1. Acute Stroke Rehabilitation: The Emergency ConsiderationsBy
Auwal Abdullahi
BSc PT (BUK), MSc Neurol Rehab (Plymouth), Fellow in Clinical Neurology Sciences (London Academy of Sports and Health Sciences)

2. Introduction
Stroke is a cerebrovascular condition resulting in focal or global neurological deficits that lasts for over 24 hours
It affects millions of people around the world annually
It is one of the leading causes of long term disability especial in activities of daily living (ADL)
(WHO, 2002; Strong et al., 2007)

3. Consequences of Stroke
Impairments of the motor function
Impairment of sensory/perceptual function
Impairment of cognitive function
Impairment of autonomic function
(Fisher et al., 2010)

4. When is Stroke Considered Acute?
It is usually the first few weeks post-stroke
It is the period when there is much opportunity for functional and structural reorganization of the brain
Thromboembolism, respiratory complication, infection, pressure sores and delirium are significant causes of morbidity during this period
(Bernheisel et al., 2011)

5. Special Considerations during Acute Stroke Rehabilitation
Detailed Physical Assessment and Examination
Chest Physiotherapy
Early mobilization (including limb mobility and transfer, and limb rehabilitation)
Improving sensory and motor functions
Improving cognitive function

6. Detailed Physical Assessment
Detailed assessment in motor, sensory/ perceptual and cognitive functions are needed early post-stroke to alleviate disability in self-care (Bernspång et al., 1987)
Assessment of motor function- Wolf motor function test (WMFT), Action research arm test (ARAT), Fugl-Meyer motor assessment (Lower and upper limb).

7. Detailed Physical Assessment (continued)
Assessment of sensory/ perceptual function- Fugl-Meyer motor assessment (Lower and upper limb), Nottingham sensory assessment,
Assessment of cognitive function- Addenbrookes cognitive assessment, mini-mental examination
Assessment of activities of daily living (ADL)- Functional independence level (FIM), Modified Barthel Index

8. Detailed Physical Assessment (continued)
Measurement of Self-efficacy- Stroke self-efficacy questionnaire, Upper limb self-efficacy test.
(Jones & Riazi, 2011)

9. Special considerations Respiratory care - Chest Physiotherapy
To dislodge secretions
To prevent atelectasis
To prevent infection focus

10. Special considerations (continued)
Mobility (including transfer from bed to chair and vice-versa, limb mobility, turning)
Prevent pressure sores
Prevent thromboembolism
Elastic stockings to prevent thromboembolism

11. Recovery of Limb Function
Severe motor impairment
Mental Practice and Motor Imagery
Mirror Therapy
Impairment oriented training such as Bobath and PNF
Robotic Rehabilitation

12. Recovery of Limb Function (continued)
Mild to moderate impairment
Hybrid therapy
Task specific training
(Constraint induced movement therapy)
(Dromerick et al., 2000)

13. Things to note in stroke rehabilitation

15. Recovery of Sensory Function
Thermal stimulation
Sensorimotor stimulation
(Chen et al., 2005; de Diego et al., 2013)

16. Conclusion
It is important to start early mobilization, chest physiotherapy, elastic stockings, turning and therapy for improving sensori-motor function early post-stroke.

17. Thank you for Listening

18. References
Bernheisel CR, Schlaudecker JD, Leopold K (2011). Subacute Management of Ischemic Stroke. Am Fam Physician. 2011 Dec 15;84(12):
Chen J-C, Liang C-C, Shaw F-Z, (2005). Facilitation of Sensory and Motor Recovery by Thermal Intervention for the Hemiplegic Upper Limb in Acute Stroke Patients A Single-Blind Randomized Clinical Trial; Stroke, 36:
de Diego C1, Puig S, Navarro X (2013). A sensorimotor stimulation program for rehabilitation of chronic stroke patients. Restor Neurol Neurosci. ;31(4): doi: /RNN
Fischer U, Baumgartner A, Arnold M, Nedeltchev K, Gralla J, De Marchis GM, Kappeler L, Mono ML, Brekenfeld C, Schroth G, Mattle HP: What is a minor stroke?. Stroke. 2010, 41: /STROKEAHA
Jones F, Partridge C, Reid F (2011). The Stroke Self-Efficacy Questionnaire: measuring individual confidence in functional performance after stroke. J Clin Nurs Apr;17(7B): doi: /j x.
World Health organization (2004). Global Burden of Disease (GBD) 2002 estimates. World Health Report Geneva, Switzerland: WHO