Clinical Review

Review of stroke rehabilitation

BMJ 2007; 334 doi: 10.1136/bmj.39059.456794.68 (Published 11 January 2007)
Cite this as: BMJ 2007;334:86

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  1. John Young, head of unit,
  2. Anne Forster, reader in elderly care
  1. 1Academic Unit of Elderly Care and Rehabilitation, University of Leeds and Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD5 0NA
  1. Correspondence to: J Young, Academic Unit of Elderly Care and Rehabilitation, St Luke's Hospital, Bradford BD5 ONA John.young{at}bradfordhospitals.nhs.uk

    Stroke causes an estimated 5.54 million deaths worldwide each year.1 The burden of stroke is set to rise over future decades because of demographic transitions of populations, particularly in developing countries.w1 Despite a meagre research investmentw2 important progress has been made, reflected in various guideline initiatives.2 3 4 These guidelines relate mainly to stroke services in developed countries. The main burden of stroke to individuals and to societies is as a leading cause for disability—about 40% of stroke survivors are left with some degree of functional impairment. Reducing this burden requires optimising stroke prevention and improving acute care, but rehabilitation is equally essential.

    What is rehabilitation?

    The many definitions of rehabilitation, most of which apply well to stroke, can be confusing. However, a clear consensus exists that the purpose of rehabilitation is to limit the impact of stroke related brain damage on daily life by using a mixture of therapeutic and problem solving approaches (see box 1).2 3 4 The high incidence and prevalence of stroke imply that stroke rehabilitation should be a major component of health service provision. In England, for example, the healthcare costs associated with stroke have been estimated at £2.8bn (€4.1bn; $5.5bn) a year.w3 A stroke is not simply a brain disease but affects the whole person and the family. There are few other conditions of such complexity that require the challenge of providing highly individualised, complex treatments to large numbers of patients.

    Box 1: What is rehabilitation?w33

    Rehabilitation is a complex set of processes usually involving several professional disciplines and aimed at improving quality of life for people facing daily living difficulties caused by chronic disease. Most people (and their carers) after a stroke will require help from a specialist team of doctors, nurses, therapists, social service staff, and psychologists. Each person will need careful assessment by …

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