Best Practices In Stroke Rehabilitation The Us Experience 1 30 09

BEST PRACTICES IN STROKE REHABILITATION: The US Experience Richard D. Zorowitz, M.D. Chairman and Associate Professor of PM&R

PHASES OF STROKE REHABILITATION Needs specific rehabilitation services Needs rehabilitation program Needs further recuperation before rehabilitation decision Too incapacitated for rehabilitation Acute inpatient rehabilitation Skilled nursing facility Home services Outpatient services Extended care facility

OUTLINE ,[object Object],[object Object],[object Object],[object Object]

KEY POINTS ,[object Object],[object Object],[object Object],[object Object],[object Object]

KEY POINTS (CONT’D) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

BEST PRACTICES ,[object Object],[object Object],[object Object],[object Object]

Horn SD et al. Arch Phys Med Rehabil. 2005;86(12 suppl 2):S101-S14.

Evidence for Specific Interventions (Cochrane Review) PT, physiotherapy; ADL, activity of daily living; OT, occupational therapy; EMG, electromyographic; EST, electrostimulation therapy. Study Impairment Therapy Findings Pollack A, et al. Cochrane Database Syst Rev. 2006;(4):CD001920 Physical functioning PT ,[object Object],[object Object],Legg LA, et al. Cochrane Database Syst Rev. 2006;(4):CD003585 ADLs OT ,[object Object],[object Object],Woodford H, et al. Cochrane Database Syst Rev. 2007;(2):CD004585 Motor function EMG biofeedback ,[object Object],Pomeroy VM, et al. C ochrane Database Syst Rev. 2006;(2):CD003241 Movement control, functional ability EST ,[object Object],[object Object]

Evidence for Specific Interventions (Cochrane Review) EM, electromechanical; PT, physiotherapy; ST, speech therapy. Study Impairment Therapy Findings Merholz J et al. Cochrane Database Syst Rev. 2007;(4):CD006185 Walking EM-assisted training ,[object Object],[object Object],Moseley AM, et al. Cochrane Database Syst Rev. 2005;(2):CD002840 Walking Treadmill training ,[object Object],Wu HM, et al. Cochrane Database Syst Rev. 2006;(3):CD004131 Stroke recovery Acupuncture ,[object Object],Greener J, et al. Cochrane Database Syst Rev. 1999;(4):CD000425 Speech Formal vs informal ST ,[object Object]

Evidence for Specific Interventions (Cochrane Review) ST, speech therapy; LT, language therapy; ADL, activity of daily living. Study Impairment Therapy Findings Sellars C, et al. Cochrane Database Syst Rev. 2005;(1):CD002088 Dysarthria ST, LT ,[object Object],Nair RD, et al. Cochrane Database Syst Rev. 2007;(1):CD002293 Memory Cognitive therapy ,[object Object],Bowen A, Lincoln B. Cochrane Database Syst Rev. 2007;(1):CD003586 Unilateral spatial neglect Cognitive therapy ,[object Object],[object Object],Lincoln NB, et al. Cochrane Database Syst Rev. 2000;(4):CD002842 Attention deficits Cognitive therapy ,[object Object]

CARE PATHWAYS ,[object Object],[object Object]

EARLY INTERVENTION ,[object Object],[object Object],[object Object]

DURATION OF GAINS ,[object Object],[object Object],[object Object]

EARLY SUPPORTED DISCHARGE ,[object Object],[object Object],[object Object],[object Object]

OUTPATIENT REHABILITATION ,[object Object],[object Object]

OUTPATIENT REHABILITATION ,[object Object],[object Object],[object Object],[object Object]

EDUCATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

EDUCATION (CONT’D) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],COMMUNICATION

CONCLUSIONS ,[object Object],[object Object],[object Object],[object Object]

Best Practices In Stroke Rehabilitation The Us Experience 1 30 09

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Best Practices In Stroke Rehabilitation The Us Experience 1 30 09