Brain Neurorehabil.  2012 Mar;5(1):1-5. 10.12786/bn.2012.5.1.1.

Optimal Timing of Rehabilitation: Overview of the Evidence in the Literature

Affiliations
  • 1Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea. njpaik@snu.ac.kr

Abstract

Stroke results in chronic disability which is a major burden in various ways and thus regaining functional independence is an important goal for the stroke patients and caregivers. Early rehabilitative training after stroke onset takes place in most stroke centers. However, optimal timing of rehabilitation after stroke remains controversial and debate on the complications and other issues induced by the early rehabilitation is still ongoing despite considerable amount evidence in the literature that supports early rehabilitation. There is uncertainty about whether very early mobilization within 24 to 48 hours of stroke onset improves outcome after stroke. Emphasis on early mobilization with increasing frequency and dose of mobilization in the early phase of stroke may contribute to improved functional outcomes after stroke. In this article, superiority of the very early mobilization after stroke is demonstrated by reviewing supporting evidence from animal studies by showing changes in task performance and anatomy, clinical comparative data by comparing outcome measurement scores, AVERT studies, a large scale randomized controlled trial currently in progress to provide sufficient clinical evidence, and the current Clinical Practice Guidelines.

Keyword

early mobilization; rehabilitation; stroke

MeSH Terms

Animals
Caregivers
Early Ambulation
Humans
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia
Stroke
Task Performance and Analysis
Uncertainty
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Reference

1. Cumming TB, Thrift AG, Collier JM, Churilov L, Dewey HM, Donnan GA, Bernhardt J. Very early mobilization after stroke fast-tracks return to walking: Further results from the phase ii avert randomized controlled trial. Stroke. 2011. 42:153–158.
2. Horn SD, DeJong G, Smout RJ, Gassaway J, James R, Conroy B. Stroke rehabilitation patients, practice, and outcomes: Is earlier and more aggressive therapy better? Arch Phys Med Rehabil. 2005. 86:S101–S114.
3. DeJong G, Horn SD, Conroy B, Nichols D, Healton EB. Opening the black box of post-stroke rehabilitation: Stroke rehabilitation patients, processes, and outcomes. Arch Phys Med Rehabil. 2005. 86:S1–S7.
4. Risedal A, Zeng J, Johansson BB. Early training may exacerbate brain damage after focal brain ischemia in the rat. J Cereb Blood Flow Metab. 1999. 19:997–1003.
5. Schallert T, Fleming SM, Woodlee MT. Should the injured and intact hemispheres be treated differently during the early phases of physical restorative therapy in experimental stroke or parkinsonism? Phys Med Rehabil Clin N Am. 2003. 14:S27–S46.
6. Schallert T, Jones TA. "Exuberant" neuronal growth after brain damage in adult rats: The essential role of behavioral experience. J Neural Transplant Plast. 1993. 4:193–198.
7. Schallert T, Kozlowski DA, Humm JL, Cocke RR. Use-dependent structural events in recovery of function. Adv Neurol. 1997. 73:229–238.
8. Biernaskie J, Chernenko G, Corbett D. Efficacy of rehabilitative experience declines with time after focal ischemic brain injury. J Neurosci. 2004. 24:1245–1254.
9. Paolucci S, Antonucci G, Grasso MG, Morelli D, Troisi E, Coiro P, Bragoni M. Early versus delayed inpatient stroke rehabilitation: A matched comparison conducted in italy. Arch Phys Med Rehabil. 2000. 81:695–700.
10. Salter K, Jutai J, Hartley M, Foley N, Bhogal S, Bayona N, Teasell R. Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke. J Rehabil Med. 2006. 38:113–117.
11. Maulden SA, Gassaway J, Horn SD, Smout RJ, DeJong G. Timing of initiation of rehabilitation after stroke. Arch Phys Med Rehabil. 2005. 86:S34–S40.
12. Bernhardt J, Thuy MN, Collier JM, Legg LA. Very early versus delayed mobilisation after stroke. Cochrane Database Syst Rev. 2009. CD006187.
13. Bernhardt J, Dewey H, Thrift A, Collier J, Donnan G. A very early rehabilitation trial for stroke (avert): Phase ii safety and feasibility. Stroke. 2008. 39:390–396.
14. Tay-Teo K, Moodie M, Bernhardt J, Thrift AG, Collier J, Donnan G, Dewey H. Economic evaluation alongside a phase ii, multi-centre, randomised controlled trial of very early rehabilitation after stroke (avert). Cerebrovasc Dis. 2008. 26:475–481.
15. Sorbello D, Dewey HM, Churilov L, Thrift AG, Collier JM, Donnan G, Bernhardt J. Very early mobilisation and complications in the first 3 months after stroke: Further results from phase ii of a very early rehabilitation trial (avert). Cerebrovasc Dis. 2009. 28:378–383.
16. Alberts MJ, Latchaw RE, Jagoda A, Wechsler LR, Crocco T, George MG, Connolly ES, Mancini B, Prudhomme S, Gress D, Jensen ME, Bass R, Ruff R, Foell K, Armonda RA, Emr M, Warren M, Baranski J, Walker MD. Revised and updated recommendations for the establishment of primary stroke centers: A summary statement from the brain attack coalition. Stroke. 2011. 42:2651–2665.
17. Bates B, Choi JY, Duncan PW, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D, Zorowitz R. Veterans affairs/department of defense clinical practice guideline for the management of adult stroke rehabilitation care: Executive summary. Stroke. 2005. 36:2049–2056.
18. Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D. Management of adult stroke rehabilitation care: A clinical practice guideline. Stroke. 2005. 36:e100–e143.
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