title: Stroke rehabilitation: clinical picture, assessment, and therapeutic challenge.
abstract: This chapter reviews the evolution of stroke rehabilitation in the last 20 years. It begins by describing the different types of stroke that can occur in adults, their potential consequences on a person's capacity to function in daily life and statistics on the number of strokes and their burden on families and the economy. The assessment of stroke severity, recovery of function over time, and the impact of initial stroke severity and age on potential recovery are then addressed as well as the concept of rehabilitation to enhance recovery. Fueled by the synthesis of an ever-increasing research knowledge base and the creation of stroke rehabilitation recommendations for optimal delivery of rehabilitation services and of therapeutic interventions, stroke rehabilitation has changed dramatically. Examples of improvements in stroke rehabilitation in Canada are given with emphasis on the "best practices" inspired stroke rehabilitation continuum recently recommended for the Province of Quebec. The need for an improved community-based rehabilitation approach that includes regular follow-ups and community-based programs promoting reintegration is emphasized. The importance of knowledge translation strategies to promote the uptake of best-practice recommendations is illustrated by describing the activities of the Sensorimotor Rehabilitation Research Team. Over the past 3 years, the researchers of this team and clinicians in three rehabilitation centers, two in Montreal and one in Quebec City, have collaborated to adopt standardized assessment tools, create a common stroke registry, a best-practice recommended approach to interventions and the participation of clinicians in the research process.
authors.affiliation: Faculty of Medicine, Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience physique de Québec (IRDPQ), Quebec City, Quebec, Canada; SensoriMotor Rehabilitation Research Team of the Canadian Institute of Health Research, Quebec, Canada. Electronic address: Carol.Richards@fmed.ulaval.ca.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Richards
authors.affiliation: Faculty of Medicine, Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience physique de Québec (IRDPQ), Quebec City, Quebec, Canada; SensoriMotor Rehabilitation Research Team of the Canadian Institute of Health Research, Quebec, Canada.
authors.forename: Francine
authors.initials: F
authors.lastname: Malouin
authors.affiliation: SensoriMotor Rehabilitation Research Team of the Canadian Institute of Health Research, Quebec, Canada; École de réadaptation, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche interdisciplinaire en réadaptation de Montréal métropolitain (CRIR), Institut de réadaptation Gingras-Lindsay-de-Montréal (IRGLM), Montreal, Quebec, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Nadeau
mesh_terms: D001921:Brain / Q000502:physiology; D006801:Humans; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function / Q000502:physiology*; D000071939:Stroke Rehabilitation; D057170:Translational Research, Biomedical; D016896:Treatment Outcome
keywords: best-practice recommendations; outcome measures; recovery; rehabilitation; stroke