36 - Neurorehabilitation of the stroke survivor

Summary

Stroke is the third most common cause of death in the Western world, behind heart disease and cancer, and comprises over half of the neurologic admissions to community hospitals. It is a leading cause for placement in nursing homes or extended care facilities (Dombovy et al., 1986). Seven-hundred thousand new or recurrent cases of stroke are reported annually, and there are nearly 5.4 million stroke survivors currently in the USA. The estimated cost of care and earnings lost due to stroke in 2005 totaled $56.8 billion, of which costs due to lost productivity equaled $21.8 billion (American Heart Association, 2005).

Comprehensive rehabilitation may improve the functional abilities of the stroke survivor, despite age and neurologic deficit, and may decrease long-term patient care costs (Feigenson, 1979). Approximately 80% of stroke victims may benefit from inpatient or outpatient stroke rehabilitation (Garraway et al., 1981). Ten percent of patients achieve complete spontaneous recovery within 8–12 weeks, while 10% of patients receive no benefit from any treatment.

The literature suggests that intensive post-stroke rehabilitation significantly improves functional outcomes. One meta-analysis of nine trials involving organized inpatient multi-disciplinary rehabilitation demonstrated significant reductions in death, death or institutionalization, and death or dependency (Langhorne and Duncan, 2001). For every 100 patients receiving organized inpatient multidisciplinary rehabilitation, an additional five returned home independently. Studies by Indredavik and colleagues demonstrated that patients who were assigned to a specialized stroke service that included rehabilitation services had significantly greater survival rates at 1 year (Indredavik et al., 1991), better quality of life after 5 years (Indredavik et al., 1998), and greater probability of surviving and living at home at 10 years (Indredavik et al., 1999).