Physical Rehabilitation Interventions Research Articles

Two innovative healthcare technologies at the intersection of serious games, alternative realities, and play therapy.

Using game technologies and digital media for improving physical and mental health and for the therapeutic benefit and well-being of a wide range of people is an area of study that is rapidly expanding. Much research in this emerging field is centered at the intersection of serious games, alternative realities, and play therapy. In this paper the authors describe their transdisciplinary work at this intersection: i) an integrative system of psychotherapy technologies called MyPsySpace currently being prototyped in Second Life with the aim of offering new and virtual translations of traditional expressive therapies (virtual sandplay, virtual drama therapy, digital expressive therapy, and virtual safe spaces) and ii) a mature body of research entitled SoundScapes that is exploring the use of interactive video games and abstract creative expression (making music, digital painting, and robotic device control) as a supplement to traditional physical rehabilitation intervention. Aside from introducing our work to a broader audience, our goal is to encourage peers to investigate ideas that reach across disciplines-to both risk and reap the benefits of combining technologies, theories, and methods stemming from multiple disciplines.

Content of physical Rehabilitation interventions: Can we generalise from Chinese trials to other geographical regions?

Content of physical Rehabilitation interventions: Can we generalise from Chinese trials to other geographical regions?

The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis

the worldwide population is ageing. One expected consequence of this is an increase in morbidity and an associated increased demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects in residents of long-term care facilities. to examine the effects of physical rehabilitation on activities of daily living (ADL) in elderly residents of long-term care facilities. systematic review with meta-analysis of randomised controlled trials. We included studies that compared the effect of a physical rehabilitation intervention on independence in ADL with either no intervention or an alternative intervention in older people (over 60 years) living in long-term care facilities. We searched 19 databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, Web of Knowledge and Google Scholar. Two researchers independently screened papers and extracted data. Outcomes of included studies were combined in a standardised mean difference random-effects meta-analysis. thirteen of 14 studies identified were included in the meta-analysis. Independence in ADL was improved by 0.24 standard units (95% CI: 0.11-0.38; P = 0.0005). This is equivalent to 1.3 points on the Barthel Index (0-20 scale). No significant differences in effect were found based on participant or intervention characteristics. Larger sample size and low attrition were associated with smaller estimates of effect. All studies were assessed to be at risk of bias. physical rehabilitation may improve independence for elderly long-term care facility residents, but mean effects are small. It is unclear which interventions are most appropriate.

Rehabilitation following cancer treatment

Purpose: Cancer survivorship is increasing. However, life-saving treatments often leave people with physical, cognitive and emotional sequelae that contribute to activity and participation limitations. The purpose of this review is to summarize current evidence regarding rehabilitation interventions to address problems during survivorship. Method: Best evidence synthesis. The review took as its starting point a systematic review of patient needs and supportive care interventions following cancer treatment. The study team identified the needs which could be addressed by rehabilitation and suggested others not originally included. Then they built on the earlier review’s conclusions regarding effective intervention through extraction of results from subsequent systematic reviews and randomized controlled trials. Results: Evidence regarding the effectiveness of potential rehabilitation interventions was reviewed for physical functioning, fatigue, pain, sexual functioning, cognitive functioning, depression, employment, nutrition and participation. With the exception of physical rehabilitation interventions following breast cancer, this literature tends to focus on psychoeducational interventions, which have demonstrated limited effectiveness for rehabilitation outcomes. Conclusions: Most of the knowledge available regarding potential rehabilitation interventions comes from psychosocial oncology literature. While there are limitations, this literature provides an excellent starting point to examine the potential effectiveness of rehabilitation interventions within cancer survivorship programs.Implications for RehabilitationGood evidence exists for the use of exercise/physical rehabilitation in reducing fatigue after treatment for most cancers, and improving upper extremity functioning following treatment for breast cancer.Preliminary evidence exists in a number of areas that may be improved by rehabilitation interventions, such as pain, sexual functioning, cognitive functioning and return to work, but further research is needed.No intervention studies addressing participation limitations were identified. Rehabilitation professionals are encouraged to take the lead in exploring participation limitations among cancer survivors and developing suitable interventions.

Ultrasound‐Guided Continuous Superficial Peroneal Nerve Block below the Knee for the Treatment of Nerve Injury

(CRPS) describes a constellation of symptoms including pain, trophic changes, hyperesthesia, allodynia, and dysregulation of local blood flow often following trauma. It is often confined to the extremities. Treatment of this disorder consists of a variety of modalities including systemic pharmacotherapy, local anesthetic injections or infusions, psychological nonpharmacotherapy, physical rehabilitation, and surgical intervention. Chronic pain not related to CRPS can also be treated with similar interventions. Despite the array of available therapies, it can still be difficult to manage. We report a case of a 19-year-old patient diagnosed by her surgeon as having CRPS Type II, secondary to foot trauma, which was treated with a continuous infusion of local anesthetic at the superficial peroneal nerve (SPN). While placement of peripheral nerve block catheters to augment chronic pain therapy is not novel, the application of a perineural catheter at the SPN has not been previously described.

Physical rehabilitation interventions in nonambulatory people with multiple sclerosis

There is an expanding body of research on exercise intervention for multidisciplinary rehabilitation of people with multiple sclerosis (PwMS). Most of this research focuses on people with mild/moderate MS who are ambulatory. As the costs of care increases with increasing disability, it is important to evaluate the evidence for interventions in nonambulatory PwMS. The aim of this study was to evaluate the evidence regarding physical rehabilitation interventions in nonambulatory PwMS. The databases AMED, CINAHL, MEDLINE, EMBASE and PSYCHARTICLES were searched up to 31 May 2011. Reference lists, Google Scholar and PEDro were also searched. Trials of physical rehabilitation interventions in nonambulatory PwMS that analysed nonambulatory results separately were included. Pharmacological, surgical, medical and assistive device interventions were excluded. Risk of bias was assessed and the GRADE approach was used to classify the quality of evidence. Sixteen low-grade studies, only three of which were randomized controlled trials (RCTs), were found. There are trends of improvement following some interventions such as cooling suits, respiratory training and multidisciplinary rehabilitation, but there is no high-grade evidence in terms of the benefits of interventions in this population. The effectiveness of physical rehabilitation interventions in nonambulatory PwMS remains unclear. Although trends in the results suggest positive benefits, conclusions cannot be drawn about the effectiveness of interventions in this population because of the small number and poor quality of studies. As approximately 25% of PwMS are nonambulatory and considerable costs are associated with their care, it is imperative that efforts be to increase the quality of evidence for nonambulatory PwMS.

Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab project

Background/objectiveExamine associations of type and quantity of physical therapy (PT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of discharge and at 1 year post-injury.MethodsPhysical therapists delivering routine care documented details of PT interventions provided. Regression modeling was used to predict outcomes at discharge and 1 year post-injury for a 75% subset; models were validated with the remaining 25%. Injury subgroups also were examined: motor complete low tetraplegia, motor complete paraplegia, and American Spinal Injury Association (ASIA) Impairment Scale (AIS) D motor incomplete tetra-/paraplegia.ResultsPT treatment variables explain more variation in three functionally homogeneous subgroups than in the total sample. Among patients with motor complete low tetraplegia, higher scores for the transfer component of the discharge motor Functional Independence Measure () are strongly associated with more time spent working on manual wheelchair skills. Being male is the most predictive variable for the motor FIM score at discharge for patients with motor complete paraplegia. Admission ASIA lower extremity motor score (LEMS) and change in LEMS were the factors most predictive for having the primary locomotion mode of “walk” or “both (walk and wheelchair)” on the discharge motor FIM for patients with AIS D injuries.ConclusionInjury classification influences type and quantity of PT interventions during inpatient SCI rehabilitation and is a strong predictor of outcomes at discharge and 1 year post-injury. The impact of PT treatment increases when patient groupings become more homogeneous and outcomes become specific to the groupings.NoteThis is the second of nine articles in the SCIRehab series.

Early Physical Rehabilitation in the ICU and Ventilator Liberation

Critically ill patients requiring mechanical ventilation are frequently subjected to long periods of physical inactivity, leading to skeletal muscle atrophy and muscle weakness. Disuse muscle atrophy is the result of complex mechanisms, including altered protein turnover and disturbed redox signaling. These ICU-acquired complications are associated with longer duration of mechanical ventilation, prolonged ICU and hospital stays, and poorer functional status at hospital discharge. Similarly, there is growing evidence that continuous mandatory ventilation alters diaphragmatic structure and contractile function and promotes oxidative injury, resulting in a rapid-onset diaphragmatic atrophy and weakness, which most likely delays discontinuing mechanical ventilation. Physical rehabilitation, when started at the onset of mechanical ventilation, has been associated with shorter periods of mechanical ventilation, decreased ICU and hospital stay, and improved physical function at hospital discharge. This review summarizes the impact of both physical inactivity and mechanical ventilation on skeletal and diaphragmatic muscles structure and function. Also reviewed is the growing evidence demonstrating the feasibility and safety of early physical rehabilitation interventions for mechanically ventilated patients, as well as their benefit on patient outcomes.

Early Physical Rehabilitation in the ICU: A Review for the Neurohospitalist

Advances in critical care have resulted in improved intensive care unit (ICU) mortality. However, improved ICU survival has resulted in a growing number of ICU survivors living with long-term sequelae of critical illness, such as impaired physical function and quality of life (QOL). In addition to critical illness, prolonged bed rest and immobility may lead to severe physical deconditioning and loss of muscle mass and muscle weakness. ICU-acquired weakness is associated with increased duration of mechanical ventilation and weaning, longer ICU and hospital stay, and increased mortality. These physical impairments may last for years after ICU discharge. Early Physical Medicine and Rehabilitation (PM&R) interventions in the ICU may attenuate or prevent the weakness and physical impairments occurring during critical illness. This article reviews the evidence regarding safety, feasibility, barriers, and benefits of early PM&R interventions in ICU patients and discusses the limited existing data on early PM&R in the neurological ICU and future directions for early PM&R in the ICU.

A Study on Efficacy of Physical Rehabilitation Intervention Programme on Carpal Tunnel Syndrome in Computer Workers

Background: Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve as it passes through the carpal tunnel. In recent years, with the expanding use of computers, it has been a matter of concern if computer use could be a risk factor for the development of Carpal tunnel syndrome. bjective: To find prevalence of self-reported carpal tunnel syndrome and to prove the effectiveness of Physical rehabilitation Intervention programme on pain and disability in carpal tunnel syndrome among Computer Professionals. Design: Experimental study. Participants: Participants were recruited from Software Companies (n=38, age range= 20-50 years, mean age= 35 years, male or female) and asked to fill questionnaire form about musculoskeletal symptoms and intensity or severity of pain experienced. Measurements: Visual analog scale, CTSQ- carpal tunnel syndrome questionnaire. Results: The data obtained was tabulated and statistically analyzed. Due to nature of outcome measures i.e. pain and disability, pre and post intervention, parametric statistical tests, dependent t sample test and un paired t test were used. The two-tailed P value is less than 0.0001 by conventional criteria, this difference is considered to be extremely statistically significant of both variables. Conclusion: This study was concluded that the Physical rehabilitation intervention programme by improving quality of life as noted through decrease in reports of pain and disability of carpal tunnel syndrome in computer workers.

Evaluation of functional outcomes of physical rehabilitation and medical complications in spinal cord injury victims of the Sichuan earthquake

To characterize a spinal cord injury (SCI) population from the 2008 Sichuan earthquake in China; to evaluate functional outcomes of physical rehabilitation interventions; to assess potential determinants of rehabilitation effectiveness; and to assess medical complications and management outcomes. A total of 51 earthquake victims with SCI were enrolled and underwent rehabilitation programming. Functional rehabilitation outcomes included ambulation ability, wheelchair mobility and activities of daily living (ADL) assessed with the Modified Barthel Index at the beginning and end of rehabilitation. Effectiveness of rehabilitation and the effect of other predictors were evaluated by mixed effects regression. Outcomes of medical complication management were determined by comparison of the incidence of respective complications at the beginning and end of rehabilitation. Ambulation, wheelchair mobility and ADL were significantly improved with rehabilitation programming. Both earlier rescue and earlier onset of rehabilitation were significant positive predictors of rehabilitation effectiveness, whereas delayed onset of rehabilitation combined with prolonged time to rescue resulted in a lesser positive effect. Medical complications were managed effectively in 63% (pressure ulcers) to 85% (deep vein thrombosis) of patients during rehabilitation. Earthquake victims with SCI may achieve significantly improved functional rehabilitation functional outcomes on a formal, institutional-based physical rehabilitation programme.

Functional outcomes and health-related quality of life in fracture victims 27 months after the Sichuan earthquake

To evaluate functional outcomes, health-related quality of life and life satisfaction in fracture victims 27 months after the 2008 Sichuan earthquake. A total of 390 earthquake survivors from 3 earthquake areas who sustained fractures were divided into early intervention, late intervention and control groups. Functional outcomes assessed included activities of daily living using the Modified Barthel Index and pain level with a visual analogue scale. Health-related quality of life was evaluated with the Medical Outcomes Study Short-Form 36 and life satisfaction using the Life Satisfaction Questionnaire. Activities of daily living and life satisfaction in the intervention groups were significantly improved compared with the control group. Health-related quality of life was higher in early intervention subjects compared with controls. Group differences in pain level were not significant. In addition, the early and late intervention groups did not differ significantly in any of the measured outcomes. Good performance of activities of daily living and widowed marital status predicted high health-related quality of life, while pain level was associated with worsened outcomes. Rehabilitation therapy, remunerative employment and female gender were predictors of improved life satisfaction. Clinical effectiveness of physical rehabilitation intervention was demonstrated in fracture earthquake victims.

La réhabilitation en centre: L’expérience de Morlaix: In-hospital chest physiotherapy: The Morlaix experience

The aim of this review is to appraise current research which examines the impact of early rehabilitation practices on functional outcomes and quality of life in adult intensive care unit (ICU) survivors.A systematic literature search was undertaken; retrieved data was evaluated against a recognised evaluation tool; research findings were analysed and categorised into themes; and a synthesis of conclusions from each theme was presented as an integrated summation of the topic.Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid Medline and Google Scholar were searched using key search terms ‘ICU acquired weakness’, ‘early rehabilitation’ ‘early mobility’ and ‘functional outcomes’ combined with ‘intensive care’ and ‘critical illness’. Additional literature was sourced from reference lists of relevant original publications.Five major themes related to the review objectives emerged from the analysis. These themes included: critically ill patients do not always receive physical therapy as a standard of care; ICU culture and resources determine early rehabilitation success; successful respiratory and physical rehabilitation interventions are tailored according to individual patient impairment; early exercise in the ICU prevents the neuromuscular complications of critical illness and improves functional status; early exercise in the ICU is effective, safe and feasible.A limited body of research supports early rehabilitation interventions to optimise the short term outcomes and long term quality of life for ICU survivors. Critical care nurses are in an excellent position to drive change within their departments ensuring that early rehabilitation practices are adopted and implemented.

Health behaviors of early-stage non-small cell lung cancer survivors.

Lung cancer survivors are at risk for cancer recurrence and other chronic illnesses related predominantly to prior tobacco use and older age. Optimal quality of post-treatment care requires greater knowledge of survivors' adherence to behavioral health recommendations. This study reports the rates of smoking, physical activity, alcohol use, cancer screenings, and routine primary care visits in non-small cell lung cancer (NSCLC) survivors. Stage IA and IB NSCLC survivors (N = 183, mean age = 69.0years) with no evidence of disease 1-6years post-treatment completed standard survey items regarding health and cancer screening behaviors. Most survivors (83.5%) had a history of smoking, but 64.8% quit prior to diagnosis and only 5.5% continued to smoke. Alcohol intake recommendations were exceeded by 5.4% and 17.3% of men and women, respectively. In a typical week, 23.1% met physical activity guidelines. Regarding cancer screenings, 89.3% were adherent to colorectal cancer screening guidelines. Among women, 72.0% had a mammogram within the previous year and 81.5% had a pap test in the previous 3years; among men, 86.7% had a prostate-specific antigen test in the previous year. Almost all (97.3%) had seen a primary care provider in the past year. The majority of lung cancer survivors were adherent to health promotion recommendations, but few engaged in the recommended level of physical activity. Physical and pulmonary rehabilitation interventions may help lung cancer survivors maintain sufficient levels of physical activity, which can have numerous benefits for older adults.

Neuropsychological decline/improvement in opsoclonus myoclonus ataxia

Opsoclonus myoclonus ataxia (OMA) is a rare neurological disorder (incidence = ∼1/5 million) primarily associated with involuntary conjugate saccadic eye movements, involuntary muscle jerks, cerebellar ataxia, and neuropsychological impairments. Unfortunately, there is limited published data regarding the nature and course of neuropsychological impairments following OMA diagnosis and treatment. This study presents neuropsychological data obtained at 1, 4, and 18 months post-diagnosis of a 52-year-old male with OMA. The patient initially demonstrated significant global neurocognitive, psychomotor, and psychological difficulties with substantial improvement over time. Treatment included medication management, physical rehabilitation, and psychological intervention.

Virtual environments for real treatments

Abstract Introduction In the era of evidence-based practice, more evidence of the beneficial impact of physical therapy and rehabilitation interventions have emerged. Kwakkel and Wagenaar's meta-analysis, Carr and Shepherd's work relating to the motor learning concept, and Fiatarone's research of strength training, emphasize the influence of rehabilitation in outcome gains by demonstrating that in conjunction with the therapist's expertise, the most influencing factors are therapy frequency and intensity. Aim To show the problem which is the gap between this knowledge and reality. Discusion Recently published observational studies revealed that patients in rehabilitation facilities receive a very small amount of therapy time during rehabilitation. Virtual reality (VR) technology offers assistance, as it enables patients who have difficulties coping in the “real world” to gradually deal with their problems via the “virtual world”. It provides the user with a real time interactive experience, through visual, audible, tactile or any other kind of feedback. Individuals find themselves in a pleasant, challenging, motivating and “inviting” functional environment, thus tending to forget their limitations or disability. In addition, VR encourages them to reach their goals which are difficult to achieve in any other treatment setting. Conclusions VR is a new, innovative technology utilizing virtual and adaptable worlds, created by sophisticated computer systems with improved graphic capability (hardware) and interactive software allowing one to interact “naturally” with the virtual environment, without the risk and cost of moving the patient into the “real world”. The interactive experience is perceived by both, therapist and patient, as very positive, enabling treatment to continue over time without feelings fatigue or boredom. VR can be created through a variety of tools, simple to complex, cheap to expensive. Basic computer systems with different input and output devices, such as different types of monitors or expensive and sophisticated systems using helmets with small video screens head mounted display have been used. Recently, cheap “on the shelf” video game consoles were adopted by clinicians as valuable tools in treating patients suffering from various pathologies and disabilities. Therefore, therapists are required to manoeuvre and plan treatments in systems where the delineation between therapy and fun is not always clear or controlled. The common practice has to be, as always, somewhere in between the most expensive and sophisticated systems and the “non adaptable” video game consoles. We estimate that in the near future, VR technology will be widely used. Meanwhile, today's technology allows us to take more of the VR advantages to the clinical world.

Comparing Individualized Rehabilitation to a Group Wellness Intervention for Persons with Multiple Sclerosis

Compare the efficacy of two interventions designed to promote health and physical activity (PA). This study was a randomized clinical trial using a time series design. Subjects were randomized into individualized physical rehabilitation (IPR) and group wellness intervention (GWI). Primary questionnaires were administered twice preintervention and twice postintervention. Physical fitness and PA frequency were assessed preintervention and postintervention. Clinic based in a metropolitan area. Fifty volunteers with multiple sclerosis. IPR consisted of four physical therapy sessions plus three telephone calls. GWI consisted of seven educational sessions. Primary: SF-36 Health Survey, Modified Fatigue Impact Scale, Mental Health Inventory. Secondary: physical assessment, PA frequency. Stability of primary questionnaires between the two pretests was examined. Efficacy of interventions was evaluated by multivariate analysis of variance (MANOVA) and effect sizes. Primary measures were stable between pretests. MANOVA showed nonsignificant differences between interventions. Eight weeks postintervention, both groups had improved PA, fatigue, resting heart rate, and strength. Effect sizes suggested that IPR had a greater effect on preventing decline of physical health, whereas GWI had a greater effect on improving mental health. Preliminary evidence indicated that health and PA improved in both groups. Effect sizes suggested that participants benefited more physically from IPR and more mentally from GWI. Future research should determine whether combining therapeutic exercise with group education improves both mental and physical health.

Prevalence and Treatment Patterns of Physical Impairments in Patients With Metastatic Breast Cancer

Physical impairments cause profound functional declines in patients with cancer. Although common rehabilitation measures can address many impairments, the extent of their delivery is unknown. We studied these issues by quantifying physical impairments in patients with metastatic breast cancer and by assessing how they are addressed. A consecutive sample of 163 community-dwelling patients with metastatic breast cancer was stratified by Karnofsky performance score and administered the Medical Outcomes Study Physical Function Subscale and the Older Americans Resource Study Activities of Daily Living subscales. Cancer-related physical impairments were identified through a physical examination, the 6-Minute Walk Test, and the Functional Independence Measure Mobility Subscale. Patients were questioned regarding the nature, type, and setting of treatments for impairments. Physical rehabilitation needs were determined through a consensus process involving physiatrists and physical/occupational therapists specializing in cancer. Ninety-two percent of patients (150 of 163) had at least one physical impairment. Among 530 identified impairments, 484 (92%) required a physical rehabilitation intervention and 469 (88%) required physical therapy (PT) and/or occupational therapy (OT). Only 30% of impairments requiring rehabilitation services and 21% of those requiring PT/OT received treatment. Impairments detected during hospitalization were overwhelmingly more likely to receive a rehabilitation intervention (odds ratio [OR] = 87.9; 95% CI, 28.5 to 271.4), and PT/OT (OR = 558.8; 95% CI, 187.0 to 1,669.6). Low socioeconomic and minority status were significantly associated with nontreatment. Remediable physical impairments were prevalent and poorly addressed among patients with metastatic breast cancer, drastically so in the outpatient setting. Undertreatment was particularly prominent among minority and socioeconomically disadvantaged groups.

Physical Activity-Mediated Functional Recovery after Spinal Cord Injury: Potential Roles of Neural Stem Cells

As data elucidating the complexity of spinal cord injury pathophysiology emerge, it is increasingly being recognized that successful repair will probably require a multifaceted approach that combines tactics from various biomedical disciplines, including pharmacology, cell transplantation, gene therapy and material sciences. Recently, new evidence highlighting the benefit of physical activity and rehabilitation interventions during the post-injury phase has provided novel possibilities in realizing effective repair after spinal cord injury. However, before a comprehensive therapeutic strategy that optimally utilizes the benefits of each of these disciplines can be designed, the basic mechanisms by which these various interventions act must be thoroughly explored and important synergistic and antagonistic interactions identified. In examining the mechanisms by which physical activity-based functional recovery after spinal cord injury is effected, endogenous neural stem cells, in our opinion, engender a potentially key role. Multipotent neural stem cells possess many faculties that abet recovery, including the ability to assess the local microenvironment and deliver biofactors that promote neuroplasticity and regeneration, as well as the potential to replenish damaged or eradicated cellular elements. Encouragingly, the functional recovery owing to physical activity-based therapies appears relatively robust, even when therapy is initiated in the chronic stage of spinal cord injury. In this article, we review experimental outcomes related to our hypothesis that endogenous neural stem cells mediate the functional recovery noted in spinal cord injury following physical activity-based treatments. Overall, the data advocates the incorporation of increased physical activity as a component of the multidimensional treatment of spinal cord injury and underscores the critical need to employ research-based mechanistic approaches for developing future advances in the rehabilitation of neurological injury and disorders.

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation

Background and Purpose: The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). Method: Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. Results: The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. Discussion and Conclusion: The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.