Review of stroke rehabilitation

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Abstract
What is rehabilitation? The many definitions of rehabilitation, most of which apply well to stroke, can be confusing. However, a clear consensus exists that the purpose of rehabilitation is to limit the impact of stroke related brain damage on daily life by using a mixture of therapeutic and problem solving approaches (see box 1).2 3 4 The high incidence and prevalence of stroke imply that stroke rehabilitation should be a major component of health service provision. In England, for example, the healthcare costs associated with stroke have been estimated at £2.8bn (€4.1bn; $5.5bn) a year.w3 A stroke is not simply a brain disease but affects the whole person and the family. There are few other conditions of such complexity that require the challenge of providing highly individualised, complex treatments to large numbers of patients. Box 1: What is rehabilitation?w33 Rehabilitation is a complex set of processes usually involving several professional disciplines and aimed at improving quality of life for people facing daily living difficulties caused by chronic disease. Most people (and their carers) after a stroke will require help from a specialist team of doctors, nurses, therapists, social service staff, and psychologists. Each person will need careful assessment by the team to identify rehabilitation goals that should be negotiated with, and agreed by, the patient. A goal is a small, measurable, discrete step along the path to recovery. The key purposes of rehabilitation can be summarised as the “five Rs”: • Realisation of potential: ensuring that the duration of contact with therapy staff has been sufficiently long to observe a plateau phase in recovery • Re-enablement: focusing on promoting independence in daily living skills such as walking and dressing • Resettlement: helping the person to leave hospital feeling safe, well supported, and confident • Role fulfilment: helping the person to re-establish their status and personal autonomy • Readjustment: helping the person to adapt to and accept a new lifestyle