Monitoring
Rehabilitation
All persons with stroke should be assessed for their rehabilitation
needs. This is for the prevention of complications such as swallowing problems,
skin breakdown, deep venous thrombosis (DVT), bowel and bladder dysfunction, malnutrition,
pain, and contractures. An intermittent pneumatic compression may be used as an
add-on therapy to routine care (eg Aspirin and hydration) to reduce DVT risk in
immobile stroke patients without contraindications. Assessment of impairments
such as communication and motor impairments, cognitive deficits, visual and
spatial deficiency (eye movements, visual field, perceptual deficits),
psychological deficits, and sensory deficits should be done. Once the patient
is stable, an individualized rehabilitation program should be started to prevent
long-term complications. Early rehabilitation interventions within 24-48 hours
for hospitalized stroke patients should be considered. Based on the Canadian
Stroke Rehabilitation Clinician Handbook 2020, the Austrian Guideline of Neurorehabilitation
After Stroke 2018 and the German Society of Neurorehabilitation 2021 guideline,
Cerebrolysin can be considered as a rehabilitative treatment to improve motor
function of the upper extremity when given within the first 1-3 days up to 21
days following moderate to severe acute ischemic stroke. Studies showed that
very early mobilization (<24 hours) may affect the outcome and thus should
be avoided.
Ischemic Stroke_Follow UpThe goals of the rehabilitation process should include prevention and management of comorbid illnesses, training for maximum independence, helping the patient and family with psychological coping and adaptation, promoting community integration, improving quality of life if disabilities are present, and prevention of recurrent stroke or other vascular events.
A multidisciplinary team for rehabilitation should include physiatrists, physical therapists, occupational therapists, speech and language pathologists, dietitians, nurses, and psychologists or mental health professionals. A tailored home exercise program is recommended after completion of a stroke rehabilitation program.