Title : From conventional rehabilitation to neuroplasticity-driven MPR: A real-world model for post-stroke recovery
Abstract:
Background: For many stroke survivors, leaving the acute care setting is not the end of the journey, but the beginning of a long and often difficult process of recovery. Walking remains limited, the affected upper limb is poorly used, spasticity and pain may persist, and returning to previous social and professional roles can be challenging. In daily rehabilitation practice, we are therefore faced with a simple but fundamental question: how can we provide rehabilitation that is sufficiently intensive, repetitive, meaningful and individualized to promote the best possible recovery?
Objective: We present a practical, patient-centered model of Physical and Rehabilitation Medicine (PRM) based on neuroplasticity principles and adapted to real-world clinical practice. The aim is not to replace conventional rehabilitation with technology, but to improve the quality, intensity and personalization of rehabilitation.
Approach: Our approach begins with the patient rather than with the device. A comprehensive assessment considers motor impairment, gait, balance, upper-limb function, spasticity, pain, cognition, activities of daily living and participation. Together with the patient and family, functional goals are defined and transformed into meaningful, repetitive and progressively challenging tasks. Depending on individual needs and available resources, technology can then become an additional therapeutic tool. Robotic-assisted gait training and exoskeletons may facilitate intensive and repetitive walking practice. Virtual reality can provide engaging environments and immediate feedback. Mirror therapy and intensive upper-limb training can encourage the use of the affected limb. Brain-computer interface technologies may offer new possibilities by strengthening the link between motor intention and sensory feedback.
The most important principle is that technology should adapt to the patient, not the patient to the technology. Assistance should progressively decrease as the patient's active participation and performance improve.
Clinical Perspective: This approach represents a shift from rehabilitation focused mainly on impairments toward rehabilitation focused on recovery, autonomy and participation. Outcomes should therefore include not only strength or walking speed, but also independence, meaningful activities, quality of life and the patient's ability to return to family, social and professional life.
Conclusion: A neuroplasticity-driven approach can transform post-stroke rehabilitation into a more intensive, individualized and meaningful process. Technology has an important role, but it should remain a means rather than an end. The future of PRM is not simply technology-driven rehabilitation, but human-centered, neuroplasticity-driven rehabilitation enhanced by appropriate technology.
