I disagree.
VEM(Very Early Mobilization) may prevent
complications with a high risk of causing harm such as deep vein
thrombosis, pulmonary embolism, contractures, infections, sores, muscle
atrophy and deterioration in cardiorespiratory function. The
complications associated with immobility were shown to be responsible
for 51 % of deaths in patients with cerebral infarction.9
Early Mobilisation Following Stroke has the above lines which I consider to be vastly more important to occur than a later rehab start. But I'm not medically trained so don't listen to me.
So what is the fucking time to start rehab? Where the hell is the protocol on this? You don't want your doctors and therapists just shooting in the dark on what to do.
Rehabilitation may work best 60-90 days after stroke
Stroke survivors may respond best to rehabilitation programs administered 60 to 90 days after the stoke, a clinical trial suggests.
For the study, researchers randomized 72 stroke patients (mean age 62.8 years) into one of four groups: acute rehabilitation delivered up to 30 days post-stroke (n=16), subacute rehabilitation delivered 2 to 3 months after the stroke (n=17), chronic rehabilitation initiated at least 6 months post-stroke (n=20), or a control group that received standard rehabilitation. All three intervention groups received 20 extra hours of self-selected, task specific motor therapy in addition to standard motor rehabilitation provided to the control group.
The primary endpoint of the study was upper extremity impairment measured by the Action Research Arm Test (ARAT) at one year post-stroke.
People in the subacute rehabilitation group had significantly better motor function based on ARAT scores than the control group (ARAT difference +6.87) at one year, the study team reports in the Proceedings of the National Academy of Sciences.
The acute rehab group also had significantly better motor function, although the difference was less pronounced (ARAT difference +5.25). The chronic rehabilitation group, however, didn't fare significantly better than the control group in motor function tests at one year, the analysis found. "The reason that specific timing is important is because, in animal models of stroke, we know that there is a series of processes that occur in the brain after stroke: first some death of cells surrounding the stroke area, and then next some sprouting of new connections, as though the brain is attempting to recover," said study co-author Elissa Newport, director of the Center for Brain Plasticity and Recovery at Georgetown University Medical Center and MedStar National Rehabilitation Hospital in Washington, D.C. "But we didn't know whether that second process occurs in humans as well, or when it happens," Newport said by email. Results of the study suggest that this process does indeed occur in people, and that the window is around 60 to 90 days after a stroke. "That brain recovery process is short-lived, and ideally any rehabilitation training must meet it, synergistically, at the perfect moment in order to produce and maintain the best connections and achieve the best recovery," Newport said. Outside of this critical time period, rehabilitation aimed at motor function recovery may not be as effective at producing new connections in the brain, Newport added. Beyond its small size, other limitations of the study include the lack of neurophysiologic and imaging studies to more fully assess stroke recovery, the researchers note. Most patients currently don't receive intensive rehabilitation within this 60-to-90 day window because Medicare and other insurers don't extend coverage to continue outpatient rehabilitation for this many days after a stroke, Newport said.
"We hope that our results, if supported by additional and larger clinical trials, can encourage Medicare and other insurance coverages to include intensive rehabilitation at the times that our scientific findings show the best outcomes," Newport said.
—Lisa Rapaport
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