Evidence for stroke rehabilitation
Stroke care is underpinned by com- prehensive clinical guidelines,1,6
which draw on the best available evi- dence. Additional NICE Clinical Guidelines for Stroke Rehabilitation were published in June 2013. These provide further and in some cases more specific direction for stroke teams.7 However, despite a signifi- cant increase in research over the last 20 years, the evidence underpin- ning rehabilitation inter ventions remains limited in some areas. These areas include strategies for those with aphasia and dysarthria, and cognitive rehabilitation.8
A recent systematic review8 examined a wide range of evidence for stroke rehabilitation, identify- ing inter ventions that were or were likely to be beneficial, those of uncertain benefit and those where the effect was presently unknown. The review drew attention to three areas where strong evidence existed. Firstly, that rehabilitation should commence as early as possi- ble after stroke.9 Secondly, that repetitive task-oriented training tar- geted at goals or activities relevant to the needs of patients can con- tribute to functional recover y,10 especially where training takes place in the patient’s own environ- ment.11,12 Lastly, there was wide- spread agreement that increased intensity of training is beneficial.13
This evidence supports the national guidelines and standards for the amount of therapy (where appropriate) that should be pro- vided daily for each patient.1,6