The next revolution in stroke care

Abstract

Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the burden of stroke have largely focused on prevention and acute care strategies. Despite considerable resources and attention, the focus on prevention and acute care has not been successful in changing the clinical trajectory for the majority of stroke patients. While efforts to prevent strokes will continue to have an impact, the total burden of stroke will increase due to the aging population and decreased mortality rates. There is strong evidence for the effectiveness of rehabilitation in better managing stroke and its related disabilities. The time has come to shift the attention in stroke care and research from prevention and cure to a greater focus and investment in the rehabilitation and quality of life of stroke survivors. The rebalancing of stroke care and research initiatives requires a reinvestment in rehabilitation and community reintegration of stroke survivors.

Keywords::

• acute care
• prevention
• rehabilitation
• stroke

Financial & competing interests disclosure

R Teasell is affiliated with the with the Canadian Stroke Network. MMurie-Fernandez has affiliations with IPSEN and Merz. R Teasell, M Murie-Fernandez and D Rice are affiliated with Allergan Canada. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Globally, the total burden of stroke is on the rise.

• Stroke prevention and acute care strategies have been given a priority focus in traditional stroke care models and research.

• This approach has led to an overall reduction in mortality following a stroke; however it has not successfully changed the clinical trajectory for the majority of stroke victims.

• Therapeutic efforts to facilitate recovery from neurological damage consist largely of stroke rehabilitation.

• There is strong evidence that rehabilitation therapies enhance and extend neurological recovery well beyond natural recovery.

• Both early and later on in the stroke care continuum, significant treatment effects are found with motor and cognitive rehabilitation therapies.

• Rehabilitation continues to be undervalued within traditional stroke care models.

• There is a need to reinvest in the rehabilitation of stroke survivors to rebalance stroke care resources, both clinically and academically.