Intensity of practice after stroke: More is better

Abstract

The present debate paper addresses four relevant issues related to the impact of intensity of practice after stroke. First, the best way to define intensity of practice is discussed. Second, the paper describes the evidence that exists for a dose-response relationship in stroke rehabilitation. Third, the relevance of an appropriate patient selection for a meaningful intensive practice is explored. Finally, the feasibility of intensive practice by: (1) early started mobilization of stroke patients (2) ability to practice in groups, (3) using forced use paradigms such as constrained induced movement therapy for the upper limb, (4) using robotics and (electronic) devices that help patients to practice on their own and (5) preventing poor compliance in terms of practice in therapeutic sessions by identifying factors that predict poor adherence are discussed.