Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015

Abstract

Stroke rehabilitation is a progressive, dynamic, goal-orientated process aimed at enabling a person with impairment to reach their optimal physical, cognitive, emotional, communicative, social and/or functional activity level. After a stroke, patients often continue to require rehabilitation for persistent deficits related to spasticity, upper and lower extremity dysfunction, shoulder and central pain, mobility/gait, dysphagia, vision, and communication. Each year in Canada 62,000 people experience a stroke. Among stroke survivors, over 6500 individuals access in-patient stroke rehabilitation and stay a median of 30 days (inter-quartile range 19 to 45 days). The 2015 update of the Canadian Stroke Best Practice Recommendations: Stroke Rehabilitation Practice Guidelines is a comprehensive summary of current evidence-based recommendations for all members of multidisciplinary teams working in a range of settings, who provide care to patients following stroke. These recommendations have been developed to address both the organization of stroke rehabilitation within a system of care (i.e., Initial Rehabilitation Assessment; Stroke Rehabilitation Units; Stroke Rehabilitation Teams; Delivery; Outpatient and Community-Based Rehabilitation), and specific interventions and management in stroke recovery and direct clinical care (i.e., Upper Extremity Dysfunction; Lower Extremity Dysfunction; Dysphagia and Malnutrition; Visual-Perceptual Deficits; Central Pain; Communication; Life Roles). In addition, stroke happens at any age, and therefore a new section has been added to the 2015 update to highlight components of stroke rehabilitation for children who have experienced a stroke, either prenatally, as a newborn, or during childhood. All recommendations have been assigned a level of evidence which reflects the strength and quality of current research evidence available to support the recommendation. The updated Rehabilitation Clinical Practice Guidelines feature several additions that reflect new research areas and stronger evidence for already existing recommendations. It is anticipated that these guidelines will provide direction and standardization for patients, families/caregiver(s), and clinicians within Canada and internationally.

Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry

“…Current US-American guidelines state that VER in the acute care hospital is optional, but all patients should at least undergo rehabilitative assessment prior to discharge to an inpatient rehabilitation care unit [41, 42]. The 2015 updated Canadian stroke rehabilitation guideline was the first to have incorporated findings from the AVERT trial and does no longer recommend frequent out-of bed activity within 24 h after stroke onset [43]. As a supranational committee, the European Stroke Organization guidelines for the management of ischemic stroke from 2008 recommend an early initiation of rehabilitation therapy but do not provide precise time frames [44].…”

“…However, the minimal demand of rehabilitation therapy is at least not to be harmful to the treated subject. The results of the AVERT trial should therefore be taken into account for the application of VER in clinical routine to avoid overly intense therapy in severely disabled patients, as done in the current Canadian stroke rehabilitation practice guidelines [43]. One further important lesson from AVERT is the urgent need for further clinical trials which will have to focus on stroke subgroups instead of the entire spectrum of IS and nontraumatic ICH.…”

Music‐supported therapy for stroke motor recovery: theoretical and practical considerations

“…A rupture in a blood vessel that leads to bleeding causes the former, and the latter is caused by a blood clot that hinders blood flow to brain cells . In Canada, approximately 62,000 individuals experience a stroke every year . While more people are surviving their strokes, it is the leading cause of adult disability.…”

Therapeutic Potential of 3D Printing Pen in Stroke Rehabilitation: Case Reports

“…Although the patient had received conventional rehabilitation therapy for more than 2 months before this training program, he showed no definite improvement in visualperceptual function. Rehabilitation approaches to improve the visual-perceptual function in stroke patients include visual scanning training, phasic alerting, cueing, and imagery [11]. Among these approaches, visual scanning training is most strongly recommended to improve visual-perceptual function [12].…”