Amphetamine paired with physical therapy accelerates motor recovery after stroke. Further evidence. No benefit from D-amphetamine when added to physiotherapy after stroke: a randomized, placebo-controlled study Amphetamine fails to facilitate motor performance and to enhance motor recovery among stroke patients with mild arm paresis: interim analysis and termination of a double blind, randomised, placebo-controlled trial. Physiotherapy Coupled With Dextroamphetamine for Rehabilitation After Hemiparetic Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial Motor response to amphetamine treatment, task-specific training, and limited motor experience in a postacute animal stroke model Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333) A Double-Blind, Placebo-Controlled Study of the Use of Amphetamine in the Treatment of Aphasia Intensive Early Physiotherapy Combined with Dexamphetamine Treatment in Severe Stroke: A Randomized, Controlled Pilot Study The significance of intensity of rehabilitation of stroke--a controlled trial. Brief cognitive behavioural interventions for regular amphetamine users: a step in the right direction. Is dosage of physiotherapy a critical factor in deciding patterns of recovery from stroke: a pragmatic randomized controlled trial. Modulation of use-dependent plasticity by d-amphetamine. Amphetamine improves cognitive function in medicated individuals with schizophrenia and in healthy volunteers Integrative rehabilitation of residents chronic post-stroke in skilled nursing facilities: the design and evaluation of the BrightArm Duo Active music therapy approach for stroke patients in the post-acute rehabilitation Randomized controlled trial of brief cognitive-behavioural interventions among regular users of amphetamine. Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial
BACKGROUND AND PURPOSE In animal models of brain injury , administration of numerous pharmaceuticals is reported to facilitate functional recovery . However , only drugs that increase the release of norepinephrine have been shown to promote recovery when administered late ( days to weeks ) after injury . To determine whether these findings were applicable to humans , we administered the norepinephrine stimulant dextroamphetamine , paired with physical therapy , to hemiplegic stroke patients . METHODS Ten hemiplegic patients who suffered an acute ischemic infa rct ion were entered between days 16 and 30 after onset and r and omly assigned to receive either 10 mg of dextroamphetamine or a placebo orally every fourth day for 10 sessions paired with physical therapy . The Fugl-Meyer Motor Scale was used at baseline , within each session , and for 12 months after onset as the dependent measure . Confounding medications such as alpha-adrenergic antagonists or agonists were excluded in all subjects . RESULTS Although there were no differences between the groups at baseline ( P = .599 ) , there was a significant ( P = .047 ) difference between the groups when the drug had been discontinued for 1 week and at the 12-month follow-up visit ( P = .047 ) . CONCLUSIONS Administration of dextroamphetamine paired with physical therapy increased the rate and extent of motor recovery in a small group of hemiplegic stroke patients . These data support and extend previous findings of the facilitatory aspects of certain types of drugs on recovery from brain injury . The use of neuromodulation may allow the nervous system to adapt previously unused or alternative pathways to relevant external input Objective : To assess the effect of D-amphetamine on the recovery of activities of daily living and motor functions after stroke , Design : R and omized , placebo-controlled study , Setting : Inpatient rehabilitation centre , Subjects : Twenty-four stroke survivors after a first ischaemic supratentorial stroke within six weeks before study onset , severely to moderately affected , with a Barthel Index ( 0–100 ) ranging from 25 to 50 , no severe concomitant internal , neurological or psychiatric diseases , and participating in a comprehensive rehabilitation programme of 10–12 weeks , Interventions : Ten sessions with 10 mg D-amphetamine ( or placebo ) every fourth day totalling 100 mg in a time period of 36 days combined with physical therapy according to the neurodevelopmental concept within 60 minutes after drug intake . Main outcome measures : Barthel Index ( 0–100 ) served as the primary outcome measure and the Rivermead Motor Assessment Score with its three sections ( gross function , leg and trunk , and arm ) as the secondary outcome measure , assessed at days 0 , 20 , 36 , 90 , 180 and 360 . Results : The two groups did not differ with respect to clinical data and outcome measures at study onset . All patients improved significantly except for arm function over the intervention period and up to day 90 after study onset . The comparison between groups did not reveal any difference at any time ; amphetamine-treated patients did not show any increase in motor function or ADL compared with the control group . Conclusions : The placebo-controlled study failed to show any effect of D-amphetamine on stroke recovery compared with control . The small number of patients , the timing and content of physical therapy were limiting factors of the present study . Further trials are warranted PURPOSE To assess the effects of d-amphetamine on motor facilitation and recovery in stroke patients with mild arm paresis receiving the Arm Ability training . METHODS Thirty-one stroke patients with mild arm paresis were r and omly assigned to either ( a. ) receiving placebo or ( b. ) d-amphetamine twice a week 2 hours before Arm Ability training sessions for three weeks . MAIN OUTCOME MEASURE time needed to perform TEMPA tasks , a measure of upper extremity performance reflecting everyday life tasks . Secondary measures : aim ed movements , tapping , and a 10 m walkway as well as motor performance during training sessions . RESULTS The interim efficacy analysis of 26 stroke patients who completed the study intervention showed overall arm motor recovery both from pre to post test after 3 weeks of training and from pre test to follow-up 1 year later . No superior effect of d-amphetamine over placebo could be substantiated for either motor facilitation during training or motor recovery ( post training or long-term ) . D-amphetamine exerted mild effects on blood pressure . Serious adverse events were not observed . CONCLUSIONS d-Amphetamine failed to facilitate motor performance during training sessions , to promote skill acquisition with training tasks , and most importantly to enhance motor recovery among patients with mild arm paresis after stroke Background and Purpose — Hemiparesis is the commonest disabling deficit caused by stroke . In animals , dextroamphetamine ( AMPH ) paired with training enhances motor recovery , but its clinical efficacy is uncertain . Methods — In a r and omized , double-blind , placebo-controlled trial , 71 stroke patients were stratified by hemiparesis severity and r and omly assigned to 10 sessions of physiotherapy coupled with either 10 mg AMPH or placebo . Study treatments were administered by 1 physiotherapist , beginning 5 to 10 days after stroke and continuing twice per week for 5 weeks . Outcomes were assessed by 1 physiotherapist at baseline , after each treatment session , at 6 weeks , and at 3 months . The primary outcome was motor recovery ( impairment level ) on the Fugl-Meyer ( FM ) scale . Secondary outcomes assessed mobility , ambulation , arm/h and function , and independence in activities of daily living . Results — Baseline hemiparesis was severe overall ( mean FM score 27.7±20.0 ) . Motor scores improved during treatment in both groups ( mean change , baseline to 3 months 29.5±16.6 ) . Repeated- measures ANOVA revealed no significant differences in recovery between the treatment groups for the entire cohort ( n=67 ) or for subgroups with a severe hemiparesis ( n=43 ) , moderate hemiparesis ( n=24 ) , or cortically based stroke ( n=26 ) . In the moderate subgroup , there was a significant drug × time interaction for upper extremity motor recovery ( F=5.14 ; P<0.001 ) , although there was a significant baseline imbalance in motor scores in this subgroup . Conclusion — In stroke patients with a severe motor deficit , 10 mg AMPH coupled with physiotherapy twice per week for 5 weeks in the early poststroke period provided no additional benefit in motor or functional recovery compared with physiotherapy alone . Patients with moderate severity hemiparesis deserve further investigation . Increased intensity and longer duration drug/therapy dosing regimens should be explored , targeting the upper and lower limbs separately Despite advances in acute treatment of ischemic cerebrovascular events , the most common clinical outcome is disabling neurological impairment . Despite experimental evidence that psychostimulant treatment can positively affect recovery rate after focal brain lesions , beyond rehabilitation therapies there are no currently accepted medical treatments indicated for diminishing neurological impairment after clinical ly established stroke . To test the effect of amphetamine , task-specific training , limiting motor experience , and their interaction on motor recovery in a postacute animal model of stroke , animals were nonaversively trained in beam walking before a unilateral photochemical sensorimotor cortex lesion and tested for 10 days after lesion . Animals were r and omized to groups receiving : a single session of motor training 24 h after lesion ; a single injection of amphetamine 2 mg/kg 24 h after lesion ; beam-walking experience limited to testing on days 1 and 10 after lesion ; and groups that received amphetamine treatment combined with training or combined with limited experience .  Motor recovery was maximally enhanced by training , delayed by amphetamine treatment , and most negatively affected by limiting beam-walking experience during the recovery period . These findings support physical training after stroke , indicating that limiting physical activity negatively affects motor recovery and raises questions about the role of stimulant treatment to enhance motor recovery in the postacute phase after stroke Amphetamine enhances recovery after experimental ischaemia and has shown promise in small clinical trials when combined with motor or sensory stimulation . Amphetamine , a sympathomimetic , might have haemodynamic effects in stroke patients , although limited data have been published . Subjects were recruited 3–30 days post-ischaemic stroke into a phase II r and omized ( 1:1 ) , double-blind , placebo-controlled trial . Subjects received dexamphetamine ( 5 mg initially , then 10 mg for 10 subsequent doses with 3- or 4-day separations ) or placebo in addition to inpatient physiotherapy . Recovery was assessed by motor scales ( Fugl – Meyer ( FM ) ) , and functional scales ( Barthel index ( BI ) and modified Rankin score ( mRS ) ) . Peripheral blood pressure ( BP ) , central haemodynamics and middle cerebral artery blood flow velocity were assessed before , and 90 min after , the first two doses . Thirty-three subjects were recruited , aged 33–88 ( mean 71 ) years , males 52 % , 4–30 ( median 15 ) days post stroke to inclusion . Sixteen patients were r and omized to placebo and seventeen to amphetamine . Amphetamine did not improve motor function at 90 days ; mean ( s.d . ) FM 37.6 ( 27.6 ) vs control 35.2 ( 27.8 ) ( P=0.81 ) . Functional outcome ( BI , mRS ) did not differ between treatment groups . Peripheral and central systolic BP , and heart rate ( HR ) , were 11.2 mm Hg ( P=0.03 ) , 9.5 mm Hg ( P=0.04 ) and 7 beats per minute ( P=0.02 ) higher , respectively , with amphetamine , compared with control . A nonsignificant reduction in myocardial perfusion ( BUI ) was seen with amphetamine . Other cardiac and cerebral haemodynamics were unaffected . Amphetamine did not improve motor impairment or function after ischaemic stroke but did significantly increase BP and HR without altering cerebral haemodynamics Background and Purpose — A number of studies suggest that drugs which increase the release of norepinephrine promote recovery when administered late ( days to weeks ) after brain injury in animals . A small number of clinical studies have investigated the effects of the noradrenergic agonist dextroamphetamine in patients recovering from motor deficits following stroke . To determine whether these findings extend to communication deficits subsequent to stroke , we administered dextroamphetamine , paired with speech/ language therapy , to patients with aphasia . Methods — In a prospect i ve , double-blind study , 21 aphasic patients with an acute nonhemorrhagic infa rct ion were r and omly assigned to receive either 10 mg dextroamphetamine or a placebo .  Patients were entered between days 16 and 45 after onset and were treated on a 3-day/4-day schedule for 10 sessions . Thirty minutes after drug/placebo administration , subjects received a 1-hour session of speech/ language therapy . The Porch Index of Communicative Ability was used at baseline , at 1 week off the drug , and at 6 months after onset as the dependent language measure . Results — Although there were no differences between the drug and placebo groups before treatment ( P = 0.807 ) , by 1 week after the 10 drug treatments ended there was a significant difference in gain scores between the groups ( P = 0.0153 ) , with the greater gain in the dextroamphetamine group . The difference was still significant when corrected for initial aphasia severity and age . At the 6-month follow-up , the difference in gain scores between the groups had increased ; however , the difference was not significant ( P = 0.0482 ) after correction for multiple comparisons . Conclusions — Administration of dextroamphetamine paired with 10 1-hour sessions of speech/ language therapy facilitated recovery from aphasia in a small group of patients in the subacute period after stroke . Neuromodulation with dextroamphetamine , and perhaps other drugs that increase central nervous system noradrenaline levels , may facilitate recovery when paired with focused behavioral treatment Background : The most severely disabled stroke patients are often excluded from studies evaluating effects of physiotherapy . This study intended to investigate the effect of an increased intensity of physiotherapy in combination with dexamphetamine the first week after ischemic stroke in patients with an impaired level of consciousness and severe motor dysfunction . Methods : Thirty patients were enrolled within 96 h after onset of symptoms . Patients were r and omized to 30–45 min of physiotherapy twice daily or to maximally 15 min per day for 5 days . All patients received dexamphetamine to achieve alertness . Functional outcome measures were assessed at baseline , the day after treatment discontinuation , and 3 and 12 months after stroke onset . Residence of living was registered at long-term follow-ups . Results : No statistically significant differences were seen between groups in the outcomes measured at any time point . However , both groups improved over time in all outcomes at 3 and 12 months ( p < 0.05 ) , except for sensory functions at 3 months and motor functions at 12 months . The number of patients needed to treat ( NNT ) to achieve the desired improvement in Lindmark motor score was 8 , with the 95 % CI being NNT(harm ) 10 to NNT(beneficial ) 3 . The fraction of patients who died was the same in both treatment groups , 47 % ( 95 % CI 28–65 % ) . Conclusions : An increased intensity of physiotherapy in combination with dexamphetamine during the first week after stroke onset did not affect short- or long-term outcome in this limited sample of patients with severe stroke Of the 373 stroke patients 95 were admitted to the feasibility study of stroke rehabilitation . The patients were divided into two groups , an intensive and a normal treatment group . In this study , the functional recovery of stroke , measured by ADL and motor function was significantly better in the intensive treatment group . There was no difference in institutionalization or incidence of death between the groups . The gain of ADL and motor function was greatest during the first three months after stroke in the intensive treatment group . The conclusion is that intensified physiotherapy seems to improve the functional recovery of stroke patients AIMS The present study sought to replicate and extend a small pilot study conducted by Baker , Boggs & Lewin ( 2001 ) which demonstrated that brief interventions consisting of motivational interviewing and cognitive-behaviour therapy ( CBT ) were feasible and associated with better outcomes compared with a control condition . DESIGN R and omized controlled trial ( RCT ) . SETTING Greater Brisbane Region of Queensl and and Newcastle , NSW , Australia . PARTICIPANTS The study was conducted among 214 regular amphetamine users . MEASUREMENTS Demographic characteristics , past and present alcohol and other drug use and mental health , treatment , amphetamine-related harms and severity of dependence . FINDINGS The main finding of this study was that there was a significant increase in the likelihood of abstinence from amphetamines among those receiving two or more treatment sessions . In addition , the number of treatment sessions attended had a significant short-term beneficial effect on level of depression . There were no intervention effects on any other variables ( HIV risk-taking , crime , social functioning and health ) . Overall , there was a marked reduction in amphetamine use among this sample over time and , apart from abstinence rates and short-term effects on depression level , this was not differential by treatment group . Reduction in amphetamine use was accompanied by significant improvements in stage of change , benzodiazepine use , tobacco smoking , polydrug use , injecting risk-taking behaviour , criminal activity level , and psychiatric distress and depression level . CONCLUSIONS A stepped-care approach is recommended . The first step in providing an effective intervention among many regular amphetamine users , particularly those attending non-treatment setting s , may include provision of : a structured assessment of amphetamine use and related problems ; self-help material ; and regular monitoring of amphetamine use and related harms . Regular amphetamine users who present to treatment setting s could be offered two sessions of CBT , while people with moderate to severe levels of depression may best be offered four sessions of CBT for amphetamine use from the outset , with further treatment for amphetamine use and /or depression depending on response . Pharmacotherapy and /or longer-term psychotherapy may be suitable for non-responders . An RCT of a stepped-care approach among regular amphetamine users is suggested BACKGROUND AND PURPOSE The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams . Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this results . Physiotherapy is one component of most rehabilitation teams and recent systematic review s have shown that patients with stroke receiving more physiotherapy  achieve more recovery from disability . However , information about the actual amounts of physiotherapy needed to achieve this result is not known . METHOD A pragmatic , r and omized , single-blind , controlled trial comparing recovery from disability in subjects receiving the current st and ard amount of 30 minutes ' physiotherapy with those receiving double that amount ( 60 minutes ) . The study included measures of physical performance and function , psychological aspects of anxiety and depression , and perceived control over recovery . RESULTS Some 114 subjects were recruited to the study ; full six-week data are available for 104 subjects and six-month data for 93 subjects . Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference . Scrutiny of the recovery curves of the whole sample showed that , in half the sample , three distinct patterns of recovery were demonstrated . CONCLUSION These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients . The subgroup analysis of patterns of recovery must be regarded as speculative , but provides the basis for hypotheses about those likely to respond well to more intensive therapy Use-dependent plasticity , thought to contribute to functional recovery after brain injury , is elicited by motor training . The purpose of this study was to determine if administration of d-amphetamine facilitates the effects of motor training on use-dependent plasticity . Healthy human volunteers underwent a training period of voluntary thumb movements under the effects of placebo or d-amphetamine in different sessions in a r and omized double-blind , counterbalanced design . Previous work in a drug-naive condition showed that such training causes changes in the direction of thumb movements evoked by transcranial magnetic stimulation and in transcranial magnetic stimulation-evoked electromyographic responses . The endpoint measure of the study was the magnitude of training-induced changes in transcranial magnetic stimulation-evoked kinematic and electromyographic responses in the d-amphetamine and in the placebo conditions . Motor training result ed in increased magnitude , faster development and longer lasting duration of use-dependent plasticity under d-amphetamine compared to the placebo session . These results document a facilitatory effect of d-amphetamine on use-dependent plasticity , a possible mechanism mediating the beneficial effect of this drug on functional recovery after cortical lesions BACKGROUND Recent research on schizophrenia indicates that cognitive deficits in this illness are important predictors of functional outcome , highlighting the need for treatments that have a positive impact on cognitive function . Here we explore the hypothesis that acute administration of d-amphetamine can improve cognitive function in individuals with schizophrenia who are well-treated with typical antipsychotics , as well as in healthy controls performing under dual task conditions design ed to elicit performance deficits analogous to those found in schizophrenia . METHODS Ten individuals with schizophrenia taking haldol or prolixin and 22 healthy controls performed spatial working memory , language production , and Stroop tasks under both placebo and 0.25 mg/kg of D-amphetamine . RESULTS D-Amphetamine improved reactions times on the spatial working memory and Stroop tasks for both individuals with schizophrenia and controls , and improved working memory accuracy in schizophrenia . In addition , D-amphetamine improved language production for both individuals with schizophrenia and controls . CONCLUSIONS These results provide support for the hypothesis that the adjunctive administration of dopamine agonist can improve cognitive in individuals with schizophrenia taking typical antipsychotics . The results are discussed in terms of their implication s for underst and ing the nature of working memory deficits in schizophrenia , and potential future avenues for cognitive enhancement in this illness Abstract Purpose : To describe the novel BrightArm Duo bimanual upper extremity ( UE ) rehabilitation system ; to determine its technology acceptance and clinical benefit for older hemiplegic participants . Methods : The system table tilted to adjust arm gravity loading . Participants wore arm supports that sensed grasp strength and wrist position on the table . Wrist weights further increased shoulder exertion . Games were design ed to improve UE strength , motor function , cognition and emotive state and adapted automatically to each participant . The system underwent feasibility trials spanning 8 weeks in two skilled nursing facilities ( SNFs ) . Participants were evaluated pre-therapy and post-therapy using st and ardized clinical measures . Computerized measures of supported arm reach , table tilt and number of arm repetitions were stored on a remote server . Outcomes : Seven participants had significant improvements in their active range of shoulder movement , supported arm reach , shoulder strength , grasp strength and their ability to focus . The group demonstrated higher arm function measured with FMA ( p = 0.01 ) and CAHAI ( p = 0.05 ) , and had an improvement in depression ( Becks Depression Inventory , II ) .  BrightArm Duo technology was well accepted by participants with a rating of 4.4 out of 5 points . Conclusions : Given these findings , it will be beneficial to evaluate the BrightArm Duo application in SNF maintenance programs . Implication s for Rehabilitation Integrative rehabilitation that addresses both physical and cognitive domains is promising for post-stroke maintenance in skilled nursing facilities . Simultaneous bilateral arm exercise may improve arm function in older hemiplegic patients several years after stroke . Virtual reality games that adapt to the patient can increase attention and working memory while decreasing depression in elderly Guidelines in stroke rehabilitation recommend the use of a multidisciplinary approach . Different approaches and techniques with music are used in the stroke rehabilitation to improve motor and cognitive functions but also psychological outcomes . In this r and omized controlled pilot trial , relational active music therapy approaches were tested in the post-acute phase of disease . Thirty-eight hospitalized patients with ischemic and hemorrhagic stroke were recruited and allocated in two groups . The experimental group underwent the st and ard of care ( physiotherapy and occupational therapy daily sessions ) and relational active music therapy treatments . The control group underwent the st and ard of care only .  Motor functions and psychological aspects were assessed before and after treatments . Music therapy process was also evaluated using a specific rating scale . All groups showed a positive trend in quality of life , functional and disability levels , and gross mobility . The experimental group showed a decrease of anxiety and , in particular , of depression ( p = 0.016 ) . In addition , the strength of non-dominant h and ( grip ) significantly increased in the experimental group ( p = 0.041 ) . Music therapy assessment showed a significant improvement over time of non-verbal and sonorous-music relationships . Future studies , including a greater number of patients and follow-up evaluations , are needed to confirm promising results of this study AIMS To identify whether brief cognitive-behavioural interventions are feasible among regular users of amphetamine , to assess the effectiveness of intervention overall and to pilot two- and four-session interventions . DESIGN Subjects were assigned r and omly to individually receive a cognitive-behavioural intervention ( n = 32 ) of either two or four sessions ' duration or a self-help booklet  ( control condition ; n = 32 ) . SETTING Subjects were volunteers recruited from needle exchange schemes and treatment centres in Newcastle , Australia . PARTICIPANTS Regular ( at least monthly ) users of amphetamine were recruited . INTERVENTION Either four sessions of cognitive-behaviour therapy , consisting of a motivational interview and skills training in avoidance of high-risk situations , coping with craving and relapse prevention , or two sessions consisting of a motivational interview and discussion of skills . MEASUREMENTS The Opiate Treatment Index was the main measure at pre-treatment and 6-month follow-up . FINDINGS There was a significant reduction in amphetamine use among the sample as a whole , with inconclusive differences between intervention subgroups . There was a moderate overall intervention effect , with the intervention group reporting over twice the reduction in daily amphetamine use as the control group . Significantly more people in the cognitive-behavioural intervention condition abstained from amphetamine at 6-month follow-up compared to the control condition . CONCLUSION Brief cognitive-behavioural interventions appear feasible among regular users of amphetamine . A larger r and omised controlled trial of the effectiveness of such interventions appears warranted Background In New Zeal and , around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained . Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities . However , on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of re sources and geographical location . Currently most people receive no treatment beyond three months post stroke . The study aims to determine if the Augmented Community Telerehabilitation Intervention ( ACTIV ) results in better physical function for people with stroke than usual care , as measured by the Stroke Impact Scale , physical subcomponent . Methods / design This study will use a multi-site , two-arm , assessor blinded , parallel r and omised controlled trial design . People will be eligible if they have had their first ever stroke , are over 20 and have some physical impairment in either arm or leg , or both . Following discharge from formal physiotherapy services ( inpatient , outpatient or community ) , participants will be r and omised into ACTIV or usual care . ACTIV uses readily available technology , telephone and mobile phones , combined with face-to-face visits from a physiotherapist over a six-month period , to help people with stroke resume activities they enjoyed before the stroke . The impact of stroke on physical function and quality of life will be assessed , measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options . These outcomes will be collected at baseline , six months and 12 months . In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study . Discussion The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation . Best practice guidelines recommend a prolonged period of rehabilitation , however this is expensive and therefore not undertaken in most publicly funded centres . An effective , cost-effective , and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home . Trial registration
No evidence exists at present to support the use of amphetamine after stroke .
INTRODUCTION The use of drugs to enhance recovery ( " rehabilitation pharmacology " ) has been assessed .
Amphetamine can improve outcome in experimental models of stroke , and several small clinical trials have assessed its use in stroke .