The change or advances in the rehabilitation of stroke is enormous: from Biofeedback, Brunnstrom, Bobath (NDT) approaches to Carr and Shephard MRP, task specific training, strength training (beyond the controversies), CIMT, FES, TMS to robotic therapy and so on. But none proves to be the most effective. Cost effectiveness of the rehab protocol is also another major concern.
Further steps depending on kind and level of neurological deficit(s) may be as follows:
1) scientific: deeper understanding of neurorehabilitation interventions and associated neuroplastical recovery processess, partly hanks to computational neuroscience,
2) prevention: development of risk factors analysis and early accurate diagnosis within risk groups,
3) methodological: development of eclectic/mixed apporach to intervention instead of mentioned by Lourembam specific intervontion techniques,
4) organizational: more interdisciplinary holistic approach toward patient-tailored rehabilitation, individual goal setting focused on patient's independence,
5) technical: increased use of novel technical assistive technologies such as brain-computer interfaces, neuroprostheses, exoskeletons, deep brain stimulation,
6) development of nanomedicine and telerehabilitation, and their applications within post-stroke rehabilitation,
resulting together in lowered mortality and increased efeictiveness of both early intervention and long-term rehabilitation.
But long-term predictions it this area are very difficult.
I may be biased here, but I believe the fundamental shift is the move towards evidence based neurorehabilitation. One of the major problems I see with this field is that it is guru based. I feel as though about 50% of what is clinically prescribed today has very little evidence or scientific merit supporting it. Furthermore many clinical approaches are loosely based on dated theories that just don't hold up to rigorous scientific scrutiny. I Agree with Emilia in that all of the points she stated will definitely start playing more important roles in clinical practice in the near future as we become more aware of health care costs. Today neurorehabilitation is moving away from wooden blocks and claiming to be high tech, but still has a very long way to go. Many "cool" technologies produce marginal if not poorer than conventional results. In fact, very few RCT's are run in this field because they cost quite a bit. At this stage to see meaningful differences in improvements would require incredible numbers of patients. So even as we move towards evidence based research much of our data is from sub-standard trials with patient as their own controls, that rarely compare one treatment with another.
In the future, I think focus will shift to meaningful combination treatments to optimize cost of recovery with novel means of harnessing patient's motivation. Neurorehabilitation at its core will still depend on repetitive movements and tasks. Even when regenerative medicine steps in to replace and recover damaged / poorly functional neural tissue, Optimizing movement training will still play a large role. But If we hold on to our current guru approach to rehab and don't embrace evidence based neurorehabilitation we might as well be selling fad diets.
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