Impact of Early vs Delayed Admission to Rehabilitation on Functional Outcomes in Persons With Stroke

Salter, Katherine; Jutai, Jeffrey W.; Hartley, Mark; Foley, Norine; Bhogal, Sanjit K.; Bayona, Nestor A.; Teasell, Robert

doi:10.1080/16501970500314350

Cited by 169 publications

(115 citation statements)

References 21 publications

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“…Rehabilitative strategies have the highest potential to improve functional recovery after stroke when delivered early, and efficacy diminishes substantially with increasing time after stroke [62][63][64][65]. A study conducted by Khodaparast et al [66] sought to evaluate whether VNS paired with rehabilitative training would be effective after a long delay between ischemic lesion and therapy initiation.…”

Section: Preclinical and Clinical Studies For Ischemic Strokementioning

confidence: 99%

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Hays

2016

Neurotherapeutics

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Pathological neural activity could be treated by directing specific plasticity to renormalize circuits and restore function. Rehabilitative therapies aim to promote adaptive circuit changes after neurological disease or injury, but insufficient or maladaptive plasticity often prevents a full recovery. The development of adjunctive strategies that broadly support plasticity to facilitate the benefits of rehabilitative interventions has the potential to improve treatment of a wide range of neurological disorders. Recently, stimulation of the vagus nerve in conjunction with rehabilitation has emerged as one such potential targeted plasticity therapy. Vagus nerve stimulation (VNS) drives activation of neuromodulatory nuclei that are associated with plasticity, including the cholinergic basal forebrain and the noradrenergic locus coeruleus. Repeatedly pairing brief bursts of VNS sensory or motor events drives robust, event-specific plasticity in neural circuits. Animal models of chronic tinnitus, ischemic stroke, intracerebral hemorrhage, traumatic brain injury, and post-traumatic stress disorder benefit from delivery of VNS paired with successful trials during rehabilitative training. Moreover, mounting evidence from pilot clinical trials provides an initial indication that VNS-based targeted plasticity therapies may be effective in patients with neurological diseases and injuries. Here, I provide a discussion of the current uses and potential future applications of VNS-based targeted plasticity therapies in animal models and patients, and outline challenges for clinical implementation.

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Section: Preclinical and Clinical Studies For Ischemic Strokementioning

confidence: 99%

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Hays

2016

Neurotherapeutics

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“…Physiotherapy, a key component of stroke rehabilitation 9 focuses on the recovery of physical function for stroke survivors 10,11,12 and plays a positive role in enhancing independent living 13 . Immediate and intensive physiotherapy after a stroke has been associated with reduction in morbidity and mortality and improvement in performing activities of daily living 14,15 .…”

Section: Introductionmentioning

confidence: 99%

Utilization of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria

Olaleye¹,

Lawal²

2017

Afr H. Sci.

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Objectives: To investigate the pattern of referral for and utilisation of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria. Methods: Referral notes and medical records of patients admitted in the University College Hospital, Ibadan with a clinical diagnosis of stroke between January, 2009 and December, 2013 were retrospectively reviewed. Information on age, sex, type of stroke, length of hospital stay, referral for physiotherapy and utilisation of physiotherapy were retrieved. Data were summarised using descriptive statistics and analysed using Chi-square test. Results: A total of 783 patients with stroke were admitted in the hospital during the period under study. The in-patient mortality rate was 37.2%. The mean Length of Hospital Stay (LoHS) was 16.17±12.34 days. Referral rate for physiotherapy was high (75.8%) and the mean time from admission to referral for physiotherapy was three days. Majority of patients referred utilised physiotherapy (63.4%) and mean number of physiotherapy sessions received during in-patient care was 8.69±6.45. There was a significant association between LoHS and utilisation of in-patientphysiotherapy (p=0.02). Conclusion:The referral rate of stroke patients for physiotherapy was relatively high. Utilisation of in-patient physiotherapy reduced length of hospital stay among patients with stroke. Utilisation of out-patient physiotherapy was low. Strategies to enhance out-patient utilisation should be explored.

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“…3 Studies of animals housed in enriched environments suggest the existence of a critical period of increased neuroplasticity that extends from 14 to 30 days post stroke onset in rats. 31 These data, along with the previously discussed data on genes upregulated after stroke and recent clinical findings, 32,33 suggest that the brain opens a post stroke window of several weeks during which plastic modifications are supported. In humans, this window may be larger, and many patients with stroke improve for months after the insult.…”

Section: Functional Considerationsmentioning

confidence: 87%

Restoring Neuronal Function After Stroke by Cell Replacement

Dihné

Hartung

Seitz

2011

Stroke

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Background and Purpose-A major challenge to effective treatment after stroke is the restoration of neuronal function.In recent years, cell-based therapies for stroke have been explored in experimental animal models, and the results have suggested behavioral improvements. However, the anatomic targets of a cell-based stroke therapy and the relationship of cell grafts to post stroke reorganization are poorly understood, which results in difficulties defining strategies for neuronal substitution. Given that stroke causes a variety of secondary changes at locations beyond the infarct lesion, overcoming these difficulties is even more important. Summary of Review-We describe which brain structures and cell types are candidates for substitution and how new neuronal functionality could be implemented in a damaged brain by capitalizing on current concepts of post stroke plasticity. (Stroke. 2011;42:2342-2350.)

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Impact of Early vs Delayed Admission to Rehabilitation on Functional Outcomes in Persons With Stroke

Abstract: Patients admitted to stroke rehabilitation within 30 days of first-ever, unilateral stroke experienced greater functional gains and shorter lengths of stay than those whose admission to rehabilitation was delayed beyond 30 days.

Cited by 169 publications

References 21 publications

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Utilization of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria

Restoring Neuronal Function After Stroke by Cell Replacement

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