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Indian Journal of Neurosurgery 2013; 02(03): 248-255
DOI: 10.4103/2277-9167.124230
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Rehabilitation of a patient with stroke

Apurba Barman
,
Ashok K. Mahapatra
1   Department of Neurosurgery, All India Institute of Medical Sciences, Sizua, Bhubaneswar, Odisha, India
› Author Affiliations
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Publication History

Publication Date:
18 January 2017 (online)

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Abstract

Stroke is a significant cause of long-term disability world-wide. The post-stroke disabilities are due to loss of locomotion, activity of daily living, cognition and communication skills. Rehabilitation is an integral part of medical management and continues longitudinally through acute care, post-acute care and community reintegration. The objectives of stroke rehabilitation are to maximize the functional independence, minimize the disabilities, reintegrate back into the home and community and improve the self-esteem of patient. A comprehensive stroke rehabilitation service should provide early assessment of impairments and disabilities, management and prevention of complications and well-organized rehabilitation program in both in-patient and out-patient settings. A multidisciplinary or interdisciplinary team approach is necessary to reduce the post-stroke disabilities. It has many members, including physicians, physical therapists, occupational therapists, speech and language pathologists, orthotist, psychotherapists, social workers, vocational rehabilitation therapists, rehabilitation nurse, patients, families and other caregivers. Physicians caring for patients with stroke during rehabilitation must be aware of potential medical complications, as well as a number of special problems that may complicate recovery, including cognitive deficits, aphasia, dysphagia, urinary incontinence, shoulder pain, spasticity, falls and depression. Involvement of patient and caregivers in the rehabilitation process is essential. This article outlines the salient features of the early comprehensive rehabilitation after stroke.

Key words

Disability - rehabilitation - stroke
 

  • References

  • 1 Khattar B, Banerjee A, Reddi R, Dutta A. Feasibility of functional electrical stimulation-assisted neurorehabilitation following stroke in India: A case series. Case Rep Neurol Med 2012; 2012: 830873
    PubMedGoogle Scholar
  • 2 DeLisa JA. Physical Medicine and Rehabilitation: Principles and Practice. 4thed Philadelphia: Lippincott Williams and Wilkins; 2005. p 1655-1676
    Google Scholar
  • 3 Braddom RL. Physical Medicine and Rehabilitation. 4thed Philadelphia: Elsevier Health Sciences; 2010. p 1177-1222
    Google Scholar
  • 4 Ferri CP, Schoenborn C, Kalra L, Acosta D, Guerra M, Huang Y. et al Prevalence of stroke and related burden among older people living in Latin America, India and China. J Neurol Neurosurg Psychiatry 2011; 82: 1074-1082
    CrossrefPubMedGoogle Scholar
  • 5 Nair KP, Taly AB. Stroke rehabilitation: Traditional and modern approaches. Neurol India 2002; (50) Suppl S85-S93
    PubMedGoogle Scholar
  • 6 Wade DT, Hewer RL. Functional abilities after stroke: Measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry 1987; 50: 177-182
    CrossrefPubMedGoogle Scholar
  • 7 Gresham GE, Alexander D, Bishop DS, Giuliani C, Goldberg G, Holland A. et al American heart association prevention Conference, IV. Prevention and rehabilitation of stroke. Rehabilitation. Stroke 1997; 28: 1522-1526
    PubMedGoogle Scholar
  • 8 Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD. et al Management of adult stroke rehabilitation care: A clinical practice guideline. Stroke 2005; 36: e100-e143
    CrossrefPubMedGoogle Scholar
  • 9 Langhorne P, Pollock A. Stroke unit trialists’ collaboration. What are the components of effective stroke unit care?. Age Ageing 2002; 31: 365-371
    CrossrefPubMedGoogle Scholar
  • 10 Indredavik B, Bakke F, Slordahl SA, Rokseth R, Hâheim LL. Stroke unit treatment. 10-year follow-up. Stroke 1999; 30: 1524-1527
    CrossrefPubMedGoogle Scholar
  • 11 Knecht S, Hesse S, Oster P. Rehabilitation after stroke. Dtsch Arztebl Int 2011; 108: 600-606
    PubMedGoogle Scholar
  • 12 Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke.. Stroke unit trialists’ collaboration. BMJ 1997; 314: 1151-1159
    CrossrefPubMedGoogle Scholar
  • 13 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2: 81-84
    PubMedGoogle Scholar
  • 14 Brott T, Adams Jr HP, Olinger CP, Marler JR, Barsan WG, Biller J. et al Measurements of acute cerebral infarction: A clinical examination scale. Stroke 1989; 20: 864-870
    CrossrefPubMedGoogle Scholar
  • 15 Côté R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C. The Canadian neurological scale: A preliminary study in acute stroke. Stroke 1986; 17: 731-737
    CrossrefPubMedGoogle Scholar
  • 16 Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957; 2: 200-215
    PubMedGoogle Scholar
  • 17 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198
    CrossrefPubMedGoogle Scholar
  • 18 Kiernan RJ, Mueller J, Langston JW, Van Dyke C. The neurobehavioral cognitive Status examination: A brief but quantitative approach to cognitive assessment. Ann Intern Med 1987; 107: 481-485
    CrossrefPubMedGoogle Scholar
  • 19 Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: A new tool for rehabilitation. Adv Clin Rehabil 1987; 1: 6-18
    PubMedGoogle Scholar
  • 20 Mahoney FI, Barthel DW. Functional evaluation: The barthel index. Md State Med J 1965; 14: 61-65
    PubMedGoogle Scholar
  • 21 Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 1975; 7: 13-31
    CrossrefPubMedGoogle Scholar
  • 22a Collin C, Wade D. Assessing motor impairment after stroke: A pilot reliability study. J Neurol Neurosurg Psychiatry 1990; 53: 576-579
    CrossrefPubMedGoogle Scholar
  • 22b Demeurisse G, Demol O, Robaye E. Motor evaluation in vascular hemiplegia. Eur Neurol 1980; 19: 382-389
    CrossrefPubMedGoogle Scholar
  • 23 Collen FM, Wade DT, Robb GF, Bradshaw CM. The rivermead mobility index: A further development of the rivermead motor assessment. Int Disabil Stud 1991; 13: 50-54
    PubMedGoogle Scholar
  • 24 Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil 1992; 73: 1073-1080
    PubMedGoogle Scholar
  • 25 Goodglass H, Kaplan E. Test procedures and rationale. Manual for the BDAE. Boston Diagnostic Aphasia Examination (BDAE). Ch. 4.. 2nd, ed Philadelphia: Lea and Febiger; 1983
    Google Scholar
  • 26 Kertesz A. Western Aphasia Battery. New York: Grune and Stratton; 1982
    Google Scholar
  • 27 Porch B. Porch index of communicative ability (PICA). Palo Alto: Consulting Psychologists Press; 1981
    Google Scholar
  • 28 Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571
    CrossrefPubMedGoogle Scholar
  • 29 Davenport RJ, Dennis MS, Wellwood I, Warlow CP. Complications after acute stroke. Stroke 1996; 27: 415-420
    CrossrefPubMedGoogle Scholar
  • 30 Johnston KC, Li JY, Lyden PD, Hanson SK, Feasby TE, Adams RJ. et al Medical and neurological complications of ischemic stroke: Experience from the RANTTAS trial. RANTTAS investigators. Stroke 1998; 29: 447-453
    CrossrefPubMedGoogle Scholar
  • 31 Sackley C, Brittle N, Patel S, Ellins J, Scott M, Wright C. et al The prevalence of joint contractures, pressure sores, painful shoulder, other pain falls, and depression in the year after a severely disabling stroke. Stroke 2008; 39: 3329-3334
    CrossrefPubMedGoogle Scholar
  • 32 Indredavik B, Rohweder G, Naalsund E, Lydersen S. Medical complications in a comprehensive stroke unit and an early supported discharge service. Stroke 2008; 39: 414-420
    CrossrefPubMedGoogle Scholar
  • 33 Najenson T, Yacubovich E, Pikielni SS. Rotator cuff injury in shoulder joints of hemiplegic patients. Scand J Rehabil Med 1971; 3: 131-137
    PubMedGoogle Scholar
  • 34 Davis SW, Petrillo CR, Eichberg RD, Chu DS. Shoulder-hand syndrome in a hemiplegic population: A 5-year retrospective study. Arch Phys Med Rehabil 1977; 58: 353-356
    PubMedGoogle Scholar
  • 35 Van Ouwenaller C, Laplace PM, Chantraine A. Painful shoulder in hemiplegia. Arch Phys Med Rehabil 1986; 67: 23-26
    PubMedGoogle Scholar
  • 36 Pandian JD, Kaur P, Arora R, Vishwambaran DK, Toor G, Mathangi S. et al Shoulder taping reduces injury and pain in stroke patients: Randomized controlled trial. Neurology 2013; 80: 528-532
    CrossrefPubMedGoogle Scholar
  • 37 Kelly J, Rudd A, Lewis R, Hunt BJ. Venous thromboembolism after acute stroke. Stroke 2001; 32: 262-267
    CrossrefPubMedGoogle Scholar
  • 38 Paolucci S, Antonucci G, Grasso MG, Morelli D, Troisi E, Coiro P. et al Early versus delayed inpatient stroke rehabilitation: A matched comparison conducted in Italy. Arch Phys Med Rehabil 2000; 81: 695-700
    CrossrefPubMedGoogle Scholar
  • 39 Chollet F, Tardy J, Albucher JF, Thalamas C, Berard E, Lamy C. et al Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): A randomised placebo-controlled trial. Lancet Neurol 2011; 10: 123-130
    CrossrefPubMedGoogle Scholar
  • 40 Pariente J, Loubinoux I, Carel C, Albucher JF, Leger A, Manelfe C. et al Fluoxetine modulates motor performance and cerebral activation of patients recovering from stroke. Ann Neurol 2001; 50: 718-729
    CrossrefPubMedGoogle Scholar
  • 41 Kesar TM, Perumal R, Jancosko A, Reisman DS, Rudolph KS, Higginson JS. et al Novel patterns of functional electrical stimulation have an immediate effect on dorsiflexor muscle function during gait for people poststroke. Phys Ther 2010; 90: 55-66
    CrossrefPubMedGoogle Scholar
  • 42 Ada L, Foongchomcheay A. Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: A meta-analysis. Aust J Physiother 2002; 48: 257-267
    CrossrefPubMedGoogle Scholar
  • 43 Koyuncu E, Nakipoglu-Yüzer GF, Dogan A, Ozgirgin N. The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial. Disabil Rehabil 2010; 32: 560-566
    CrossrefPubMedGoogle Scholar
  • 44 Price CI, Pandyan AD. Electrical stimulation for preventing and treating post-stroke shoulder pain. Cochrane Database Syst Rev 2000; (04) CD001698
    PubMedGoogle Scholar
  • 45 Merletti R, Andina A, Galante M, Furlan I. Clinical experience of electronic peroneal stimulators in 50 hemiparetic patients. Scand J Rehabil Med 1979; 11: 111-121
    PubMedGoogle Scholar
  • 46 Sheffler LR, Hennessey MT, Naples GG, Chae J. Peroneal nerve stimulation versus an ankle foot orthosis for correction of footdrop in stroke: Impact on functional ambulation. Neurorehabil Neural Repair 2006; 20: 355-360
    CrossrefPubMedGoogle Scholar
  • 47 Hausdorff JM, Ring H. Effects of a new radio frequency-controlled neuroprosthesis on gait symmetry and rhythmicity in patients with chronic hemiparesis. Am J Phys Med Rehabil 2008; 87: 4-13
    CrossrefPubMedGoogle Scholar
  • 48 Cameirao MS, Badia SB, Oller ED, Verschure PF. Neurorehabilitation using the virtual reality based rehabilitation gaming system: Methodology, design psychometrics, usability and validation. J Neuroeng Rehabil 2010; 7: 48
    CrossrefPubMedGoogle Scholar
  • 49 Deutsch JE, Merians AS, Adamovich S, Poizner H, Burdea GC. Development and application of virtual reality technology to improve hand use and gait of individuals post-stroke. Restor Neurol Neurosci 2004; 22: 371-386
    PubMedGoogle Scholar
  • 50 Mirelman A, Patritti BL, Bonato P, Deutsch JE. Effects of virtual reality training on gait biomechanics of individuals post-stroke. Gait Posture 2010; 31: 433-437
    CrossrefPubMedGoogle Scholar
  • 51 Mehrholz J, Elsner B, Werner C, Kugler J, Pohl M. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev 2013; 7: CD006185
    PubMedGoogle Scholar
  • 52 Ada L, Dean CM, Vargas J, Ennis S. Mechanically assisted walking with body weight support results in more independent walking than assisted overground walking in non-ambulatory patients early after stroke: A systematic review. J Physiother 2010; 56: 153-161
    CrossrefPubMedGoogle Scholar
  • 53 Barbeau H, Visintin M. Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. Arch Phys Med Rehabil 2003; 84: 1458-1465
    CrossrefPubMedGoogle Scholar
  • 54 Visintin M, Barbeau H, Korner-Bitensky N, Mayo NE. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke 1998; 29: 1122-1128
    CrossrefPubMedGoogle Scholar
  • 55 Platz T. Evidence-based arm rehabilitation - A systematic review of the literature. Nervenarzt 2003; 74: 841-849
    CrossrefPubMedGoogle Scholar
  • 56 Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet 2011; 377: 1693-1702
    CrossrefPubMedGoogle Scholar
  • 57 Yavuzer G, Selles R, Sezer N, Sutbeyaz S, Bussmann JB, Koseoglu F. et al Mirror therapy improves hand function in subacute stroke: A randomized controlled trial. Arch Phys Med Rehabil 2008; 89: 393-398
    CrossrefPubMedGoogle Scholar
  • 58 Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev 2012; 3: CD008449
    PubMedGoogle Scholar
  • 59 Norouzi-Gheidari N, Archambault PS, Fung J. Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: Systematic review and meta-analysis of the literature. J Rehabil Res Dev 2012; 49: 479-496
    CrossrefPubMedGoogle Scholar
  • 60 Liepert J. Evidence-based methods in motor rehabilitation after stroke. Fortschr Neurol Psychiatr 2012; 80: 388-393
    Article in Thieme ConnectPubMedGoogle Scholar
  • 61 Ploumis A, Varvarousis D, Konitsiotis S, Beris A. Effectiveness of botulinum toxin injection with and without needle electromyographic guidance for the treatment of spasticity in hemiplegic patients: A randomized controlled trial. (Epub ahead of print May 14, 2013) Disabil Rehabil 2013
    PubMed
  • 62 Kelly H, Brady MC, Enderby P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2010; 5: CD000425
    PubMedGoogle Scholar
  • 63 Hoffmann M, Chen R. The spectrum of aphasia subtypes and etiology in subacute stroke. (Epub ahead of print May 13, 2013) J Stroke Cerebrovasc Dis 2013; 22 (08) 1385-1392
    CrossrefPubMedGoogle Scholar
  • 64 Cherney LR, Patterson JP, Raymer A, Frymark T, Schooling T. Evidence-based systematic review: Effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia. J Speech Lang Hear Res 2008; 51: 1282-1299
    CrossrefPubMedGoogle Scholar
  • 65 Breier JI, Juranek J, Maher LM, Schmadeke S, Men D, Papanicolaou AC. Behavioral and neurophysiologic response to therapy for chronic aphasia. Arch Phys Med Rehabil 2009; 90: 2026-2033
    CrossrefPubMedGoogle Scholar
  • 66 Wallace T, Bradshaw A. Technologies and strategies for people with communication problems following brain injury or stroke. Neuro Rehabilitation 2011; 28: 199-209
    PubMedGoogle Scholar
  • 67 Cumming TB, Marshall RS, Lazar RM. Stroke, cognitive deficits, and rehabilitation: Still an incomplete picture. Int J Stroke 2013; 8: 38-45
    CrossrefPubMedGoogle Scholar
  • 68 Bakheit AM. Drug treatment of poststroke aphasia. Expert Rev Neurother 2004; 4: 211-217
    CrossrefPubMedGoogle Scholar
  • 69 Ozeren A, Sarica Y, Mavi H, Demirkiran M. Bromocriptine is ineffective in the treatment of chronic nonfluent aphasia. Acta Neurol Belg 1995; 95: 235-238
    PubMedGoogle Scholar
  • 70 Ashtary F, Janghorbani M, Chitsaz A, Reisi M, Bahrami A. A randomized, double-blind trial of bromocriptine efficacy in nonfluent aphasia after stroke. Neurology 2006; 66: 914-916
    CrossrefPubMedGoogle Scholar
  • 71 Flowers HL, Silver FL, Fang J, Rochon E, Martino R. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. J Commun Disord 2013; 46: 238-248
    CrossrefPubMedGoogle Scholar
  • 72 Rosenbek JC, Lemme ML, Ahern MB, Harris EH, Wertz RT. A treatment for apraxia of speech in adults. J Speech Hear Disord 1973; 38: 462-472
    CrossrefPubMedGoogle Scholar
  • 73 Hayes A, Chen CS, Clarke G, Thompson A. Functional improvements following the use of the NVT Vision rehabilitation program for patients with hemianopia following stroke. Neuro Rehabilitation 2012; 31: 19-30
    PubMedGoogle Scholar
  • 74 Schofield TM, Leff AP. Rehabilitation of hemianopia. Curr Opin Neurol 2009; 22: 36-40
    CrossrefPubMedGoogle Scholar
  • 75 Keane S, Turner C, Sherrington C, Beard JR. Use of fresnel prism glasses to treat stroke patients with hemispatial neglect. Arch Phys Med Rehabil 2006; 87: 1668-1672
    CrossrefPubMedGoogle Scholar
  • 76 Mizuno K, Tsuji T, Takebayashi T, Fujiwara T, Hase K, Liu M. Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial neglect: A randomized, controlled trial. Neurorehabil Neural Repair 2011; 25: 711-720
    CrossrefPubMedGoogle Scholar
  • 77 Pedersen PM, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Hemineglect in acute stroke - Incidence and prognostic implications. The Copenhagen stroke study. Am J Phys Med Rehabil 1997; 76: 122-127
    CrossrefPubMedGoogle Scholar
  • 78 Rode G, Rossetti Y, Badan M, Boisson D. Role of rehabilitation in hemineglect syndromes. Rev Neurol (Paris) 2001; 157: 497-505
    PubMedGoogle Scholar
  • 79 Marshall RS. Rehabilitation approaches to hemineglect. Neurologist 2009; 15: 185-192
    CrossrefPubMedGoogle Scholar
  • 80 Meng NH, Wang TG, Lien IN. Dysphagia in patients with brainstem stroke: Incidence and outcome. Am J Phys Med Rehabil 2000; 79: 170-175
    CrossrefPubMedGoogle Scholar
  • 81 Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke 2005; 36: 2756-2763
    CrossrefPubMedGoogle Scholar
  • 82 McCullough GH, Kim Y. Effects of the Mendelsohn maneuver on extent of hyoid movement and UES opening post-stroke.(Epub ahead of print March 14, 2013) Dysphagia 2013
    PubMed
  • 83 Geeganage C, Beavan J, Ellender S, Bath PM. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst Rev 2012; 10: CD000323
    PubMedGoogle Scholar
  • 84 Shigematsu T, Fujishima I, Ohno K. Transcranial direct current stimulation improves swallowing function in stroke patients. Neurorehabil Neural Repair 2013; 27: 363-369
    CrossrefPubMedGoogle Scholar
  • 85 Bath PM, Bath FJ, Smithard DG. Interventions for dysphagia in acute stroke. Cochrane Database Syst Rev 2012; 10: CD000323
    PubMedGoogle Scholar
  • 86 Nakayama H, Jørgensen HS, Pedersen PM, Raaschou HO, Olsen TS. Prevalence and risk factors of incontinence after stroke. The Copenhagen stroke study. Stroke 1997; 28: 58-62
    PubMedGoogle Scholar
  • 87 Brittain KR, Peet SM, Castleden CM. Stroke and incontinence. Stroke 1998; 29: 524-528
    CrossrefPubMedGoogle Scholar
  • 88 Harari D, Norton C, Lockwood L, Swift C. Treatment of constipation and fecal incontinence in stroke patients: Randomized controlled trial. Stroke 2004; 35: 2549-2555
    CrossrefPubMedGoogle Scholar
  • 89 McKenzie P, Badlani GH. The incidence and etiology of overactive bladder in patients after cerebrovascular accident. Curr Urol Rep 2012; 13: 402-406
    CrossrefPubMedGoogle Scholar
  • 90 Tsuchida S, Noto H, Yamaguchi O, Itoh M. Urodynamic studies on hemiplegic patients after cerebrovascular accident. Urology 1983; 21: 315-318
    CrossrefPubMedGoogle Scholar
  • 91 Sakakibara R, Hattori T, Yasuda K, Yamanishi T. Micturitional disturbance after acute hemispheric stroke: Analysis of the lesion site by CT and MRI. J Neurol Sci 1996; 137: 47-56
    CrossrefPubMedGoogle Scholar
  • 92 Burney TL, Senapati M, Desai S, Choudhary ST, Badlani GH. Effects of cerebrovascular accident on micturition. Urol Clin North Am 1996; 23: 483-490
    CrossrefPubMedGoogle Scholar
  • 93 Gelber DA, Good DC, Laven LJ, Verhulst SJ. Causes of urinary incontinence after acute hemispheric stroke. Stroke 1993; 24: 378-382
    CrossrefPubMedGoogle Scholar