title: Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: proprioceptive or cognitive approach?
abstract: BACKGROUND
  Early/intensive mobilization may improve functional recovery after stroke but it is not clear which kind of "mobilization" is more effective. Proprioceptive neuromuscular facilitation (PNF) and cognitive therapeutic exercise (CTE) are widespread applied in post-stroke rehabilitation but their efficacy and safety have not been systematically investigated.
  
  
  OBJECTIVE
  To compare PNF and CTE methods in a two different time setting (early versus standard approach) in order to evaluate different role of time and techniques in functional recovery after acute ischemic stroke.
  
  
  METHODS
  We designed a prospectical multicenter blinded interventional study of early versus standard approach with two different methods by means of both PNF and CTE.
  
  
  METHODS
  A discrete stroke-dedicated area for out-of-thrombolysis patients, connected with two different comprehensive stroke centres in two different catchment areas.
  
  
  METHODS
  Three hundred and forty consecutive stroke patient with first ever sub-cortical ischemic stroke in the mean cerebral artery (MCA) territory and contralateral hemiplegia admitted within 6 and 24 hours from symptoms onset.
  
  
  METHODS
  All patients were randomly assigned by means of a computer generated randomization sequence in blocks of 4 to one to the 4 interventional groups: early versus delayed rehabilitation programs with Kabat's schemes or Perfetti's technique. Patients in both delayed group underwent to a standard protocol in the acute phase.
  
  
  METHODS
  disability at 3-12 months. Disability measures: modified Rankin Score and Barthel Index. Safety outcome: immobility-related adverse events.
  
  
  METHODS
  Six-Minute Walking Test, Motricity Index, Mini-Mental State Examination, Beck Depression Inventory.
  
  
  RESULTS
  Disability was not different between groups at 3 months but Barthel Index significantly changed between early versus delayed groups at 12 months (P=0.01). Six-Minute Walking Test (P=0.01) and Motricity Index in both upper (P=0.01) and lower limbs (P=0.001) increased in early versus delayed groups regardless rehabilitation schedule.
  
  
  CONCLUSIONS
  A time-dependent effect of rehabilitation on post stroke motor recovery was observed, particularly in lower limb improvement. According to our results, rehabilitation technique seems not to affect long term motor recovery.
  
  
  CONCLUSIONS
  These results show a significant effect of time but not of technique that may impact the decision making in the acute phase of care.
authors.affiliation: Section of Neurology, Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy - manuelamorreale@yahoo.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: Morreale
authors.forename: Pasquale
authors.initials: P
authors.lastname: Marchione
authors.forename: Antonio
authors.initials: A
authors.lastname: Pili
authors.forename: Antonella
authors.initials: A
authors.lastname: Lauta
authors.forename: Stefano F
authors.initials: SF
authors.lastname: Castiglia
authors.forename: Aldo
authors.initials: A
authors.lastname: Spallone
authors.forename: Francesco
authors.initials: F
authors.lastname: Pierelli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giacomini
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy; D005260:Female; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011434:Proprioception; D020127:Recovery of Function; D016037:Single-Blind Method; D020521:Stroke / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome