There are four stages in rehabilitation for stroke patients. The first is an assessment of the patient’s functional status and his/her requirement of rehabilitation. The second is setting a realizable, optimizing rehabilitation goal. The third is a rehabilitation program to achieve the goal. The last is a reassessment of the rehabilitation process and goal achievement.

Patient assessment is categorized into global assessment and specific assessment. With the acute phase, radiologic imaging study and assessment of global neurological impairment, consciousness, muscle power, and pain are performed to figure out the neurological status within 24–48 h after hospitalization. Based on these parameters, the necessity of early rehabilitation or intensive rehabilitation is determined. With the subacute phase, an assessment of the global activity limitation, balance, hand function, and swallowing function is performed to establish the patient’s functional status. In order to perform these various assessments, multidisciplinary comprehensive approaches with a rehabilitation specialist, physical therapist, occupational therapist, speech therapist, clinical psychologist, social worker, and caregiver are needed. That is why a comprehensive rehabilitation stroke unit is required. With the chronic phase, an assessment is performed from the point of view related to the stroke patient’s quality of life at home or in an institution and maintenance of ADL. In addition, all assessment tools should be standard tools with reliability and validity and should be performed by experts. To hospitalize in a stroke rehabilitation unit, a patient should be in medically stable and have some functional impairment. Also, the patient should have a cognitive ability to communicate to some degree and be able to maintain in the sitting position on a wheelchair to actively participate in one session of the rehabilitation training for about 20–30 min.

In order to explain chronic disease that constantly affects humans, the World Health Organization International Classification of Functioning, Disability and Health (WHO ICF 2001) introduced new concepts of human functioning. There are three parts of functioning, namely, body structure and function, activity, and participation. Both individual and environmental factors interact with functioning here. WHO wanted to make a kind of a frame to collect the data commonly available in the world [4]. However, what constitutes ICF was so large-scale that WHO made several comprehensive core sets and brief core sets; clinically brief core sets are more likely to be used [5]. A brief core set for stroke consists of 18 components: six related to body functions, two to body structures, seven to activities and participation, and three to environmental factors. With an objective and scientific assessment of a stroke patient using the ICF stroke core set, his/her functioning or disabilities make it possible to recognize neurological impairment, individual activity limitation, interpersonal and social participation restriction, and the information about nearby medical facilities, family members, and house structure. The global neurological impairment assessments include National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), and Glasgow Coma Scale (GCS), among others. The global assessments for activity limitations are Modified Barthel Index (MBI), Functional Independence Measure (FIM), and modified Rankin Scale (mRS); also for participation restriction, there are Europal-5D, SF-18, etc. (Table 33.1).

Comprehensive stroke rehabilitation units should consist of well-organized team members who work in different professional fields and have sufficient experience on rehabilitation. They should manage stroke patients’ complications and/or comorbidities with evidence-based practice. Furthermore, each stroke patient should be provided with individualized, different rehabilitation programs depending on the severity of stroke through a multidisciplinary systematic evaluation [6]. Stroke patients with more moderate severity have an opportunity to be admitted into comprehensive stroke rehabilitation units. Once a week, every member should attend a conference for patients and pay attention to family, caregivers, and sociopsychological factors. In report on the systematically randomized comparative trials for the patients hospitalized in comprehensive stroke rehabilitation units or in a general ward, Stroke Unit Trialists’ Collaboration reported that the patients who were hospitalized in comprehensive stroke rehabilitation units had a more functional recovery, lower death rate, shorter length of hospital stay, and severe stroke patients’ lower rate of admission in a long-term care institution [2].

Functional impairment after stroke onset is due to neural loss of the injured area as well as to the decrement of the neural function of another area connected to the injured area. The degree of diaschisis, which is a malfunction in the opposite area connected to the damaged brain tissue, represents the degree of brain nerves’ damage, and reversal of diaschisis is an indicator of functional recovery. The mechanism of recovery after a stroke is not exactly known; however, the mechanism of early functional recovery is mainly known as (1) reversal of diaschisis, (2) hyperactivity of the existing neuronal pathway, and (3) neuroplasticity developed by the relearning process. Let us examine neuroplasticity, which is the main mechanism of functional recovery by rehabilitation.

Brain plasticity is a broad term connected to adapting characteristics of the human brain after environment, experience, and brain injury. The adaptability in a changing environment is the basic attribution and basic element of learning. This occurs in several levels, from molecules to cortical reorganization in brain cells [7].