These people still don't understand that therapy after the stroke is not where research should take place. You stop the neuronal cascade of death and that will result in much less death and disability. Once again we see that nothing exists as standardized stroke protocols. Why do I have to point out these fucking simplistic facts.
http://www.touchneurology.com/articles/early-mobilisation-following-stroke
Stroke is a sudden loss of cerebral blood flow caused
either by occlusion (85 % of cases) or rupture of the cerebral artery
manifesting with focal neurological deficits.1 One-third of stroke patients are younger than and two-thirds are older than 65 years of age.2
Stroke can have both immediate and ongoing physical consequences.
Disability and mortality represent the most relevant clinical outcomes.
The degree of disability varies from devastating outcome with total
dependence on family/carer to minimal and manageable disability.3
Within 12 months of stroke, one-third of stroke patients will die and
another third are left with restriction in performing simple activities
of daily living (ADL). Considering the high prevalence of the disease,
the burden of post-stroke disability is of primary public health
importance, translating to a substantial cost worldwide. In the US in
2008, for example, the direct and indirect costs of stroke are estimated
to be more than $65 billion.4 Much of this cost probably
relates to the physical disability. Any treatment that improves
functional outcome can significantly reduce disability and costs,
setting regaining of functional independence, defined as improvement in
mobility and activities of ADL, as an important goal.4 The
potential for recovery varies substantially across stroke patients.
Factors associated with poor functional recovery include stroke
severity, age and, to a lesser extent, diabetes.5
Today, rehabilitation is recognised as a cornerstone of
multidisciplinary stroke care and can reduce the number of patients who
are left handicapped. Forty per cent of stroke patients require active
rehabilitation services.3 In recent years, rehabilitation has
been shown to influence both brain recovery and reorganisation,
especially in relation to motor impairment. Comprehensive rehabilitation
programmes appear to improve functional recovery over standard care in
terms of speed and extent of recovery.6 It is noteworthy that
neurological recovery is not linear and most of it occurs within the
first 3–6 months, although some patients show recovery over prolonged
timelines.
Rehabilitation intensity depends on the status of the
patient and degree of disability. If the patient is unconscious,
rehabilitation is passive to prevent contractions, pressure ulcers and
to prevent distress when movement is regained.3 However,
there is still debate regarding the optimal intensity of physical
therapy following stroke, with conflicting results across the different
studies ranging from no benefit to significant functional improvement.6 This discrepancy may reflect differences in methodology, patient selection and outcome scales.
The Rationale Behind Very Early Mobilisation
Very early
mobilisation (VEM) is a distinctive characteristic of care that involves
starting mobilisation, including sitting up, getting out of bed,
standing and walking, early after stroke and continuing at frequent
intervals. However, the exact meaning of VEM is not well established and
varies between 1 day to 3 months following symptoms onset.7
Previous studies have shown that induction of neurotrophic factors is
associated with neural repair within the first 2 weeks after stroke and,
thus, may modulate greater plasticity that may restore function in the
periinfarct tissue and supplementary motor areas.8 This experience dependent cortical plasticity has been well documented in normal and injured brains.7
It may also enable the brain to better respond to rehabilitation,
suggesting that efficacy of therapy may vary considerably with the
timeline of initiation. The interaction between plasticity and recovery
is, however, complicated and individualistic; therefore, it is of
importance to apply the appropriate rehabilitation strategy at the
appropriate time. Efforts are being made to develop more efficient
rehabilitate strategies that utilise current knowledge of cortical
plasticity. In addition to enhancing plasticity, VEM 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 In another analysis of stroke unit systems,9
stroke unit care appeared to reduce complications of immobility, and
infections, in particular. Early mobilisation may also have important
psychological effects on a patient’s motivation, well-being and quality
of life.6
Another page and references at link.
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