Stroke rehabilitation: from diagnosis to therapy

Just a regurgitation of standard stroke knowledge.

Stroke rehabilitation: from diagnosis to therapy

Xiaohong Li¹Yanjin He¹Dawu Wang^1*Mohammad J. Rezaei^2*

• ¹Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
• ²School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Stroke remains a significant global health burden, necessitating comprehensive and innovative approaches in rehabilitation to optimize recovery outcomes. This paper provides a thorough exploration of rehabilitation strategies in stroke management, focusing on diagnostic methods, acute management, and diverse modalities encompassing physical, occupational, speech, and cognitive therapies. Emphasizing the importance of early identification of rehabilitation needs and leveraging technological advancements, including neurostimulation techniques and assistive technologies, this manuscript highlights the challenges and opportunities in stroke rehabilitation. Additionally, it discusses future directions, such as personalized rehabilitation approaches, neuroplasticity concepts, and advancements in assistive technologies, which hold promise in reshaping the landscape of stroke rehabilitation. By delineating these multifaceted aspects, this manuscript aims to provide insights and directions for optimizing stroke rehabilitation practices and enhancing the quality of life for stroke survivors.

1 Introduction

Stroke stands as a significant global burden, impacting millions of lives annually and presenting a substantial challenge to healthcare systems worldwide. Statistics from the World Health Organization (WHO) reveal that stroke is a leading cause of mortality and disability globally. Annually, approximately 13.7 million new cases of stroke are reported, making it a prevalent health issue across continents and demographics (1). The latest findings from the 2019 Global Burden of Disease (GBD) report revealed that stroke continues to hold its position as the second leading cause of mortality and the third leading cause of mortality and disability combined, measured in terms of disability-adjusted life-years lost (DALYs) worldwide (2). The projected economic impact of stroke globally exceeds US$891 billion, accounting for approximately 1.12% of the global Gross Domestic Product (GDP) (3). Between 1990 and 2019, there was a significant surge in the burden of stroke, indicated by a 70.0% rise in new stroke cases, a 43.0% increase in stroke-related deaths, a 102.0% uptick in existing stroke cases, and a 143.0% elevation in DALYs. The majority of the worldwide burden of stroke, accounting for 86.0% of deaths and 89.0% of DALYs, was observed in countries categorized as lower-income and lower-middle-income countries (LMIC).

Considerable variations were evident in age-standardized stroke incidence (six-fold), mortality (15-fold), prevalence (four-fold), and DALYs (20-fold) rates across different geographical regions. The regions with the highest rates were predominantly observed in LMIC, notably in Eastern Europe, Asia, and Sub-Saharan Africa (4). Beyond its high incidence, stroke accounts for a substantial number of deaths globally. Those who survive often experience varying degrees of disability, which significantly affects their quality of life (5). Disabilities resulting from stroke encompass motor impairments, cognitive deficits, speech and language difficulties, and psychological challenges (6). The aftermath of stroke extends beyond the individual affected, impacting families, caregivers, and society at large. The disabilities and long-term care needs of stroke survivors impose emotional, financial, and practical burdens on families (7, 8). Furthermore, the societal cost is immense, encompassing healthcare expenses, loss of productivity, and the need for long-term rehabilitation and support services (9). Disparities in stroke incidence, management, and outcomes exist globally, often correlated with socio-economic factors (10). Low-and middle-income countries face greater challenges due to limited access to healthcare services, diagnostics, and rehabilitation facilities. These disparities contribute to higher mortality rates and poorer recovery outcomes in certain regions (11).

Efforts to reduce the global burden of stroke emphasize prevention through awareness campaigns targeting risk factors like hypertension, smoking, obesity, and physical inactivity (3). Additionally, interventions focusing on timely access to acute care, advanced treatments such as thrombolytic therapy, and comprehensive rehabilitation are crucial in mitigating the impact of stroke (12). Addressing the global burden of stroke necessitates collaborative efforts between governments, healthcare organizations, advocacy groups, and communities. Initiatives aimed at improving access to healthcare, enhancing stroke awareness, promoting healthier lifestyles, and advancing rehabilitation services are fundamental in reducing the burden of stroke on a global scale (13). The pervasive impact of stroke underscores the urgent need for concerted global action. Strategies encompassing prevention, timely intervention, access to quality healthcare, and comprehensive rehabilitation are essential to alleviate the burden of stroke and improve outcomes for individuals affected by this debilitating condition (14). This paper aims to provide a comprehensive overview of the evolving landscape of stroke rehabilitation, emphasizing the critical phases from diagnosis to therapy. By synthesizing current knowledge and highlighting emerging trends, this review intends to serve as a resource for clinicians, researchers, and policymakers involved in stroke care and rehabilitation. This manuscript endeavors to contribute to the evolving discourse on stroke rehabilitation by synthesizing and analyzing diverse literature from across the spectrum of stroke care. While not a systematic review in the traditional sense, this manuscript adopts a rigorous approach to literature selection, guided by clear inclusion criteria. These criteria prioritize relevance, quality, credibility, diversity of perspectives, and a keen focus on emerging technologies and innovations in stroke rehabilitation. Central to our approach is the recognition of the multifaceted nature of stroke rehabilitation. Each section of this manuscript delves into specific aspects of stroke care, from the early diagnosis and assessment to the implementation of rehabilitation programs across different stages of stroke recovery. By integrating evidence from various publication types, including original research articles, clinical trials, systematic reviews, meta-analyses, and review articles, we aim to provide a comprehensive overview of the current state of stroke rehabilitation. Moreover, our commitment to inclusivity extends beyond the traditional boundaries of stroke research. Efforts have been made to incorporate literature from diverse geographical regions, healthcare settings, and patient populations, acknowledging the unique challenges and perspectives that shape stroke rehabilitation practices globally.

Special attention is also given to the exploration of emerging technologies and innovations in stroke rehabilitation. From robotics to virtual reality and neurostimulation techniques, the evolving landscape of rehabilitation technology offers promising avenues for enhancing outcomes and improving the quality of life for stroke survivors. By embarking on this comprehensive review journey, we seek to not only consolidate existing knowledge but also identify gaps, challenges, and opportunities for future research and practice in stroke rehabilitation. Through our collective efforts, we aspire to contribute to the advancement of evidence-based, patient-centered care that optimizes outcomes and fosters resilience in the face of stroke.

The multifaceted field of stroke rehabilitation is explored in this review paper, providing a comprehensive overview of current practices, challenges, and future directions. The paper begins with a background on stroke rehabilitation, discussing its significance, historical context, and the evolution of practices. This section sets the stage for understanding the critical role of rehabilitation in stroke recovery. Next, current rehabilitation practices are examined, detailing interventions such as early rehabilitation strategies, physical therapy, occupational therapy, speech and language therapy, and cognitive rehabilitation. Each subsection highlights evidence-based practices and their impact on recovery. The challenges and opportunities in stroke rehabilitation are then addressed. Issues such as the lack of standardized timing for rehabilitation initiation, disparities in access to services, stroke-related infections, the need for individualized rehabilitation plans, and the importance of interdisciplinary collaboration are analyzed. Potential improvements and innovations are discussed. Finally, the future directions are explored. Emerging trends and advancements, including personalized rehabilitation approaches, the integration of neuroplasticity concepts, and the development of assistive technologies, are highlighted. These innovations are shown to have the potential to transform rehabilitation practices and improve outcomes for stroke survivors. This structured approach provides a clear roadmap for readers, ensuring a thorough coverage of each aspect of stroke rehabilitation. It offers valuable insights for clinicians, researchers, and stakeholders in the field.

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