The evolution of stroke rehabilitation

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By Douglas J Lanska MD MS MSPH

"Stroke rehabilitation involves a combined and coordinated use of medical, social, educational, and vocational measures for retraining individuals to reach their maximal physical, psychological, social, vocational, and avocational potential. Specifically, stroke rehabilitation programs are provided to optimize neurological recovery, teach compensatory strategies for residual deficits, teach activities of daily living (ADLs) and skills required for community living, and provide psychosocial and medical interventions to manage depression. The team provides patient and family education about the medical management of poststroke complications and secondary stroke prevention… Practice guidelines for rehabilitation are well established in this area, although patients often do not receive a level of care that is consistent with these guidelines… The intensity of rehabilitation services often is a critical determinant in the recovery of stroke patients. The use of coordinated, multidisciplinary stroke rehabilitation teams has been shown to diminish mortality rates for stroke patients. In addition, stroke patients who receive care in an inpatient rehabilitation facility are more likely to return to the community and to recover their ability to perform ADLs… Building stroke systems throughout the United States is the critical next step in improving patient outcomes in the prevention, treatment, and rehabilitation of stroke. The current fragmented approach to stroke care in most regions of the United States provides inadequate linkages and coordination among the fundamental components of stroke care (Schwamm et al 2005)."