Abstract
Comprehensive stroke centers should be the leading choice for treating stroke victims. Concomitant neurorehabilitation program should be an integral part of any CSC (39). A coordinated multidisciplinary rehabilitation within stroke units has been one of the components credited for long-term reductions in death, dependency, and need for institutional care (40). Integrating neurorehabilitation services and initiating rehabilitation care pathways with acute, sub-acute, home, and chronic components offers a CSC the opportunity to significantly improve patient outcomes. Via this structure, emerging treatment options such as constraint therapy for motor and language recovery, synergy of motor-language rehabilitation, and virtual feedback approaches, and non-invasive magnetic and electrical brain stimulation (41) can better customize therapy so that maximum recovery may take place. This allows for appropriate early rehabilitation, counseling of patients and families on sub-acute options, and takes action against preventable morbidity in the hospital and at the time of home transition. Health outcomes research in stroke needs to extend to studying rehabilitation interventions in order to evaluate optimal regimens for early intervention that are feasible in many settings, cost-effective, and well-accepted by patients and families.
Highlights
INTRODUCTIONStrokes have become a leading cause of disability and cognitive impairment
With the aging population, strokes have become a leading cause of disability and cognitive impairment
Concomitant neurorehabilitation program should be an integral part of any comprehensive stroke center (CSC) [39]
Summary
Strokes have become a leading cause of disability and cognitive impairment. Acute management of stroke volume has increased in order to meet the demand This includes initial assessment, diagnostic imaging, laboratory studies, and appropriate acute treatments [3]. The ideal way to integrate neurorehabilitation services in CSCs is to base recommendations on quality improvement studies that have demonstrated how to manage referral protocols to optimize rehabilitation outcomes. CSCs are ideal settings for examining differences in outcome based on systems of care, and we urge stroke researchers to begin evaluating and comparing rehabilitation referral pathways. With a more systematically integrated assessment of progress, including attention to psychosocial issues and early comprehensive discharge planning, this model for stroke-care potentially improves patient outcomes, and decreases the financial burden on the medical care system and improves hospital–home transitions. Since peak neurological recovery occurs within the first 3 months of the initial insult [15] and large numbers of stroke survivors may not be able to access outpatient www.frontiersin.org
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