The Management of Stroke Rehabilitation: A Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

Sall, James; Eapen, Blessen C.; Tran, Johanna; Bowles, Amy O.; Bursaw, Andrew; Rodgers, Margaret E.

doi:10.7326/m19-1695

Cited by 32 publications

(22 citation statements)

References 35 publications

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“…Although it has been recognized that sleep disturbances increase stroke risk and deteriorate poststroke recovery (Bassetti et al., 2020 ; Duss et al., 2017 ; Hermann & Bassetti, 2009 ; Sterr et al., 2018 ), sleep problems are still insufficiently considered in the prevention and management of stroke patients (Boulanger et al., 2018 ; Hepburn et al., 2018 ; Powers et al., 2019 ; Sall et al., 2019 ). Hence, it is necessary to incorporate treatments aimed at sleep disorders (e.g., insomnia) in stroke rehabilitation practices.…”

Section: Discussionmentioning

confidence: 99%

Melatonin supplementation in the subacute phase after ischemia alleviates postischemic sleep disturbances in rats

Hao

Zhong

et al. 2021

Brain and Behavior

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Background: Sleep disorders are highly prevalent among stroke survivors and impede stroke recovery. It is well established that melatonin has neuroprotective effects in animal models of ischemic stroke. However, as a modulator of endogenous physiological circadian rhythms, the effects of melatonin on poststroke sleep disorders remain unclear. In the present study, we investigated how melatonin delivered intraperitoneally once daily in the subacute phase after stroke onset, influencing neuronal survival, motor recovery, and sleep-wake profiles in rats.Methods: Transient ischemic stroke in male Sprague-Dawley rats was induced with 30 min occlusion of the middle cerebral artery. Melatonin or vehicle was delivered intraperitoneally once daily in the subacute phase, from 2 to 7 days after stroke. Electroencephalogram and electromyogram recordings were obtained simultaneously.Results: Compared to the effects observed in the vehicle-treated ischemic group, after 6 daily consecutive treatment of melatonin at 10 mg/kg starting at ischemic/reperfusion day 2, the infarct volume was significantly decreased (from 39.6 to 26.2%), and the degeneration of axons in the ipsilateral striatum and the contralateral corpus callosum were significantly alleviated. Sensorimotor performances were obviously improved as evidenced by significant increases in the latency to falling off the wire and in the use of the impaired forelimb. In addition to those predictable results of reducing brain tissue damage and mitigating behavioral deficits, repeated melatonin treatment during the subacute phase of stroke also alleviated sleep fragmentation through reducing sleep-wake stage transitions and stage bouts, together with increasing stage durations. Furthermore, daily administration of melatonin at 9 a.m. significantly increased the nonrapid eye movement sleep delta power during both the light and dark periods and decreased the degree of reduction of the circadian index.

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Section: Discussionmentioning

confidence: 99%

Melatonin supplementation in the subacute phase after ischemia alleviates postischemic sleep disturbances in rats

Hao

Zhong

et al. 2021

Brain and Behavior

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“…For good-quality stroke care, early rehabilitation after stroke onset has been proposed in several Stroke Treatment Guidelines ( 3 – 5 ). Mechanism that may support the effectiveness of early rehabilitation include restoration of brain function, which promotes neuroplasticity ( 6 ), and reduction of bedridden syndrome, infections, deep vein thrombosis, and pressure sores ( 7 ).…”

mentioning

confidence: 99%

Impact of rehabilitation start time on functional outcomes after stroke

Otokita

Uematsu²,

Kunisawa³

et al. 2021

J Rehabil Med

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This study examined the effect on functional outcomes of the time after stroke of starting rehabilitation. A large national database was searched for eligible stroke patients, resulting in a total of 140,655 patients from 1,161 hospitals. Starting rehabilitation on the day of admission or second day of hospitalization after stroke was found to be associated with better functional outcomes at dis charge than starting rehabilitation on the third day or later. For patients with haemorrhagic stroke, those who started rehabilitation on the second day of hospitalization had better functional outcome at discharge than those who started on the day of admission. Thus, starting rehabilitation on the day of admission or the second day of hospitalization after stroke may be the best timing for improved functional outcomes. However, among patients with haemorrhagic stroke, starting rehabilitation on the second day of hospitalization may result in better out comes than starting on the day of admission.Objective: To investigate the optimum rehabilitation start timing for improved functional outcomes after stroke in Japan. Design: A retrospective database study. Subjects: A total of 140,655 patients with stroke from 1,161 acute hospitals in Japan. Only data for those patients who were discharged alive was includ ed in the analysis. Methods: Activities of daily living were assess ed. Comparisons were made using the rehabilita tion start day after hospital admission. Reference day 2 was compared with days 1, 3, 4, 5, and 6 or later. Modified Rankin Scale at time of discharge was used as the primary outcome. In addition, cases of is chaemic stroke and haemorrhagic stroke were analysed as separate subgroups. Results: Univariate and multivariate logistic regres sion analyses showed that starting rehabilitation on day 2 resulted in a better outcome than starting on day 3 or later. There was no significant difference in outcome between starting rehabilitation on days 1 or 2 in all cases and subgroup of patient with infarc tion stroke. For a subgroup of patients with haem orrhagic stroke, starting rehabilitation on day 2 resulted in a better outcome than starting on day 1. Conclusion:Starting post-stroke rehabilitation on the day of admission or second day of hospitalization may be the optimum timing for functional outcomes. However, for haemorrhagic stroke, starting rehabil itation on the second day of hospitalization may be more effective than on the day of admission.

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“…It also includes the objective of the guidelines in relation to exercise prescription as a means of rehabilitation, health lifestyle guidance, further stroke prevention or a combination of these. Of the 22 CPGs included and reviewed: seven were from America [14,[26][27][28][29][30][31], five were from England [10,11,[32][33][34], three from Canada [35][36][37], and one each from: Scotland [15], the European collaborative (multiple countries in Europe collaborating) [38], Spain [39], Wales [40], Malaysia [41], The Netherlands [42], and Australia [43].…”

Section: Resultsmentioning

confidence: 99%

Examining Clinical Practice Guidelines for Exercise and Physical Activity as Part of Rehabilitation for People with Stroke: A Systematic Review

Church

Ali

Smith

et al. 2022

IJERPH

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Background: Stroke is the leading cause of chronic physical disability in Western industrialised nations. Despite clear guidelines for exercise in individuals with many non-communicable diseases, the guidance for people with stroke (PwS) who frequently present with multiple comorbidities is less clear. A systematic review of exercise guidelines was undertaken to synthesise themes and patterns. Methods: The review was completed according to the PRISMA statement. Guideline-specific databases were searched for worldwide clinical practice guidelines (CPGs). All included papers underwent quality assessment using the AGREE II protocol. Content synthesis and analysis of the guidelines was undertaken using CERT. Results: Searching identified 2184 papers. After duplicate removal and screening by title and abstract, 22 CPGs remained for review. Seven guidelines identified three key roles for exercise interventions: (1) promoting a healthy lifestyle, (2) prevention of further strokes and (3) rehabilitation. Of concern, many CPGs fail to recommend appropriate safety measures and standards, pre-, during and post-exercise or tailor for specific needs. Conclusions: Global guidelines for exercise in PwS lack in-depth and technical information on the exercise delivery methods, application and dosage required to progress exercise interventions for PwS.

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The Management of Stroke Rehabilitation: A Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

Cited by 32 publications

References 35 publications

Melatonin supplementation in the subacute phase after ischemia alleviates postischemic sleep disturbances in rats

Melatonin supplementation in the subacute phase after ischemia alleviates postischemic sleep disturbances in rats

Impact of rehabilitation start time on functional outcomes after stroke

Examining Clinical Practice Guidelines for Exercise and Physical Activity as Part of Rehabilitation for People with Stroke: A Systematic Review

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