General themes Of the interventions that we have identifi ed to show promise, most could be

argued to involve elements of intensive, repetitive task-specifi c practice (constraintinduced

movement therapy, robotics, mental practice, repetitive task training, increased intensity therapy,
physical fi tness training, electro mechanical-assisted gait training, mixed physiotherapy treatment
approaches, rhythmic gait cueing, and training with a moving platform). This observation lends
support to the belief that high-intensity repetitive task-specifi c practice might be the most eff ective
principle when trying to promote motor recovery after stroke. Despite the undoubted progress in
the evaluation of interventions to improve motor recovery after stroke, much more work is still
needed to be able to provide prescriptive advice for specifi c problems in specifi c patients. The
general advice from recent clinical guidelines broadly refl ects that of the clinical trials. The main
areas of discrepancy between the results of meta-analyses and clinical practice guidelines seem to
refl ect the appropriate conclusion that the clinical trial evidence is based on very selected
populations (eg, individuals who have minimum levels of recovery, no cognitive impairment, who are
able to walk independently, and who are considered at least 2 weeks after stroke); furthermore, at
present, it is not possible to translate this into broad, practical recommendations for the wider
patient population.

There are still many gaps and shortcomings in the evidence base for interventions to promote motor
recovery after stroke. To a large extent, individual clinical decisions will continue to rely on the
knowledge and judgment of the individual therapists. At present, the evidence base for clinical
practice can provide only broad indicative guidance. The main general recommendations seem to be
that the alleviation of motor impairment and restoration of motor function should (as much as
possible) focus on high-intensity, repetitive task-specifi c practice with feedback on performance.