Early rehabilitation is widely regarded as an important feature of effective stroke care. But what is ‘early’, and what kinds of therapies should, or can, we begin soon after stroke onset? In this commentary, some of the barriers and drivers for early rehabilitation research and practice are explored.
AdamsHJAdamsRBrottT. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the stroke council of the American Stroke Association. Stroke2003; 34:1056–83.
2.
The European Stroke Organisation (ESO) Executive Committee and the ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Disc2008; 25:457–507.
3.
KozlowskiDAJamesDCSchallertT. Use-dependent exaggeration of neuronal injury after unilateral sensorimotor cortex lesions. J Neurosci1996; 16:4776–86.
4.
AldhousP. Adding exercise to injury. New Sci Mag1996; 151:17.
Boutron I, Hoher D, Altman D, Schulz F, Ravaud P, for the CONSORT Group. Extending the CONSORT statement to randomized controlled trials of nonpharmacological treatment: explanation and elaboration. Ann Intern Med2008; 148:259–309.
7.
IndredavikBBakkeFSlordahlSRoksethRHaheimLHolmeI. Benefits of a stroke unit: a randomized controlled trial. Stroke1991; 22:1026–31.
8.
IndredavikBBakkeRPTSlordahlSARoksethRHaheimLL. Treatment in a combined acute and rehabilitation stroke unit: which aspects are most important?Stroke1999; 30:917–23.
9.
RonningOGuldvogB. Outcome of subacute stroke rehabilitation: a randomized controlled trial. Stroke1998; 29:779–84.
10.
BernhardtJDeweyHThriftACollierJDonnanG. A Very Early Rehabilitation Trial for stroke (AVERT): Phase II safety and feasibility. Stroke.2008;39:390–6.
11.
Tay-TeoKMoodieMBernhardtI. Economic evaluation alongside a phase II, multi-centre, randomised controlled trial of very early rehabilitation after stroke (AVERT). Cerebrovasc Dis2008; 26:475–81.
12.
CummingTThriftACollierJ. Very early mobilisation after stroke fast tracks return to walking: further results from a randomised controlled trial (AVERT). Stroke2011; 42:153–8.
13.
BernhardtJDeweyHDonnanGThriftALindleyRMoodieM. A very early rehabilitation trial (AVERT) : phase III (Australian Clinical Trials Registry: 1260600185561). Lancet Protocol Review: Protocol 06PRT/54242007. Available at http://www.thelancet.com/journals/lancet/misc/protocol/06PRT-5424.
14.
LanghornePStottDKnightABernhardtJBarerDWatkinsC. Very early rehabilitation or intensive telemetry after stroke: a pilot randomised trial. Cerebrovasc Dis2010; 29:352–60.
15.
DiserensKMoreiraTHirtL. Early mobilization out of bed after ischaemic stroke reduces severe complications but not cerebral blood flow: a randomized controlled pilot trial. Clin Rehabil2012; 26:451–9.
16.
SundsethAThommessenBRønningOM. Outcome after mobilization within 24 hours of acute stroke: a randomized controlled trial. Stroke2012; 43:2389–94. published online before print June 14 2012.
SkarinMBernhardtJSjoholmANilssonMLindenT. ‘Better wear out sheets than shoes': a survey of stroke professionals’ early mobilisation practices and concerns. Int J Stroke2011; 6:10–5.
19.
CramerSC. The VECTORS study: when too much of a good thing is harmful. Neurology2009; 73:195–6.
20.
DromerickAWLangCEBirkenmeirerRL. Very early constraint-induced movement during stroke rehabilitation (VECTORS): a single-centre RCT. Neurology2009; 73:195–201.
21.
JanssenHSpeareSSprattNJ. Exploring the efficacy of constraint in animal models of stroke: meta-analysis and systematic review of the current evidence. Neurorehabil Neural Repair2012; PMID: 22714123. doi: 10.1177/1545968312449696.
22.
CheeranBCohenLDobkinB. The future of restorative neuro-sciences in stroke: driving the translational research pipeline from basic science to rehabilitation of people after stroke. Neurorehabil Neural Repair2009; 23:97–107.
23.
SchweickertWDKressJP. Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest2011; 140:1612–7.
24.
MorrisPGoadMThomposonC. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med2008; 36:2238–43.
25.
SchweickertWDPohlmanMCPohlmanASNigosCPawlikAJEsbrookCL. Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. Lancet.2009; 373:1874–82.
26.
Stroke Unit Trialists Collaboration. Organised inpatient (stroke unit) care for stroke (review). Cochrane Database Syst Rev2007; (4): CD000197. doi: 10.1002/14651858.CD000197.pub2.
27.
SteinerT. Stroke unit design: intensive monitoring should be a routine procedure. Stroke2004; 35:1018–9.
28.
IndredavikB. Intensive monitoring should not be routine. Stroke2004; 35:1019.
