Neurorehabilitation predicated on the principles of evidence-based medicine: Austrian recommendations for the rehabilitation of post-stroke patients

Modern neurorehabilitation, based on the principles of evidence-based medicine, makes us move away from the GRADE-concept (model of successive rehabilitation). There were grounds for the beginning of rehabilitation in the emergency room in the first 24-48 hours. Proper organization of the stroke compartment reduces mortality and disability. Prerequisites are the presence of a rehabilitation team (level A), whose members are: a neurologist, a physiotherapist, an ergotherapist, a speech therapist, as well as a psychologist and a social worker; regular consultations with leading neurologists and other doctors to determine and document the therapy, its dynamics; cognitive screening; discussion of the results of the examination and treatment plan with relatives. Rehabilitation activities are based on the use of the International Classification of Functioning, Vital Activity and Health (ICF) and are performed at structural and functional levels (for example, muscle strength, tone, breathing), differ in goals, types of activity, patient participation and should be easily measured and painted time, to enable the patient to be motivated, as well as to be relevant to his condition (level A). On the other hand, the rehabilitation assessment at the early stages may also have predictive value (the Bartel index is within 5 days), based on the use of standard scales. The use of various therapeutic techniques that have a level of evidence of IA-III is performed in various combinations in each individual patient, depending on the existing pathological syndromes. There is evidence of the positive effects of levodopa and selective serotonin reuptake inhibitors (class II - III, level B - C), as well as specific peptide complexes - Cerebrolysin at a dose of 30 ml in a course of 3 weeks or more (class II, level B). Rehabilitation in the long term can be carried out at home, even a year after a stroke, balance exercises, gait training using different methods, training for the upper limbs are effective (grade B) and contribute to the reduction of disability.

stroke, comprehensive rehabilitation, clinical recommendations for stroke, early rehabilitation, outpatient rehabilitation