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Introduction and Methods Clinical Consequences of Stroke Background Concepts in Stroke Rehabilitation Managing the Stroke Rehabilitation Triage Process The Efficacy of Stroke Rehabilitation The Elements of Stroke Rehabilitation Outpatient Stroke Rehabilitation Secondary Prevention of Stroke Mobility and the Lower Extremity Upper Extremity Interventions Painful Hemiplegic Shoulder Cognitive Disorders and Apraxia Perceptual Disorders Aphasia Dysphagia and Aspiration Post Stroke Nutritional Interventions Following Stroke Medical Complications Post Stroke Post-Stroke Depression Community Reintegration Miscellaneous Treatments Outcome Measures The Rehabilitation of Younger Stroke Patients Rehabilitation of Severe Strokes

Evidence Reviews

Study in the field of stroke rehabilitation is extensive and wide-ranging, owing largely to the complexity of the clinical presentation of the individual with stroke and the interdisciplinary nature of the practice of stroke rehabilitation. The Evidence-Based Review of Stroke Rehabilitation (EBRSR) is the most comprehensive and up-to-date review available examining both therapy-based and pharmacological interventions associated with stroke rehabilitation. We continue to update the review regularly, with the aim of providing a comprehensive, easily accessible review, which will help to facilitate a best-practice approach to stroke rehabilitation.

List of Reviews

1 - Introduction and Methods

Keywords:

methods, abstraction, scoring, PEDro, levels of evidence

This section describes the methods and the process used to formulate levels of evidence.

2 - Clinical Consequences of Stroke

Keywords:

Acute care, clinical outcomes, localization, hemisphere, disorder, artery, lesion

This review highlights the varied clinical outcomes of stroke and their relation to lesion site.

3 - Background Concepts in Stroke Rehabilitation

Keywords:

Classification, outcomes, impact, recovery, mechanisms, time, plasticity, reorganization

Stroke rehabilitation, and promoting recovery from neurological deficits, requires a foundation of knowledge in stroke identification and management. This review presents evidence related the underlying concepts of stroke rehabilitation.

4 - Managing the Stroke Rehabilitation Triage Process

Keywords:

Triage, system, model, screening, assessment, intensity, severity, age, inpatient, outpatient

This chapter review's evidence and dialogue relating to stroke rehabilitation triage systems.

5 - The Efficacy of Stroke Rehabilitation

Keywords:

Meta-analysis, model of care, stroke unit, mobile stroke team, acute care, intensive care, specialized care, subacute

The variety of stroke rehabilitation units and systems requires their measurement for efficacy. This chapter presents evidence comparing various stroke rehabilitation models.

6 - The Elements of Stroke Rehabilitation

Keywords:

Outcomes, intensity, duration, timing, occupational therapy, physical therapy, speech therapy, care pathways, readmission, compensatory, remedial, specialized

Interdisciplinary stroke rehabilitation is a multifaceted approach of fostering stroke recovery. This review examines specific aspects of stroke rehabilitation for efficacy.

7 - Outpatient Stroke Rehabilitation

Keywords:

Outpatient, hospital, community, early supported discharge, cost, therapy. length of stay, home-based

This review details the outpatient stroke rehabilitation dialogue comparing hospital-based, community-based and early supported discharge models.

8 - Secondary Prevention of Stroke

Keywords:

Risk factors, TIA, education, hypertension, hyperlipidemia, cholesterol, diabetes, glycemic control, infection, diet, anti-oxidants, homocysteine, folic acid, smoking, alcohol, physical activity, atherosclerosis, atrial fibrillation, antiplatelet, anticoagulant, carotid endarterectomy, carotid artery angioplasty, stenting.

Secondary prevention should be regarded as an integral part of stroke rehabilitation. The present review provides information regarding management of modifiable risk factors, treatment of atherosclerosis and cardiac abnormalities such as atrial fibrillation and reperfusion techniques.

9 - Mobility and the Lower Extremity

Keywords:

Compensatory, restorative, task-specific, intensity, treadmill, strength training, balance, gait, strength, cardiovascular conditioning, wheelchair, canes, walking aids, robotics, electrical stimulation, EMG, splinting, botulinum toxin, ultrasound, physical therapy, orthoses

This review contrasts the compensatory and restorative approaches to lower extremity rehabilitation. Literature pertaining to specific treatments is summarized and recommendations are made based on levels of evidence.

10 - Upper Extremity Interventions

Keywords:

Repetitive/task specific training, constraint-induced movement therapy, physical therapy, spasticity, botulinum toxin, robotics, electrical stimulation, TENS, FES, EMG, mental imagery, virtual reality, sensorimotor, hand splinting, hand edema

In this review, rehabilitative therapies of upper extremity complications are summarized, the current literature articles are described and scored, and recommendations are made based on the most up to date evidence.

11 - Painful Hemiplegic Shoulder

Keywords:

Painful hemiplegic shoulder, subluxation, spasticity, contractures, rotator cuff, scapular rotation, shoulder hand syndrome, positioning, strapping, range of motion, FES, injections, massage, surgery, aromatherapy, mirror therapy

This review provides a complete discussion of the current literature on painful hemiplegic shoulder and shoulder hand syndrome post stroke. Levels of evidence are provided to clarify research based recommendations.

12 - Cognitive Disorders and Apraxia

Keywords:

Cognitive impairment, dementia, delirium, apraxia, attention, memory, executive function, problem-solving, multimodal interventions, TENS, music listening, exercise, rTMS, tDCS, electrical stimulation, ASA, depression, pharmacotherapy

This review provides information regarding the importance and impact of cognitive impairment, delirium and apraxia post stroke. Treatment interventions are reviewed and levels of evidence assigned

13 - Perceptual Disorders

Keywords:

Unilateral spatial neglect, USN, limb activation, sensory stimulation, visual scanning, prisms, feedback, computer-based training, eye-patching, trunk rotation, vestibular stimulation, galvanic stimulation, optokinetic stimulation, neck vibration, TENS, rTMS, tDCS

Unilateral spatial neglect (USN) affects a significant number of individuals with stroke. The present review focuses on interventions to improve USN either by increasing patient's awareness of or attention to the neglected space or remediating deficits of position sense or body orientation.

14 - Aphasia

Keywords:

Aphasia, language therapy, trained volunteers, community-based, conversation partners, group therapy, education, computer-based therapy, telerehabilitation, filmed language, transcranial stimulation, direct current stimulation, constraint induced, forced use, alexia, word retrieval, global aphasia, drug therapy

A comprehensive review of aphasia post stroke that includes both therapy-based and drug-based interventions.

15 - Dysphagia and Aspiration Post Stroke

Keywords:

dysphagia, aspiration, pneumonia, screening, assessment, videofluoroscopy, non-oral feeding, texture-modified diet, rTMS, electrical stimulation, black pepper oil

This review provides information regarding the assessment and treatment of dysphagia.

16 - Nutritional Interventions Following Stroke

Keywords:

malnutrition, nutritional markers, hypermetabolism, increased catabolism, gastrointestinal function, enteral feeding, oral supplementation, dysphagia, parenteral nutrition, feeding tubes

This review includes discussion of nutritional status and malnutrition following stroke including incidence rates, detection markers, underlying causes, treatment interventions, and potential complications. Articles are summarized and conclusions are drawn based on levels of evidence.

17 - Medical Complications Post Stroke

Keywords:

Medical complications, urinary incontinence, fecal incontinence, constipation, venous thromboembolism, DVT, seizure, osteoporosis, vitamin D, sunlight therapy, central pain

This review identifies clinically relevant post stroke complications and methods used to control them. Treatment interventions are reviewed and levels of evidence assigned.

18 - Post-Stroke Depression

Keywords:

PSD, assessment, prevention, care provision, treatment, SSRI, heterocyclic antidepressants, therapy, care management, alternative medicine, light therapy, music therapy, physical activity, post-stroke emotionalism

Depression is a well-documented sequela of stroke that may have a negative impact on functional recovery, cognition and social activity. Interventions to prevent and treat post-stroke depression are reviewed.

19 - Community Reintegration

Keywords:

social support, care management, discharge planning, informal caregiver, education, information provision, skills training, driving, attention re-training, on-road evaluation, return to work, leisure, sexuality

The present review examines aspects around the return to life in the community following stroke.

20 - Miscellaneous Treatments

Keywords:

Acupuncture, Chinese medicine, Reiki, massage therapy, amphetamines, hyperbaric oxygen, repetitive transcranial magnetic stimulation, motor cortex stimulation

This review examines the use of non-traditional treatments as they relate to stroke care. Treatment interventions are reviewed and levels of evidence have been assigned.

21 - Outcome Measures

Keywords:

Outcomes, assessment, ICF, body structure, impairment, activity, disability, participation, handicap

To enhance the meaningfulness the SREBR, the present review provides information about assessment tools commonly used in stroke rehabilitation research and practice including summary reviews of 38 assessment tools used in the evaluation of Body Structure (14 tools), Activity (15 tools) and Participation (9 tools) outcomes.

22 - The Rehabilitation of Younger Stroke Patients

Keywords:

Young, adult, incidence, risk factors, etiology, diagnosis, prognosis, recovery, work, return to work, family stress, institutionalization, discharge planning, future needs

This review highlights the unique rehabilitation needs of young stroke patients.

23 - Rehabilitation of Severe Strokes

Keywords:

Severe, definition, classification, FRG, case-mix, cortical reorganization, animal studies, admission, slow-stream, specialized interdisciplinary stroke rehabilitation, SISR, ethics

This review presents research focused on the admission, classification, treatment, recovery and rehabilitation of severe stroke patients.