Integrating Evidence into Clinical Practice in Stroke Rehabilitation: The Forgotten Revolution Robert Teasell MD FRCPC Professor and Chair-Chief Physical Medicine & Rehabilitation. Objectives. Understand the evidence for why stroke rehabilitation works
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Integrating Evidence into Clinical Practice in Stroke Rehabilitation: The Forgotten RevolutionRobert Teasell MD FRCPC Professor and Chair-ChiefPhysical Medicine & Rehabilitation
29 trials (6536 patients)
Independent of age and gender
Trials primarily acute-subacute rehab or subacute rehab
Significant benefit still seen at 10 years
BI Score > 50 at time of admission to rehabilitation
Stroke rehab units associated with:
Subacute Stroke Rehab Units result in:
In SWOntario there are only 2 designated stroke rehab units with PT or OT:patient ratios <10:1
> 50% not admitted to stroke rehab units!
Early Admission results in:
In Canada waiting lists are common!
Rehab training (enriched environments with animals) increases cortical representation with subsequent functional recovery
In animal studies key factors promoting recovery include increased activity and complex, stimulating environment
Lack of rehab decreases cortical representation and delays recovery
In a therapeutic day
Contrary to the evidence that increased activity and environmental stimulation is important to neurological recovery
(Inactive and alone, Bernhardt et al, Stroke 2004)
“Doctor says you can come home when I am up to it.”
RCT of 300 patients and caregivers
Formal training of caregivers during patient’s rehab associated with: