Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, March 11, 2023

Intensive Rehabilitation Program in Older Adults with Stroke: Therapy Content and Feasibility—Preliminary Results from the BRAIN-CONNECTS Study

 FYI.

Intensive Rehabilitation Program in Older Adults with Stroke: Therapy Content and Feasibility—Preliminary Results from the BRAIN-CONNECTS Study 

1
Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
2
Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
3
Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron, 119-129, 08035 Barcelona, Catalonia, Spain
4
Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
5
WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, 4000 Liège, Belgium
6
Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Aiguader 80, 08003 Barcelona, Catalonia, Spain
7
Department of Radiology, Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Doctor Josep Trueta University Hospital of Girona, Avinguda de França, s/n, 17007 Girona, Catalonia, Spain
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2023, 20(6), 4696; https://doi.org/10.3390/ijerph20064696
Received: 22 January 2023 / Revised: 23 February 2023 / Accepted: 28 February 2023 / Published: 7 March 2023

Abstract

The main objective was to assess the feasibility of an intensive rehabilitation program (IRP) for stroke patients; and secondly, to detect eventual age-related differences in content, duration, tolerability, and safety in a prospective observational cohort of patients diagnosed with subacute stroke, admitted to inpatient rehabilitation (BRAIN-CONNECTS project). Activities during physical, occupational and speech therapy, and time dedicated to each one were recorded. Forty-five subjects (63.0 years, 77.8% men) were included. The mean time of therapy was 173.8 (SD 31.5) minutes per day. The only age-related differences when comparing patients ≥65 and <65 years were a shorter time allocated for occupational therapy (−7.5 min (95% CI −12.5 to −2.6), p = 0.004) and a greater need of speech therapy (90% vs. 44%) in the older adults. Gait training, movement patterns of upper limbs, and lingual praxis were the most commonly performed activities. Regarding tolerability and safety, there were no losses to follow-up, and the attendance ratio was above 95%. No adverse events occurred during any session in all patients. Conclusion: IRP is a feasible intervention in patients with subacute stroke, regardless of age, and there are no relevant differences on content or duration of therapy.

1. Introduction

There are more than 101 million stroke survivors in the world, and every year, more than 12.2 million individuals suffer a new stroke [1]. As the population increases and lives longer, the incidence of stroke, long-term sequelae, and associated costs are expected to grow dramatically; about one of every four people over the age of 25 will have a stroke in their lifetime [1]. Many survivors experience motor, sensory, perceptual, and cognitive impairments, and require rehabilitation in the months following the stroke [2].
The intensive rehabilitation programs (IRP) offer multidisciplinary care for patients with subacute stroke, and lead to better functional results and less institutionalization. The individual’s cognitive status, comorbidity, and previous functional level are determining factors for admitting patients to IRP [3]. Advanced age is considered a risk of receiving poorer quality of care and a limitation for rehabilitation outcomes following stroke [4]. The influence of age on stroke rehabilitation has been a controversial issue, with studies showing a negative effect on outcomes, whereas others have not found any relationship. Although older patients present more dependence in activities of daily living (ADL) three months after stroke, no significant differences in the efficacy of the rehabilitation have been found in older stroke survivors [5]. Some quality care indicators such as the number of computerized tomography head scans and carotid image analyses in older patients with stroke seem to be lower than in younger adults [4], but there is presently no evidence showing that content and/or intensity of rehabilitation therapies are different in the oldest patients with stroke [6].
Current guidelines recommend that rehabilitation programs should provide at least 3 h per day of physiotherapy, occupational therapy, and speech therapy, 5 days a week [7,8]. Although age in itself is not considered as a selection criterion for IRP, in daily practice, older patients, who might have higher medical and social needs, are often referred to nursing homes and intermediate care settings where rehabilitation programs are of lower intensity.
The medical literature on stroke IRP does not usually report the intensity and content of interventions. Factors such as patient tolerance, the resources of each facility, and the physical environment can modify the intensity of the given therapies [3,7,9,10,11,12]. The measurement of the interventions included in the rehabilitation programs represents a challenge for professionals, and it is essential to advance in the demonstration of their benefits. In daily practice, the rehabilitation process starts with a clinical and functional assessment of patients, followed by the establishment of objectives according to individual needs and a therapeutic plan to achieve them. However, the exact content and description of the interventions are usually unknown. The complex variety of treatment goals and therapies have been called the “black box” of rehabilitation [10,11,12]. There is a need for an adequate system to classify the wide range of interventions [13]. Moreover, the standardization of the therapies will provide the external validity necessary for clinical trials. Several objective systems to measure the activities and the time dedicated to each of them have been proposed [12,14,15], but only one study gives detailed information about physical, occupational, and speech therapies [3]. Feasibility studies are important, especially in the development of complex interventions and multidisciplinary programs [10]. Before testing the efficacy of an intervention through a clinical trial, it is recommended to verify that it can be carried out as proposed in clinical settings [16].
Based on these considerations, this study aimed at assessing the feasibility of an IRP for stroke patients by recording the type of activities and quantifying the time dedicated to each one during physiotherapy, occupational, and speech therapy; and secondly, to assess eventual differences according to age.
More at link.

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