Intensive Proprioceptive Reprogramming as Enabler of Vocational Recovery in Chronic Stroke: Occupational Outcomes from 11 Cases in Rural Cameroon

Background In sub-Saharan Africa, where 80% of employment occurs in the informal economy, stroke-related disability threatens not only individual autonomy but family economic survival. Despite recent advances in intensive neuroplasticity-based protocols showing motor improvements, no data exist on whether these translate into actual return-to-work outcomes in resource-limited settings. Objective To evaluate occupational recovery outcomes following Intensive Proprioceptive Neuromotor Reprogramming (IPNR) in chronic stroke survivors engaged in manual labor in rural Cameroon, introducing three conceptual frameworks: Occupational Neuroplasticity, the Informal Work Advantage Paradox, and Proprioceptive Vocational Readiness. Methods Prospective case series of 11 chronic stroke survivors (> 6 months post-stroke, mean 14.8 ± 8.5 months) treated with a 6-week IPNR protocol emphasizing proprioceptive integration and task-specific retraining. Primary outcome: return-to-work status at 6 months (full/modified/none). Secondary outcomes: Fugl-Meyer Upper Extremity (FMUE), EFAMRA instrumental activities scale, self-reported work capacity, and weekly work hours. Results Return-to-work rate reached 73% (8/11 patients): 3 at full capacity, 5 with modified work arrangements. Mean FMUE improved from 31.8 ± 9.1 to 44.6 ± 8.9 points (+ 12.8 points, 40% improvement, p < 0.001). Work hours recovered from pre-stroke 48 ± 6 h/week to post-IPNR 32 ± 11 h/week (67% recovery). EFAMRA instrumental activities improved by 6.2 points (p = 0.003). Self-reported work capacity increased from 3.8/10 to 7.1/10 (p < 0.001). All occupations (farmers, artisans, vendors, drivers) showed functional gains enabling vocational re-engagement. Conclusions This exploratory series suggests that intensive proprioceptive reprogramming, when combined with contextual awareness of informal economy dynamics, may facilitate return-to-work outcomes exceeding Western benchmarks. The informal economy's flexibility—often viewed as a development challenge—may paradoxically constitute a rehabilitation asset. The three proposed concepts (Occupational Neuroplasticity, Informal Work Advantage Paradox, Proprioceptive Vocational Readiness) provide theoretical frameworks for understanding and optimizing vocational rehabilitation in resource-limited contexts. Controlled trials with larger samples are warranted.