What are clinically relevant strategies for effective patient care regarding post stroke rehabilitation?
It seems therapists can regularly find themselves in a “rut” when treating each patient with the same therapeutic exercises—day after day. They often question: what is the magic exercise intervention to help post stroke patients (or those with other severe conditions) recover back to their prior level of function?
In a systematic review by Langhorne et al. different methods, structure and organization, processes of care, and discharge planning and follow up were analyzed and compared. All data analyzed was gathered in survey form. The survey was then implemented in order to compare 11 different inpatient stroke units for similarities, differences, and effectiveness of patient care.
Of the 11 stroke units, 8 were similar in structure and described as “acute care and rehabilitation.” The remaining 3 were either “acute care” or “rehabilitation.” Each unit had a range from 6-15 patient beds available. All units had the following healthcare disciplines: medical, nursing, physical therapy, occupational therapy, speech and language therapy, and social work. All disciplines took part in a formal meeting once per week to discuss patient care, goal setting, and discharge planning. In most of the 11 units, the following was standard assessment for each patient admitted to the unit if necessary: history and examination, biochemistry, hematology, ECG, CT scanning, general nursing needs, and therapy assessment.
Most of the stroke units in this study practiced early mobilization techniques, which typically, began on the day of admission. Various other interventions took place such as fluid and food intake, bowel management, compression stockings, and use of oxygen if needed.
The therapy group all had an average treatment of 45 minutes per patient, per day. Intervention was based on each individual patient but focused on a functional approach including tests in strength, endurance, balance, bathing, dressing, toileting, and communication.
Detailed methods of therapeutic exercise interventions were not stated in this study, but it was consistent across the stroke units involved that early mobilization was an important feature to insuring effective patient care when utilizing a multidisciplinary team approach.
Langhorne et al. again, found similar conclusions in another review article of functional movement as the primary focus for therapy interventions. This article goes further stating that repetitive task-specific training and high-intensity practice “show promise for improving motor recovery in post stroke patients.”Â
In a systematic review and meta-analysis article by French et al. task training was assessed to see if it improved functional activity in post stroke patients. There were 14 trials assessed within this review and three different rehabilitation approaches were examined: task-specific motor relearning, mixed task practice, or single task practice. Of the three different rehabilitation approaches– repetitive, task-specific training revealed the most sufficient evidence of functional activity gains in the lower limbs of post stroke patients compared to other usual care/interventions.
Although some therapists may feel they are in a “rut” with the interventions they provide for their patients, research is in favor of repetitive task training in post stroke patients. Although sample size was fairly small in each of the above three articles, it is clear that it is of importance to focus on pieces of functional mobility tasks/exercises in which patients can put together and apply the movements to real-life situations. There is no specific answer to the “magic exercise intervention” question, but therapists can continue to focus on high intensity, task-specific, functional mobility for patients post stroke in order to improve quality of life.
1. French, B., et. al. (2010). Does repetitive task training improve functional activity after stroke? A Cochrane systematic review and meta-analysis. Retrieved August 21, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/20111838
2. Langhorne, P., Coupar, F., & Pollock, A. (2009, August). Motor recovery after stroke: A systematic review. Retrieved August 21, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/19608100
3. Langhorne, P., & Pollock, A. (2002, April 16). What are the components of effective stroke unit care? Retrieved August 21, 2015, from http://ageing.oxfordjournals.org/content/31/5/365.full.pdf+html
