Rehabilitation after stroke is a complex journey, yet our field often falls short of addressing three critical pillars of recovery: dosage, data collection, and relevance to real-world function. A recent pilot study examining the Keys Treatment Protocol, a distributed form of Constraint-Induced Movement Therapy (CIMT), demonstrates just how pivotal these factors are to effective rehabilitation.

1. Dose Matters—A Lot.

In the Keys protocol, participants engaged in 33 hours of structured therapy spread over eight weeks, rather than the traditional intensive two-week CIMT model. The results? Significant gains in upper extremity motor function and real-world use. These improvements align with evidence showing that repetition and sustained practice are critical for driving neuroplasticity. By extending the timeline and tapering the frequency, this protocol not only fits within real-world clinical constraints but also amplifies outcomes by leveraging consistent, repeated engagement.

2. Data is the Compass of Recovery.

To measure progress, the study utilized validated tools such as the Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), and Stroke Impact Scale (SIS). The data revealed improvements not just in movement quality, but also in strength, mobility, and activities of daily living. Importantly, these gains persisted—some even increased—at the three-month follow-up.

What does this tell us? Without rigorous data collection, we’re flying blind. Objective measures illuminate which interventions work, where to tweak, and—most importantly—what matters to the patient’s daily life.

3. Real-World Context is Non-Negotiable.

Traditional therapy often stops at the clinic’s door. The Keys protocol breaks this barrier with the Transfer Package, a set of strategies to integrate the affected limb into daily life. By extending these behavioral components over eight weeks, patients were not only moving better but living better. Why? Because the brain doesn’t just rewire itself for artificial tasks—it adapts to meaningful, real-world challenges. Rehabilitation must bridge the lab and life.

The Takeaway:

Stroke rehabilitation isn’t just about regaining movement—it’s about restoring participation, agency, and quality of life. To achieve this, we need to:

• Prescribe dose thoughtfully, understanding that neuroplasticity thrives on repetition and sustained effort.
• Collect and interpret data systematically to guide decisions and measure what truly matters.
• Adapt interventions to real-world environments, ensuring gains in the clinic translate to lasting changes in life.

The Keys protocol is a promising step forward, but it also reminds us: Recovery is a marathon, not a sprint.

Let’s push the boundaries of rehabilitation by emphasizing what science already tells us: with the right dose, the right data, and real-world relevance, recovery is not just possible—it’s transformative.

What are your thoughts on balancing these principles in real-world clinical settings? Let’s discuss. 👇

Read the whole publication «Effects of a Distributed Form of Constraint-Induced Movement

Therapy for Clinical Application: The Keys Treatment Protocol» here: https://www.mdpi.com/2076-3425/15/1/87#:~:text=MAL%20scores%20for%20Amount%20of,greatest%20gains%20observed%20mid%2Dintervention.

José López Sánchez

CEO @ Centro Europeo de Neurociencias | Intensive Therapy Specialist