Introduction—The changing view of neurorehabilitation: A new era of optimism

Abstract

Stroke is the leading health care problem requiring rehabilitation services today (CDC, 2001; Lee et al., 1996) with the worldwide incidence estimated to be between 300 and 500 per 100,000 people (Sudlow & Warlow, 1997). In most recent years, the rates of mortality are decreasing, resulting in a significant increase in the number of survivors living with the disabilities/handicaps associated with stroke (Thorvaldsen et al., 1997). Not only is stroke a common health problem, but the cognitive disorders that result are common as well (Mayo, 1993; Paolucci et al., 1996).This article is based in part on a Presidential Address by the first author to the Annual meeting of the International Neuropsychological Society in Honolulu, Hawaii in February, 2002.

Advancing the Evidence Base of Rehabilitation Treatments: A Developmental Approach

“…Thus, phase IV, a less formally organized effectiveness research phase, is devoted to assessing the impact of the drug as actually used in practice by more varied clinicians on more varied patients, and establishing differences in benefits and adverse effects among different patient subgroups, such as those with more comorbidities and complicating factors. 10,11 …”

The case for single-case studies in treatment research—comments on Howard, Best and Nickels “Optimising the design of intervention studies: critiques and ways forward”

“…Randomised clinical trial (RCT) studies that are typically used to test the effectiveness of pharmaceutical treatments are not ideal for testing the efficacy of behavioural treatments in aphasia. Although this issue has been discussed at length elsewhere (e.g., Elman, 2006; Rothi & Barrett, 2006; Whyte, Gordon, & Rothi, 2009), there are several arguments against the use of RCTs that are worth noting because of their relevance to single-case study research. As noted by Rothi and Barrett (2006) and Whyte et al (2009), the emphasis on RCTs for rehabilitation research minimises the value of single case-studies to establish “proof of concept”.…”

Treatment innovation in behavioral rehabilitation of stroke: Removing limits on recovery

“…We are now entering an exciting period in poststroke care in which the time span and extent of continued improvement is extending incredibly. In another recent publication, we commented on the "new era of optimism" for cognitive recovery and poststroke cognitive rehabilitation [11]. An attitude of hope and expectation in stroke rehabilitation is likely to benefit survivors and families in and of itself.…”