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Cited by 417Stroke Rehabilitation and RecoveryMedical Practices and RehabilitationDysphagia Assessment and Management

Impact of intensity of practice after stroke: Issues for consideration

Kwakkel, Gert·2006·Disability and Rehabilitation
DOI 10.1080/09638280500534861
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Abstract

PURPOSE: 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 paper raises the question of what it is that patients actually learn when they improve their functional skills. Search strategy. For this purpose articles from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE and PiCarta and references presented in relevant publications were examined. DISCUSSION AND CONCLUSION: Although, there is strong evidence that early augmented exercise therapy time (expressed as time dedicated to practice) may enhance functional recovery, there is a discrepancy between the evidence for the benefits of intensive practice, on the one hand, and, the implementation of intensive rehabilitation treatment programmes in the current healthcare system on the other. Further emphasis should be given on a better understanding of the time-dependency of prognostic factors that determine the effectiveness of intensive practice in patients with stroke. In addition, a better understanding is needed of the neurophysiological and biomechanical mechanisms that underlie compensation-related learning of functional tasks after stroke.

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Crossref · 10.1080/09638280500534861

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  • To date, the focus of therapy intensity has been on amount (minutes) rather than frequency (repetitions of a task, or sessions per day).

    “Definitions for therapy intensity vary, but to date the focus has been on amount (minutes) rather than frequency (repetitions of a task, or sessions per day).16”

    From Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT) (2016) · cites this paper as [16]

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Authors
Kwakkel, G.
Affiliations
University Medical Center Utrecht (NL)
Corresponding author
Kwakkel, Gert
ORCID
Kwakkel, Gert
Venue
Disability and Rehabilitation
Publisher
Informa UK Limited
Published
2006-01
Volume
28
Issue
13-14
Pages
823-830
ISSN
  • 0963-8288 (ISSN-L)
  • 1464-5165
DOI
10.1080/09638280500534861
OpenAlex
W2135838445
Cited by
417
References
58
Citations by year
2026: 10 · 2025: 5 · 2024: 11 · 2023: 28 · 2022: 29 · 2021: 21 · 2020: 17 · 2019: 23 · 2018: 24 · 2017: 14 · 2016: 24 · 2015: 30 · 2014: 37 · 2013: 19 · 2012: 21
FWCI
3.51
Type
journal article
Language
en
Open access
closed
Locations
  • Disability and Rehabilitation (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
ZonMw
Topics
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
Keywords
stroke rehabilitation, intensive rehabilitation, dose-response relationship, patient selection, functional recovery, neurophysiological mechanisms, biomechanical mechanisms
MeSH terms
Stroke Rehabilitation, Activities of Daily Living, Exercise Therapy, Humans, Motor Activity, Prognosis, Rehabilitation, Randomized Controlled Trials as Topic, Treatment Outcome, Recovery of Function, Physical Therapy Modalities

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