapists, and speech language pathologists.