Rehabilitation after stroke

Spasticity, if moderate to severe, may impede rehabilitation after stroke. Botulinum toxin has been shown in small studies to reduce tone and improve range of movement but robust evidence for improvement in function is lacking (van Kuijk et al. 2002). 

A multicenter study. Stroke 31 1223-1229 Langton Hewer R (1990). Rehabilitation after stroke. Quarterly Journal of Medicine 76 659-674... 

Tertiary Active rehabilitation after stroke to improve speech and mobility and prevent pressure sores and other complications Treatment of asthma by reducing or eliminating exposure, with drug treatment if necessary, to prevent complications such as death... 

Some degree of recovery occurs in the majority of patients after stroke, and complete recovery is possible although the prognosis is difficult to predict in an individual patient. Rehabilitation to aid recovery and enable the patient to develop strategies for coping with disability forms the mainstay of treatment after the acute stroke period. 

A systematic review of randomized control trials of inpatient multidiscipUnary stroke rehabilitation has shown the benefits of rehabilitation, beyond seven days after stroke, as distinct from the acute medical management aspects of acute stroke care in the first week after stroke (Langhorne and Duncan 2001), with a reduction in death (OR 0.66 95% odds ratio [OR], coirfidence interval [Cl], 0.49-0.88) and death or dependency (OR, 0.65 95% Cl, 0.50-0.85). For every 20 patients with stroke treated in a post-acute (beyond seven days) multidiscipUnary rehabihtation unit, one additional person returns home independent in activities of daily Uving. 

Neglect is one of the most disabling impairments for patients after stroke. Although individual studies of rehabilitation specifically for neglect have shown benefit, a review of 15 such studies showed no impact on disability or discharge home (Bowen et al 2002). Visuo-spatial-motor training, in which the affected limb is moved to increase attention to that side, has been shown to be effective in a single randomized controlled trial (Kalra et al. 1997). 

Wade DT, Legh-Smith J, Langton Hewer R (1985). Social activities after stroke measurement and natural history using the Frenchay Activities Index. International Rehabilitation Medicine 7 176-181... 

Wade DT, Wood VA, Heller A et al. (1987). Walking after stroke. Measurement and recovery over the first 3 months. Scandinavian Journal of Rehabilitation Medicine 19 25-30... 

Stroke-induced motor impairments are amenable to rehabilitative treatment. Recent evidence from both animal and human research suggests that improved recoveiy is possible for both the upper and lower extremities with intensive movement practice. In studies of the upper extremity, repetitive-movement practice unproved movement ability of the hand and arm after stroke. - - This improved movement ability arose at least in part from cortical reorganization. It has been hypothesize that intensive movement practice facilitates rewiring of the tnahi, with undamaged cortical areas assuming control functions previously allocated to damaged ones. ... 

E. Taub, N. Miller, T. Novack, E. Cook, W. Fleming, C. Nepomuceno, J. Connell, and J. Crago (1993), Technique to improve chronic motor deficit after stroke. Archives of Physical Medicine and Rehabilitation 74 347-354. 

Song R, Tong KY, Hu X, and Li L, Assistive control system using continuous myoelectric signal in robot-aided arm training for patients after stroke, IEEE Transactions on Neural Systems and Rehabilitation Engineering, vol. 16 4, pp. 371-379,2008. 

Lum PS, Burgar CG, Shor PC, Majmundar M, and Van der Loos M, Robot assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Archives of Physical Medicine and Rehabilitation, vol. 83 7, pp. 952-959, 2002. 

Peurala SH, Airaksinen O, Huuskonen P, Jakala P, Juhakoski M, Sandell K, Tarkka IM, and Sivenius J, Effects of intensive therapy using gait trainer or floor walking exercises early after stroke. Journal of Rehabilitation Medicine, vol. 41, pp. 166-173, 2009. 

Iwamuro BT, Cruz EG, Connelly LL, Fischer HC, and Kamper DG, Effect of a gravity-compensating orthosis on reaching after stroke Evaluation of the Therapy Assistant WREX, Archives of Physical Medicine and Rehabilitation, vol. 89, pp. 2121-2128,2008. 

Grant JS, ElUott TR, Weaver M, Bartolucci AA, Giger JN. Telephone intervention with family caregivers of stroke survivors after rehabilitation. Stroke 2002 33 2060-2065. 

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