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Stroke rehabilitation: therapies and treatments
Published on April 28, 2021 27 min
A selection of talks on Neurology
Neuropathology of neurodegenerative disorders
- Prof. Jillian Kril
- University of Sydney, Australia
Brachial plexus and nerves of upper limb
- Prof. S. P. Banumathy
- Madurai Medical College, India
How are synapses affected by Alzheimer's disease?
- Dr. Mariana Vargas-Caballero
- University of Southampton, UK
Convergence and joint prevention of stroke and dementia
- Prof. Vladimir Hachinski
- University of Western Ontario, Canada
I'm Robert Teasell, Professor of Physical Medicine and Rehabilitation. In the second part of this talk, we're going to discuss more of the specific therapies and treatments that are out there, and discuss motor and cognitive rehabilitation. We're going to talk about the use of technology and its increasing role, we're going to discuss integration of different therapeutic approaches (which is becoming an exciting new field), and finally, the shift of rehab from hospitals to home with an increasing emphasis on community-based care.
That's it for personalized care. The second point we wanted to make about the limits of standardization was the idea of individual treatment approaches. Surprisingly in stroke rehabilitation there's a spectacular amount of evidence, particularly in terms of randomized controlled trials for individual treatment approaches, but there's still limited clinical consensus as to what individual therapies should be consistently applied. This is particularly true for things like motor deficits, for example: do we use constraint-induced movement therapy; do we apply different technologies; do we use strengthening exercises? We may need to begin to rethink our approach to individual therapies. That's becoming quite clear, because right now there is no consensus as to what clinical therapies we should be using. Everybody has their own ideas, but if you go through any of the guidelines the consensus is not clear.
This slide shows you the number of stroke rehab motor-based randomized controlled trials over each half-decade, just up to 2016. You can see that we have 1,245 randomized controlled trials that focus on motor outcomes (so hemiplegia, or gait, or upper extremity function). You can see that they're pretty evenly divided among upper and lower extremity trials, there are a few more upper extremity trials than there are lower extremity trials. What stands out here is the sheer number of randomized controlled trials, it's very impressive. I know for a fact that by the end of 2018, we're up to around 1,500 randomized controlled trials looking at motor outcomes, and you can see that that number has been increasing exponentially with each half-decade. This looks pretty impressive, but one of the challenges