© Springer International Publishing Switzerland 2017
Hardik P. Amin and Joseph L. Schindler (eds.)Vascular Neurology Board Review10.1007/978-3-319-39605-7_1818. Stroke Rehab
(1)
Assistant Professor of Neurology, Yale University School of Medicine, Associate Director, Vascular Neurology Fellowship, Yale-New Haven Hospital, New Haven, CT, USA
(2)
Associate Professor of Neurology and Neurosurgery, Yale University School of Medicine, Director, Acute Stroke and TeleStroke Services, Director, Vascular Neurology Fellowship, Yale-New Haven Hospital, New Haven, CT, USA
Abbreviations
ADL
Activities of daily living
AFO
Ankle foot orthotic
BI
Barthel index
CIMT
Constraint-induced movement therapy
FIM
Functional independence measure
LTACH
Long-term acute care hospital
GABA
Gamma-aminobutyric acid
GOS
Glasgow outcome scale
Introduction
Ninety percent of stroke patients have a residual deficit, and nearly 50 % have a motor deficit. Conventional rehabilitation methods have shown modest results. There is substantial research in pharmacological and technological approaches to enhance recovery. You should familiarize yourself with the rehabilitative approaches and scales for measuring level of function and disability. Please take note of the evolving criteria involved in admitting stroke patients to various facilities for post-stroke care.
Goals of Rehab
To reach maximal physical, functional, and psycho-social recovery within limits of the patient’s level of impairment, to optimized activities of daily living
Includes speech and cognitive aspects
Relearning skills that were present prior to event
Adaptation
Priority is on self-care and mobility
Rehab should begin within 24 h of stroke
Natural History of Motor Recovery
Most recovery occurs within first 3–12 months
Patients with some residual function are most likely to improve
Degree of damage to the corticospinal tract can predict outcome
Patients with a plegic limb are less likely to respond
Can predict severity of outcome based on recovery at 1 month
Upper extremity: poor outcome likely if no voluntary movement at 15 days, or no grip at 1 month
Lower extremity: voluntary movement of hip at 1 week can indicate eventual mobility, albeit with the aid of an assistive device or ankle orthosis
Pattern of recovery
Recovery almost always occurs in the proximal muscles of upper and lower extremities first
Treatment with SSRI has been shown to improve motor recovery in selected patients (See FLAME trial below); however, scales such as NIHSS , mRS, and Montgomery Depression Scale showed no improvement
Scales
Measure disability or functional status
Functional Independence Measure (FIM): a thorough measure of function (as well as social interactions, cognitive function, balance); indicates how much assistance is required to carry out activities of daily living (ADL): dressing, feeding, bathing, toileting
Most commonly used scale measuring functionality after stroke, recommended by American Stroke Association
Barthel Index (BI): measure of a patient’s ability for self-care and mobility (ADLs such as feeding, dressing, grooming, and bathing)
NIHSS : quantitative scale measuring symptom severity, not level of disability; concordant with stroke volume. Biased toward anterior circulation strokes, particularly left hemisphere, with poor evaluation of cranial nerves and gaitRelated posts:
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