A Critical Time Window for Recovery Extends beyond One-Year Post-Stroke
Open accessAbstract
The impact of rehabilitation on post-stroke motor recovery and its dependency on the patient’s chronicity remain unclear. The field has widely accepted the notion of a proportional recovery rule with a “critical window for recovery” within the first 3–6 mo poststroke. This hypothesis justifies the general cessation of physical therapy at chronic stages. However, the limits of this critical window have, so far, been poorly defined. In this analysis, we address this question, and we further explore the temporal structure of motor recovery using individual patient data from a homogeneous sample of 219 individuals with mild to moderate upper-limb hemiparesis. We observed that improvement in body function and structure was possible even at late chronic stages. A bootstrapping analysis revealed a gradient of enhanced sensitivity to treatment that extended beyond 12 mo poststroke. Clinical guidelines for rehabilitation should be revised in the context of this temporal structure. NEW & NOTEWORTHY Previous studies in humans suggest that there is a 3- to 6-mo “critical window” of heightened neuroplasticity poststroke. We analyze the temporal structure of recovery in patients with hemiparesis and uncover a precise gradient of enhanced sensitivity to treatment that expands far beyond the limits of the so-called critical window. These findings highlight the need for providing therapy to patients at the chronic and late chronic stages.
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Physical activity improves patients' functioning, especially during the early post-stroke window of enhanced neuroplasticity, but also at a later time.
“Physical activity (PA), i.a., by stimulating neuroplasticity improves patients functioning (especially during the window of enhanced neuroplasticity early after stroke, but also at a later time [5]) [6,7].”
From Physical Activity, Psychological and Functional Outcomes in Non-Ambulatory Stroke Patients during Rehabilitation—A Pilot Study (2022) · cites this paper as [5]
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Błaszcz, M., Prucnal, N., Wrześniewski, K., Pasiut, S., Mika, P., Kucia, M., Stach, B., Woźniak, M., & Mirek, E. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11247260 · Cited by 12 · see citing works
“, by stimulating neuroplasticity improves patients functioning (especially during the window of enhanced neuroplasticity early after stroke, but also at a later time [5]) [6,7].”
Background
- Authors
- Ballester, B. R., Maier, M., Duff, A., Cameirão, M., Bermúdez, S., Duarte, E., Cuxart, A., Rodríguez, S., San Segundo Mozo, R. M., & Verschure, P. F. M. J.
- Affiliations
- Institute for Bioengineering of Catalonia (ES)
- Universidade da Madeira (PT)
- Madeira Interactive Technologies Institute and Universidade da Madeira, Campus Universitário da Penteada, Funchal, Portugal
- Hospital de l'Esperança (ES)
- Vall d'Hebron Hospital Universitari (ES)
- Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Servei de Medicina Física i Rehabilitació, Hospital Joan XIII, Tarragona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ES)
- Corresponding author
- Verschure, Paul F. M. J.
- ORCID
- Venue
- Journal of Neurophysiology
- Publisher
- American Physiological Society
- Published
- 2019-07-01
- Volume
- 122
- Issue
- 1
- Pages
- 350-357
- ISSN
- 0022-3077 (ISSN-L)
- 1522-1598
- PMC
- PMC6689791
- OpenAlex
- W2947148718
- Cited by
- 184
- References
- 40
- Citations by year
- 2026: 35 · 2025: 34 · 2024: 15 · 2023: 27 · 2022: 24 · 2021: 35 · 2020: 13 · 2019: 1
- FWCI
- 12.76
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Journal of Neurophysiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion, cc-by)
- Funders
- EC H2020 (H2020EU.1.2.2. 641321)
- MINECO (TIN201344200REC)
- AAL Joint Program (Rehabilitation Gaming System)
- ERC (CDAC 341196)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Motor Control and Adaptation
- Keywords
- stroke, motor recovery, critical time window, upper limb hemiparesis, chronic stroke, rehabilitation timing, treatment sensitivity, neuroplasticity, physiotherapy
- MeSH terms
- Stroke Rehabilitation, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Movement, Neuronal Plasticity, Paresis, Time, Recovery of Function
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