Neurological rehabilitation of patients after stroke: Guidelines of Austrian Stroke Society 2018
Keywords:stroke, neuroprotection, neurorehabilitation
Post-stroke rehabilitation includes a complex of measures aimed to continue intensive emergency therapy in purpose to do everything possible to reduce damage to the brain of patient. The primary goal of such interventions is to start promptly after the urgent treatment that contributes patients to adapt as soon as possible and recover social functioning. The article presents a brief review of the guidelines of Austrian Stroke Society (ASS, 2018) on neurological rehabilitation of patients after stroke.
There are early and late or long-term rehabilitation. The terms “neuroreparation”, “neuroplasticity” and “neurorecovery” appear to be appropriate for evidence-base guidelines.
The standard approach to further recovery of patients after stroke included a care model providing the following but not the parallel care. However, taking into account stroke-induced biological process, the urgent need in particular early rehabilitation (within 24 hours if possible) is a incontestable fact.
Neuroprotection and neurorecovery require integrated therapeutic approach. It is of great importance to make a decision about early prescription of necessary medications. The fact of high priority of neurovascular system protection from ischemic injury is supported. Thus, sometimes the ischemic penumbra could be saved even within 24 hours after stroke by recovering perfusion of brain tissues and administrating neuroprotective agents.
Recovery after stroke is a targeted process enabling patient to achieve better physical, cognitive, emotional, social and functional status. That is why reasonable measures should be started as early as possible (within 24–48 hours) after stroke with the assistance of multidisciplinary professional team in specialized medical centers.
2. Cramer SC, Sur M, Dobkin BH, O’Brien C, Sanger TD, Trojanowski JQ, Rumsey JM, Hicks R, Cameron J, Chen D, Chen WG, Cohen LG, deCharms C, Duffy CJ, Eden GF, Fetz EE, Filart R, Freund M, Grant SJ, Haber S, Kalivas PW, Kolb B, Kramer AF, Lynch M, Mayberg HS, McQuillen PS, Nitkin R, Pascual-Leone A, Reuter-Lorenz P, Schiff N, Sharma A, Shekim L, Stryker M, Sullivan EV, Vinogradov S. Harnessing neuroplasticity for clinical applications. Brain. 2011 Jun;134(Pt 6):1591-609. [CrossRef] [PubMed] [PubMed Central]
3. Brainin M, Barnes M, Baron JC, Gilhus NE, Hughes R, Selmaj K, Waldemar G; Guideline Standards Subcommittee of the EFNS Scientific Committee. Guidance for the preparation of neurological management guidelines by EFNS scientific task forces--revised recommendations 2004. Eur J Neurol. 2004 Sep;11(9):577-81. [CrossRef] [PubMed]
4. Wein T, Lindsay MP, Côté R, Foley N, Berlingieri J, Bhogal S, Bourgoin A, Buck BH, Cox J, Davidson D, Dowlatshahi D, Douketis J, Falconer J, Field T, Gioia L, Gubitz G, Habert J, Jaspers S, Lum C, McNamara Morse D, Pageau P, Rafay M, Rodgerson A, Semchuk B, Sharma M, Shoamanesh A, Tamayo A, Smitko E, Gladstone DJ; Heart and Stroke Foundation Canadian Stroke Best Practice Committees. Canadian stroke best practice recommendations: Secondary prevention of stroke, sixth edition practice guidelines, update 2017. Int J Stroke. 2018 Jun;13(4):420-443. [CrossRef] [PubMed]
5. Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, Pomeroy VM, Langhorne P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev. 2014 Apr 22;(4):CD001920. [CrossRef] [PubMed] [PubMed Central]
6. International Classification of Functioning, Disability and Health (ICF) [Internet]. World Health Organization; 2018. Available from: https://www.who.int/classifications/icf/en/
8. AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet. 2015 Jul 4;386(9988):46-55. [CrossRef] [PubMed]
9. Bernhardt J, Churilov L, Ellery F, Collier J, Chamberlain J, Langhorne P, Lindley RI, Moodie M, Dewey H, Thrift AG, Donnan G; AVERT Collaboration Group. Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT). Neurology. 2016 Jun 7;86(23):2138-45. [CrossRef] [PubMed] [PubMed Central]
10. Janssen H, Ada L, Bernhardt J, McElduff P, Pollack M, Nilsson M, Spratt NJ. An enriched environment increases activity in stroke patients undergoing rehabilitation in a mixed rehabilitation unit: a pilot non-randomized controlled trial. Disabil Rehabil. 2014;36(3):255-62. [CrossRef] [PubMed]
11. Lang CE, MacDonald JR, Gnip C. Counting repetitions: an observational study of outpatient therapy for people with hemiparesis post-stroke. J Neurol Phys Ther. 2007 Mar;31(1):3-10. [CrossRef] [PubMed]
12. Royal College of Physicians. Spasticity in Adults: Management using Botulinum Toxin. National guidelines. 2009. Royal College of Physicians. 2009
13. Scheidtmann K, Fries W, Müller F, Koenig E. Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: a prospective, randomised, double-blind study. Lancet. 2001 Sep 8;358(9284):787-90. [CrossRef] [PubMed]
14. Gu SC, Wang CD. Early Selective Serotonin Reuptake Inhibitors for Recovery after Stroke: A Meta-Analysis and Trial Sequential Analysis. J Stroke Cerebrovasc Dis. 2018 May;27(5):1178-1189. [CrossRef] [PubMed]
15. Bornstein NM, Guekht A, Vester J, Heiss WD, Gusev E, Hömberg V, Rahlfs VW, Bajenaru O, Popescu BO, Muresanu D. Safety and efficacy of Cerebrolysin in early post-stroke recovery: a meta-analysis of nine randomized clinical trials. Neurol Sci. 2018 Apr;39(4):629-640. [CrossRef] [PubMed] [PubMed Central]
16. Muresanu DF, Heiss WD, Hömberg V, Bajenaru O, Popescu CD, Vester JC, Rahlfs VW, Doppler E, Meier D, Moessler H, Guekht A. Cerebrolysin and Recovery After Stroke (CARS): A Randomized, Placebo-Controlled, Double-Blind, Multicenter Trial. Stroke. 2016 Jan;47(1):151-9. [CrossRef] [PubMed] [PubMed Central]
17. Guekht A, Vester J, Heiss WD, Gusev E, Hoemberg V, Rahlfs VW, Bajenaru O, Popescu BO, Doppler E, Winter S, Moessler H, Muresanu D. Safety and efficacy of Cerebrolysin in motor function recovery after stroke: a meta-analysis of the CARS trials. Neurol Sci. 2017 Oct;38(10):1761-1769. [CrossRef] [PubMed] [PubMed Central]
How to Cite
Copyright (c) 2019 Editorial team of the journal "NeuroNews"
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.