title: Early rehabilitation after stroke.
abstract: Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions.
  
  
  
  Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (<24 h) after stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging.
  
  
  
  Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize 'early' recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.
authors.affiliation: aThe Florey Institute of Neuroscience and Mental Health, University of Melbourne bNHMRC Centre of Research Excellence in Stroke Rehabilitation and Recovery, Melbourne cSchool of Health Science, Latrobe University, Melbourne dSpeech Pathology, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia eClinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia fInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Bernhardt
authors.forename: Erin
authors.initials: E
authors.lastname: Godecke
authors.forename: Liam
authors.initials: L
authors.lastname: Johnson
authors.forename: Peter
authors.initials: P
authors.lastname: Langhorne
mesh_terms: D001037:Aphasia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D018579:Patient Selection; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D061665:Time-to-Treatment