Neurorehabilitation: bridging neurophysiology and clinical practice

  • Daniele PiscitelliEmail author
Letter to the Editor

Dear Editor-in-Chief,

Sensorimotor impairment of upper limb (UL) movements after stroke persists over time in a large proportion of patients. At 6 months post-stroke, 50–70% of patients continue to have UL impairments. The most common deficits of the UL are paresis and spasticity leading to residual functional deficits. These impairments affect the ability to perform functional tasks and lead to decreased quality of life and participation [1].

The focus of early acute stroke management (i.e., 72 h post-stroke) is on stabilizing the medical condition of the patient [2, 3]. In the post-acute stage (i.e., < 3 months after stroke), the focus shifts to neurorehabilitation that may include exercise combined with technology such as robot-assisted training [4] or neuromuscular electrical stimulation for UL rehabilitation [5] that has been shown to play a key role in functional recovery. Clinical trials aiming at enhancing training-based neuroplasticity have incorporated different principles...



The author is grateful to Mindy F. Levin for her valued comments and suggestions.

Funding information

DP is supported by the Fonds de la Recherche du Québec en Santé (FRQS).

Compliance with ethical standards

Conflict of interest

The author declares that he has no conflict of interest.


  1. 1.
    Aprile I, Piazzini DB, Bertolini C, Caliandro P, Pazzaglia C, Tonali P, Padua L (2006) Predictive variables on disability and quality of life in stroke outpatients undergoing rehabilitation. Neurol Sci 27(1):40–46. CrossRefGoogle Scholar
  2. 2.
    Bornstein NM, Guekht A, Vester J, Heiss WD, Gusev E, Homberg V, Rahlfs VW, Bajenaru O, Popescu BO, Muresanu D (2018) Safety and efficacy of Cerebrolysin in early post-stroke recovery: a meta-analysis of nine randomized clinical trials. Neurol Sci 39(4):629–640. CrossRefGoogle Scholar
  3. 3.
    Agostoni E, Carolei A, Micieli G, Provinciali L, Toni D, Vidale S (2018) The organisation of the acute ischemic stroke management: key notes of the Italian Neurological Society and of the Italian Stroke Organization. Neurol Sci 39(3):415–422. CrossRefGoogle Scholar
  4. 4.
    Bertani R, Melegari C, De Cola MC, Bramanti A, Bramanti P, Calabro RS (2017) Effects of robot-assisted upper limb rehabilitation in stroke patients: a systematic review with meta-analysis. Neurol Sci 38(9):1561–1569. CrossRefGoogle Scholar
  5. 5.
    Monte-Silva K, Piscitelli D, Norouzi-Gheidari N, Batalla MAP, Archambault P, Levin MF (2019) Electromyogram-related neuromuscular electrical stimulation for restoring wrist and hand movement in poststroke hemiplegia: a systematic review and meta-analysis. Neurorehabil Neural Repair 33(2):96–111. CrossRefGoogle Scholar
  6. 6.
    Kleim JA, Jones TA (2008) Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res 51(1):S225–S239. CrossRefGoogle Scholar
  7. 7.
    Winters C, van Wegen EE, Daffertshofer A, Kwakkel G (2015) Generalizability of the proportional recovery model for the upper extremity after an ischemic stroke. Neurorehabil Neural Repair 29(7):614–622. CrossRefGoogle Scholar
  8. 8.
    Stinear CM (2016) Stroke rehabilitation research needs to be different to make a difference. F1000Res 5.
  9. 9.
    Rand D, Eng JJ (2012) Disparity between functional recovery and daily use of the upper and lower extremities during subacute stroke rehabilitation. Neurorehabil Neural Repair 26(1):76–84. CrossRefGoogle Scholar
  10. 10.
    Rand D, Eng JJ (2015) Predicting daily use of the affected upper extremity 1 year after stroke. J Stroke Cerebrovasc Dis 24(2):274–283. CrossRefGoogle Scholar
  11. 11.
    Stinear CM (2017) Prediction of motor recovery after stroke: advances in biomarkers. Lancet Neurol 16(10):826–836. CrossRefGoogle Scholar
  12. 12.
    Dos Santos RBC, Galvao SCB, Frederico LMP, Amaral NSL, Carneiro MIS, de Moura Filho AG, Piscitelli D, Monte-Silva K (2019) Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients. Neurol Sci 40:1199–1207. CrossRefGoogle Scholar
  13. 13.
    Soros P, Teasell R, Hanley DF, Spence JD (2017) Motor recovery beginning 23 years after ischemic stroke. J Neurophysiol 118(2):778–781. CrossRefGoogle Scholar
  14. 14.
    Feldman AG (2015) Referent control of action and perception: challenging conventional theories in behavioral neuroscience. Springer, New York. CrossRefGoogle Scholar
  15. 15.
    Musampa NK, Mathieu PA, Levin MF (2007) Relationship between stretch reflex thresholds and voluntary arm muscle activation in patients with spasticity. Exp Brain Res 181(4):579–593. CrossRefGoogle Scholar
  16. 16.
    Turpin NA, Feldman AG, Levin MF (2017) Stretch-reflex threshold modulation during active elbow movements in post-stroke survivors with spasticity. Clin Neurophysiol 128(10):1891–1897. CrossRefGoogle Scholar
  17. 17.
    Subramanian SK, Feldman AG, Levin MF (2018) Spasticity may obscure motor learning ability after stroke. J Neurophysiol 119(1):5–20. CrossRefGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.School of Physical & Occupational TherapyMcGill UniversityMontrealCanada
  2. 2.Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR)LavalCanada

Personalised recommendations