Rehabilitation Of The Older Adult With Stroke : Advanced Reading on Healthline

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General Rehabilitation Principles In The Stroke Patient

Stroke rehabilitation begins as soon as the diagnosis of stroke is established. Rehabilitation during the acute phase should be to prevent recurrent stroke, avoid medical complications, mobilize the patient, encourage the resumption of self-care activities, and provide emotional support to the patient and family. During this phase, specific goals may include measures to prevent deep vein thrombosis or pressure sores, to minimize spasticity or contracture, to manage bowel and bladder issues, and to prevent respiratory complications. Therapy involves range-of-motion exercises and bed positioning with progressive increase in intensity as tolerated. A study of 145 patients with first-ever strokes showed better effectiveness on a functional outcome scale, the Barthel Index, with early rehabilitation treatment compared with delayed initiation of services [54]. Pooling the results of nine controlled trials revealed a small, but statistically significant intensity-effect relationship in the rehabilitation of stroke patients [55]. Subsequent studies support higher intensity of upper and lower limb training to improve activities of daily living, walking ability, and dexterity [56]. The general consensus is that greater intensity of rehabilitation produces slightly better outcomes [57]. It is still unknown whether there is a minimum threshold of intensity, below which there is no benefit.