Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury.

The paper is a narrative review and lecture synopsis, so it is not a single controlled study with a primary outcome. The stroke dose trial enrolled people with long-standing mild-to-moderate upper limb paresis, so it says little about early stroke or severe paresis. The spinal cord injury inflammation and eccentric training findings are from rodents, so they cannot be treated as tested human rehabilitation. The human spinal cord injury locomotor training study was pre-post, so improvement cannot be separated from natural recovery. The meta-analysis used time scheduled for therapy as a surrogate for dose, so it did not measure the active ingredient directly.

Do not read the stroke dose trial as proof that more therapy never helps. It tested upper limb repetitions in people with long-standing mild-to-moderate paresis, and the paper separately reported that larger amounts of therapy were associated with better walking.