World Health Organization defines stroke as ‘rapidly developed clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than of vascular origin (K. Aho, 2020). According to Donkor (2018) Stroke is ranked as the second leading cause of death worldwide.

 Main problems faced by stroke patients are abnormal coordination of movement patterns combined with abnormal tonus (Bassøe Gjelsvik, Bente E., author 2016). 

Pathological types of stroke are

  1. ischemic
  2. intracerebral hemorrhage (ICH)
  3.  sub arachnoid hemorrhage (SAH) (Harris et al. 2018). 

Ischemic stroke can occur due to large-artery atherothrombotic disease, disease of the small intracranial arteries and cardiac emboli.

ICH can occur mainly due to hypertension and arteriovenous malformation. 

SAH can occur mainly due to ruptured aneurysm (Krafft et al. 2012). Stroke can be categorized under upper motor neuron lesion and have characteristics which are associated with affecting descending motor pathways (Micieli et al. 2020). 

 Recovery depends on factors such as

Age, personal motivation, extent and type of the brain lesion, severity of impairments due to brain lesion. 

Objectives of stroke rehabilitation are improve independence and improve functions  According to Maier et al. (2019), there are three major approaches to stroke rehabilitation.

  • Restoration of functional activities
  • compensation of lost function by relearning
  • modification of environment to aid the functional activities.  

Borschmann and Hayward (2020) suggests that the majority of the improvement of upper limb capacity and performance occurs in early post-stroke. The majority of the improvements of the upper limb occur during 2-6 weeks of post-stroke and highlights the importance of targeting the behavioral interventions during this period. 

The goal of neurological rehabilitation is to enhance motor recovery and reduce functional disability through neoplastic changes in the brain. Neuroplasticity is an inherent capability of the brain which is responsible for learning and relearning. This leads to structural, functional changes and permanent improvement in the healthy and damaged brain (Cai et al. 2014). 

Motor recovery after stroke is complex with a combination of neurological recovery and functional recovery. Neurological recovery is the recovery of neurological impairments which primarily depend on the site of the lesion and extent of the damage.

 Further it has been suggested that majority of the recovery occurs in the first 3 months.

Functional recovery is an improvement in activities of daily living and mobility by the influence of rehabilitation. It is influenced by neurological recovery but does not depend on it (Borschmann and Hayward 2020). 

Rehabilitation is an educational process based on concepts of disability which involve the disabled. Factors affecting the outcome of the rehab are Specificity, Intensity, Motivation on the part of both the therapist and the patient, Opportunities for varied practice.

Common treatment techniques use in neuro-rehabilitation. 

According to the evidence, combination of treatment approaches such as Bobath,  PNF, constraint-induced movement therapy and motor learning can be effective for managing stroke patients.