Definitions and Descriptions

Definitions and descriptions

Stroke Rehabilitation is a progressive, dynamic, goal orientated process that addresses stroke-related impairments, activity limitations and participation restrictions to optimize individuals’ physical, cognitive, emotional, communicative, and social functional levels. In the chronic stage of stroke, rehabilitation may also focus on maintaining current functional abilities and preventing or slowing future functional decline and secondary health conditions (such as depression).

Rehabilitation is NOT a setting, rather, it is a process that includes a set of activities that begins soon after the initial event, once the individual with stroke is medically stable to participate and goals for rehabilitation, recovery and participation can be identified.  

Rehabilitation occurs across the continuum of stroke care in a variety of formal and informal settings such as acute care or sub-acute care; rehabilitation units, on general or mixed rehabilitation units; palliative care units; in ambulatory or community settings, such as outpatient or day clinics, home-based services (includes early supported discharge and long-term care services), recreation centres, and outreach teams.   Rehabilitation considers the individual’s goals of care, including integration of appropriate palliative care principles as part of the care continuum.

Palliative Rehabilitation is an integral part of this continuum by focusing on improving quality of life, helping to manage symptoms, maintain functional abilities and support independence (Refer to CSBPR Stroke Systems of Care, Section 9 Palliative Care)

Stroke Systems of Care are defined as a comprehensive, diverse and longitudinal system that addresses all aspects of stroke care within an integrated, organized and coordinated approach. A stroke system spans the continuum of care from primary prevention to end of life.  A stroke system ensures access to evidence-based therapies which optimize their survival and recovery.

Integrated Stroke Systems consider all aspects of planning and delivering care, such as access, assessment, treatment, clinical evidence, data, outcomes, benchmarking, guidelines, planning, organization of services, funding, and education.

Spasticity Spasticity is manifested as velocity- and muscle length–dependent increase in resistance to externally imposed muscle stretch. It results from hyperexcitable descending excitatory brainstem pathways and from the resultant exaggerated stretch reflex responses. Other related motor impairments, including abnormal synergies, inappropriate muscle activation, and anomalous muscle coactivation, coexist with spasticity and share similar pathophysiological origins.⁶

Considerations Regarding Stroke Rehabilitation

Screening is a process for evaluating the possible presence of a particular problem. Screening is a purposeful action or query for early identification of individuals who may be at risk of developing a specific condition or disorder or problem. Screening may suggest that an issue may exist. Findings from screens can indicate the need for more comprehensive assessment. Screening is usually brief and used to identify possible concerns, not typically to diagnose. Healthcare providers may use preliminary screening measures to support clinical decision making.

Assessment is a process for defining and measuring the nature of a stroke-related health problem, informing a diagnosis, formulating a prognosis, and contributing to developing specific treatment recommendations for addressing the problem or diagnosis. Assessment may also include monitoring response to therapeutic intervention. The purpose of assessment is to gather more specific and detailed information to provide a comprehensive understanding of a potential issue. Assessments will include other information to help provide a broader context of results.

Note: Screening and assessment of individuals following stroke must take into consideration multiple factors.  Ideally, both screening and assessment tools should be validated for their specific use and target population to provide the most accurate interpretation of results.

Settings: Settings for stroke rehabilitation care refers to the physical locations where rehabilitation care and services are delivered to, and received by, individuals who have experienced a stroke, their families and caregivers.  Rehabilitation assessments and interventions, key components of comprehensive stroke care, are provided in a range of settings such as: acute inpatient care centres, sub-acute care settings; inpatient rehabilitation units: on stroke-specific, general or mixed rehabilitation units; in outpatient clinics, ambulatory or community settings, such as outpatient, day clinics and recreation centres; long-term care, complex care, and an individual’s home and place of residence (receiving services such as early supported discharge services and homecare rehabilitation or outreach teams). Care may be provided in person or virtually.

Duration: Length of service or stay for stroke rehabilitation varies depending upon factors such as the types of services required, accessibility of those services and the goals and needs of the individual with stroke, their families and caregivers. In some regions and local areas, the availability of staff and resources may impact duration, and all providers should strive to achieve guideline-directed therapy recommendations.

Timeframe: Stroke rehabilitation requirements often continue for many months and even years after an index stroke. Currently in Canada, publicly funded healthcare systems tend to allow for stroke rehabilitation within the first six months following stroke onset, even though many individuals with stroke will require some of these services beyond that arbitrary time frame. Rehabilitation is an ongoing process and rehabilitation needs and goals should be re-assessed periodically and plans updated as needed. 

Stroke Rehabilitation Delivery: Stroke rehabilitation can be delivered in person or virtually, as both individual sessions and group activities.  Decisions regarding mode of delivery of stroke rehabilitation therapies and interventions should be based on the individual with stroke’s personal factors, goals of the encounter, type of services to be provided, and the appropriateness and feasibility of each modality.

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WHO International Classification of Functioning, Disability and Health ⁶

Impairment: Problems in body function or structure such as a significant deviation or loss 

Activity limitation: Difficulties an individual may have in executing activities 

Participation restrictions: Problems an individual may experience in involvement in life situations