What do we mean by early stroke management?

In the UK there are approximately 152,000 strokes annually. There are also 1.1million stroke survivors and 76% of these have physical deficits. Stroke remains the largest cause of complex disability in the UK.

The physiotherapists role is to help people reach their full physical potential and maximise their functional abilities to enable them where possible to reintegrate into society.

There is evidence emerging that early physiotherapy intervention following a stroke leads to improved physical outcomes. The Very Early Rehabilitation Trial (AVERT) in 2011 found that patients starting physiotherapy mobilisation as early as 24 hours after stroke achieved a better outcome. This does however depend upon age and severity of stroke.

This begs the question what do we mean by early stroke rehabilitation? Are we talking number of days or weeks following stroke? Certainly timescales are increasingly used within the NHS for limiting hospital stays, then rehabilitation i.e. you have 12 weeks of community care and then discharge. However do all our patients fit into these timescales? The answer must be no.

There is an argument to put forward that some patients 6-12 months following stroke are still in the “early” phase. This could be patients who suffered more severe strokes or who had other conditions which were impacting upon their rehabilitation and sometimes it is patients who were unable to engage in the rehabilitation process in the early stages. We tend to forget that the adjustment to life with stroke can take people a very long time. Therefore by the time people are ready to engage in the rehabilitation process, services are not always available.

We know that recovery occurs through neuroplasticity, which can take place early or late. Brain plasticity is the ability of the nervous system to modify its structural and functional organization. A key aspect of neuroplasticity that has important implications for rehabilitation is the fact that the modifications in neuronal networks are use-dependent. Therefore if movement is not occurring what we term learned non use occurs and then the ability to move becomes decreased. The old phrase of use it or lose it is very true.

The process of neuroplasticity and rehabilitation needs exploiting at the most appropriate times for the patient and not the most appropriate times for the services involved.

Karen Hodgson MSc MCSP

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