Advertisement

Rehabilitation After Hemorrhagic Stroke: From Acute to Chronic Stage

  • Yun-Hee KimEmail author
Chapter
Part of the Stroke Revisited book series (STROREV)

Abstract

The ultimate goal of rehabilitation in hemorrhagic stroke does not differ from that in ischemic stroke: to reduce disability, regain independence, and improve quality of life. Due to the lack of studies in this specific population, the rehabilitation principles and practice guidelines for hemorrhagic stroke follow those for ischemic stroke. Stroke is a complex syndrome, and the rehabilitation process therefore requires an integrated program provided by a multidisciplinary team. Although controversy about very early rehabilitation in stroke patients has arisen recently, it is generally accepted that early rehabilitation prevents stroke complications and promotes functional recovery. As stroke has various symptoms, the rehabilitation process should include a comprehensive assessment of motor, cognitive, and communication functions, swallowing, and emotions. Medical complications during rehabilitation affect functional recovery and may even increase the risk of mortality in stroke patients. Thus, preventing stroke complications should be considered not only in the acute phase but also in the chronic phase of stroke. Most spontaneous recovery in stroke patients occurs within 6 months after onset, and a substantial number of patients are left with chronic disabilities. Novel therapies to reduce residual disabilities and improve functional outcomes have attracted much attention recently, with rehabilitation robots, virtual reality, and noninvasive brain stimulation being of particular interest in this field. Researchers and clinicians are attempting to combine these novel therapies with conventional stroke rehabilitation. The gathered evidence may impact future rehabilitative practice.

References

  1. 1.
    Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:2032–60.CrossRefPubMedGoogle Scholar
  2. 2.
    Saulle MF, Schambra HM. Recovery and rehabilitation after intracerebral hemorrhage. Semin Neurol. 2016;36:306–12.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377:1693–702.CrossRefPubMedGoogle Scholar
  4. 4.
    Zhang P, Xianglei J, Hongbo Y, et al. Neuroprotection of early locomotor exercise poststroke: evidence from animal studies. Can J Neurol Sci. 2015;42:213–20.CrossRefPubMedGoogle Scholar
  5. 5.
    Coleman ER, Moudgal R, Lang K, et al. Early rehabilitation after stroke: a narrative review. Curr Atheroscler Rep. 2017;19:59.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bernhardt J, Langhorne P, Lindley RI, et al. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet. 2015;386:46–55.CrossRefGoogle Scholar
  7. 7.
    Liu N, Cadilhac DA, Andrew NE, et al. Randomized controlled trial of early rehabilitation after intracerebral hemorrhage stroke: difference in outcomes within 6 months of stroke. Stroke. 2014;45:3502–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Olkowski BF, Devine MA, Slotnick LE, et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther. 2013;93:208–15.CrossRefPubMedGoogle Scholar
  9. 9.
    Shimamura N, Matsuda N, Satou J, et al. Early ambulation produces favorable outcome and nondemential state in aneurysmal subarachnoid hemorrhage patients older than 70 years of age. World Neurosurg. 2014;81:330–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Ma Z, Wang Q, Liu M. Early versus delayed mobilisation for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2013;5:CD008346.Google Scholar
  11. 11.
    Meijer R, Ihnenfeldt DS, De Groot IJ, et al. Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature. Clin Rehabil. 2003;17:119–29.CrossRefPubMedGoogle Scholar
  12. 12.
    Stinear CM. Prediction of motor recovery after stroke: advances in biomarkers. Lancet Neurol. 2017;16:826–36.CrossRefPubMedGoogle Scholar
  13. 13.
    Lawrence ES, Coshall C, Dundas R, et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. 2001;32:1279–84.CrossRefPubMedGoogle Scholar
  14. 14.
    Yekutiel M, Guttman E. A controlled trial of the retraining of the sensory function of the hand in stroke patients. J Neurol Neurosurg Psychiatry. 1993;56:241–4.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Management of Stroke Rehabilitation Working G. VA/DOD clinical practice guideline for the management of stroke rehabilitation. J Rehabil Res Dev. 2010;47:1–43.CrossRefGoogle Scholar
  16. 16.
    Pulvermuller F, Neininger B, Elbert T, et al. Constraint-induced therapy of chronic aphasia after stroke. Stroke. 2001;32:1621–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Horner J, Massey EW, Brazer SR. Aspiration in bilateral stroke patients. Neurology. 1990;40:1686–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Trapl M, Enderle P, Nowotny M, et al. Dysphagia bedside screening for acute-stroke patients: the Gugging swallowing screen. Stroke. 2007;38:2948–52.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Martino R, Silver F, Teasell R, et al. The Toronto bedside swallowing screening test (TOR-BSST): development and validation of a dysphagia screening tool for patients with stroke. Stroke. 2009;40:555–61.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47:e98–e169.CrossRefPubMedGoogle Scholar
  22. 22.
    Shaker R, Easterling C, Kern M, et al. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122:1314–21.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Chang WH, Kim YH. Robot-assisted therapy in stroke rehabilitation. J Stroke. 2013;15:174–81.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Morone G, Paolucci S, Cherubini A, et al. Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics. Neuropsychiatr Dis Treat. 2017;13:1303–11.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Mehrholz J, Thomas S, Werner C, et al. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2017;5:CD006185.PubMedGoogle Scholar
  26. 26.
    Mehrholz J, Pohl M, Platz T, et al. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2015;6:CD006876.Google Scholar
  27. 27.
    Hummel FC, Cohen LG. Non-invasive brain stimulation: a new strategy to improve neurorehabilitation after stroke? Lancet Neurol. 2006;5:708–12.CrossRefPubMedGoogle Scholar
  28. 28.
    Chang WH, Kim YH, Bang OY, et al. Long-term effects of rTMS on motor recovery in patients after subacute stroke. J Rehabil Med. 2010;42:758–64.CrossRefPubMedGoogle Scholar
  29. 29.
    Fregni F, Pascual-Leone A. Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS. Nat Clin Pract Neurol. 2007;3:383–93.CrossRefPubMedGoogle Scholar
  30. 30.
    Bastani A, Jaberzadeh S. Does anodal transcranial direct current stimulation enhance excitability of the motor cortex and motor function in healthy individuals and subjects with stroke: a systematic review and meta-analysis. Clin Neurophysiol. 2012;123:644–57.CrossRefPubMedGoogle Scholar
  31. 31.
    Elsner B, Kugler J, Pohl M, et al. Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke. Cochrane Database Syst Rev. 2016;3:CD009645.PubMedGoogle Scholar
  32. 32.
    Elsner B, Kugler J, Pohl M, et al. Transcranial direct current stimulation (tDCS) for improving aphasia in patients with aphasia after stroke. Cochrane Database Syst Rev. 2015;5:CD009760.Google Scholar
  33. 33.
    Laver KE, Lange B, George S, et al. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2017;11:CD008349.PubMedGoogle Scholar
  34. 34.
    Ingeman A, Andersen G, Hundborg HH, et al. In-hospital medical complications, length of stay, and mortality among stroke unit patients. Stroke. 2011;42:3214–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Passero S, Rocchi R, Rossi S, et al. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia. 2002;43:1175–80.CrossRefPubMedGoogle Scholar
  36. 36.
    Lin YJ, Chang WN, Chang HW, et al. Risk factors and outcome of seizures after spontaneous aneurysmal subarachnoid hemorrhage. Eur J Neurol. 2008;15:451–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Xi G, Strahle J, Hua Y, et al. Progress in translational research on intracerebral hemorrhage: is there an end in sight? Prog Neurobiol. 2014;115:45–63.CrossRefPubMedGoogle Scholar
  38. 38.
    Chen Z, Song W, Du J, et al. Rehabilitation of patients with chronic normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage benefits from ventriculoperitoneal shunt. Top Stroke Rehabil. 2009;16:330–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Kelly J, Rudd A, Lewis R, et al. Venous thromboembolism after acute stroke. Stroke. 2001;32:262–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Paciaroni M, Agnelli G, Venti M, et al. Efficacy and safety of anticoagulants in the prevention of venous thromboembolism in patients with acute cerebral hemorrhage: a meta-analysis of controlled studies. J Thromb Haemost. 2011;9:893–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Lord AS, Langefeld CD, Sekar P, et al. Infection after intracerebral hemorrhage: risk factors and association with outcomes in the ethnic/racial variations of intracerebral hemorrhage study. Stroke. 2014;45:3535–42.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Westendorp WF, Vermeij JD, Zock E, et al. The preventive antibiotics in stroke study (PASS): a pragmatic randomised open-label masked endpoint clinical trial. Lancet. 2015;385:1519–26.CrossRefPubMedGoogle Scholar
  43. 43.
    Poisson SN, Johnston SC, Josephson SA. Urinary tract infections complicating stroke: mechanisms, consequences, and possible solutions. Stroke. 2010;41:e180–4.CrossRefPubMedGoogle Scholar
  44. 44.
    Turner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil. 2002;16:276–98.CrossRefPubMedGoogle Scholar
  45. 45.
    Lindgren I, Jonsson AC, Norrving B, et al. Shoulder pain after stroke: a prospective population-based study. Stroke. 2007;38:343–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Faghri PD, Rodgers MM, Glaser RM, et al. The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. Arch Phys Med Rehabil. 1994;75:73–9.PubMedGoogle Scholar
  47. 47.
    Morris PL, Robinson RG, Raphael B. Prevalence and course of depressive disorders in hospitalized stroke patients. Int J Psychiatry Med. 1990;20:349–64.CrossRefPubMedGoogle Scholar
  48. 48.
    Gainotti G, Azzoni A, Marra C. Frequency, phenomenology and anatomical-clinical correlates of major post-stroke depression. Br J Psychiatry. 1999;175:163–7.CrossRefPubMedGoogle Scholar
  49. 49.
    Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. 2016;173:221–31.CrossRefPubMedGoogle Scholar
  50. 50.
    Hackett ML, Kohler S, O’brien JT, et al. Neuropsychiatric outcomes of stroke. Lancet Neurol. 2014;13:525–34.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2018

Authors and Affiliations

  1. 1.Department of Physical and Rehabilitation MedicineSungkyunkwan University School of MedicineSeoulSouth Korea
  2. 2.Center for Prevention and RehabilitationHeart Vascular Stroke Institute, Samsung Medical CenterSeoulSouth Korea
  3. 3.Samsung Advanced Institute for Health Science and TechnologySungkyunkwan UniversitySeoulSouth Korea

Personalised recommendations