Increasing Practice after Stroke to Optimise Rehabilitation

Dean C.¹, Ada L.², Kwakkel G.³, Teixeira-Salmela L.⁴

¹The University of Sydney, Discipline of Physiotherapy, Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, Sydney, Australia, ²The University of Sydney, Discipline of Physiotherapy, Clinical and Rehabilitation Sciences, Faculty Research Group, Sydney, Australia, ³VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam, Netherlands, ⁴Federal University of Minas Gerais, Department of Physical Therapy, Minas Gerais, Brazil

Learning objectives:

1. Outline the evidence regarding the relationship between rehabilitation outcomes and amount of practice after stroke 2. Describe strategies to increase practice during rehabilitation after stroke 3. Discuss ways to increase practice in the inpatient setting and to embed physical activity in the community after rehabilitation. 

Description:

Globally, stroke accounts for 5.7 million deaths each year and ranks second to ischaemic heart disease as a cause of death. It is a leading cause of serious disability, sparing no age, sex, ethnic origin or country (www.world-stroke.org).

Rehabilitation for the person after stroke involves labour-intensive treatment. Investigations in the 1980's found that patients spent the majority of their day alone and inactive and that therapy occupied a small percentage of the day. Disappointingly, the findings of recent investigations into physical activity in rehabilitation units identified a similar situation, ie, most of the time outside therapy was spent alone and inactive while most physical activity occurred in the therapy area where patients spent only a small proportion of the day. These findings suggest that, currently, rehabilitation units do not function as learning environments and that the therapy area is an isolated area of physical activity. There is a need to introduce interventions that will increase the amount of practice undertaken because the amount of physical activity undertaken in rehabilitation has been shown to be related to outcome. Furthermore, given limited health resources, interventions should be implemented in a way that does not solely rely on increasing the numbers of therapists.

This focused symposium will present the evidence of the relationship between amount of practice and outcome. It will also examine the research describing the implementation of effective strategies to increase the amount of practice undertaken after stroke both during rehabilitation and in the community. The strategies to be discussed include use of protocols, classes, forced-use paradigms, video-self-monitoring, workstations, circuit classes, robotics, covert monitoring and practice books. Examples of implementation of strategies during inpatient rehabilitation as well as embedding practice in the community will be presented. The examples will draw on the presenters´ global experience working in Australia, Brazil, Canada, the Netherlands and USA. Collectively,the presenters and participants will identify the barriers to implementation of strategies to increase practice. Symposium participants and presenters will then work together to develop ways of overcoming these barriers.

Implications/Conclusions:

The broad objective of this symposium is to improve outcomes after stroke by facilitating the translation of evidence into professional practice. This symposium will be of interested to physiotherapists and researchers interested in stroke, a global health issue, as well as those interested in strategies to promote health and well-being in individuals with significant activity limitations and participation restrictions. The symposium will not only cover the evidence for increasing amount of practice but also address the steps in translating the evidence into practice. Participants will gain practical insights on how to increase practice from presenters from Australia, Brazil and the Netherlands who will draw on their local knowledge and international experience. It is expected that participants will leave the symposium with concrete strategies to increase practice. Strategies that will be relevant to their local health and cultural contexts.

Keywords:

Stroke; rehabilitation; amount of practice

Funding acknowledgements:

None

Relevance to WCPT and expected audience

Stroke is a global health problem and a leading cause of death and disability throughout the world. Physiotherapists have a major role in rehabilitation of people after stroke in order to improve the individuals's physical abilities and participation in the community. Symposium participants will gain insight into practice in different regions such as Brazil, Netherlands, Australia. The symposium is relevant to professional practice and covers global health and health promotion and well being topics.

Target audience

Physiotherapists and researchers interested in improving outcome after stroke. Particularly physiotherapists who would like insights into stroke rehabilitation in Australia, Brazil Canada,the Netherlands,UK and USA.

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