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  • Print publication year: 2009
  • Online publication date: May 2010

20 - Neurorehabilitation

from Section IV - Therapeutic strategies and neurorehabilitation


Introduction and overview

Stroke is one of the most common causes of long-term disability in adults, especially in elderly people. Although progress in the acute treatment of stroke (e.g. thrombolysis, the concept of stroke units) has occurred over recent years, neurorehabilitation (mainly organized inpatient multidisciplinary rehabilitation) remains one of the cornerstones of stroke treatment. The overall benefit of stroke units results not only from thrombolysis – only a small proportion of all stroke patients (less than 10%) are treated with this regimen – but more generally from the multidisciplinary stroke unit management, including treatment optimization, minimization of complications, and elements of early neurorehabilitation [1, 2].

After the acute treatment, stroke patients with relevant neurological deficits should in general be treated by a specialized neurorehabilitation clinic or unit. The best timing for transferring a patient after initial treatment (e.g. on a stroke unit) to a specialized neurorehabilitation ward or clinic is still under discussion, but early initiation of rehabilitation is mandatory for outcome optimization (whereas ultra-early high-intensity training in the first hours to few days might be problematic).

Neurorehabilitation nowadays is considered as a multidisciplinary and multimodal concept to help neurological patients to improve physiological functioning, activity and participation by creating learning situations, inducing several means of recovery including restitution, functional remodeling, compensation and reconditioning [1]. A key point in successfully diminishing negative long-term effects after stroke and achieving recovery is the work of a specialized multidisciplinary team (physicians, nursing staff, therapists, others) with structured organization and processes and the stroke patient taking part in a multimodal, intense treatment program which is well adapted in detail to the individual goals of rehabilitation and deficits.

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