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Stroke rehabilitation
Most motor recovery after stroke occurs in the first three months, so rehabilitation starts early, is intensive and task-focused — but not "too early and too much" in the first 24 hours.
Why it matters in the exam
The exam asks about the right rehabilitation setting, predictors of recovery, the Brunnstrom stages, syndromes by vascular territory and interventions with evidence. Under the 2016 AHA/ASA guideline, a patient who can take part in intensive rehabilitation is referred to an inpatient rehabilitation unit rather than a nursing facility, and repetitive task-specific practice is the foundation. The AVERT trial showed that very early, high-dose mobilisation within 24 hours of stroke was linked with a less favourable outcome, so short, frequent mobilisation starts once the patient is stable.
Predictors of recovery: initial severity is the strongest predictor. For the arm, the ability to extend the fingers and abduct the shoulder in the first days predicts good recovery of hand function. Recovery slows markedly after about three months and usually plateaus around six months, but functional gains can continue with practice. The Brunnstrom stages describe the course of recovery: flaccidity, appearance of spasticity and synergies, spasticity at its peak, movement out of synergies, more isolated movement and finally near-normal movement.
Interventions with evidence: constraint-induced movement therapy (CIMT) in patients with some active wrist and finger extension; focused gait training with aids as needed; functional electrical stimulation (FES) for movement and foot drop; an AFO for foot drop; and robotics as an adjunct. Telling the syndromes apart matters for planning: an anterior cerebral artery (ACA) stroke affects the leg more than the arm; a middle cerebral artery (MCA) stroke affects the face and arm more than the leg; right hemisphere damage often brings neglect and denial of illness, and left hemisphere damage — aphasia and apraxia. "Pusher" syndrome — the patient pushes towards the paretic side — is linked with thalamic or right hemisphere lesions.
Key points
- Intensive, task-specific and early rehabilitation.
- No high-dose mobilisation within 24 hours.
- Initial severity is the strong predictor.
- Most recovery by 3 months.
- CIMT, FES and AFO — evidence-based.
Summary table
| Topic | What to know | Practical meaning |
|---|---|---|
| Setting | Intensive inpatient rehabilitation for those able to take part | Preferred over a nursing facility |
| Timing | Early mobilisation but not high-dose within 24 hours | AVERT |
| Predictors | Initial severity; early finger extension and shoulder abduction | Prognosis of the arm |
| Course | Most recovery by 3 months, plateau around 6 months | Practice keeps improving function |
| Interventions | CIMT, task-specific practice, FES, AFO | CIMT needs partial wrist and finger extension |
Free exam questions
בן 67 , התקבל לשיקום לאחר אירוע מוחי איסכמי המיספרלי ימני עם המיפלגיה משמאל, נושם דרך קנולה, מוזן דרך PEG . מה נכון לגבי הפרעת ה ב ליעה של מט ה ל ופ ? (the question as examined, in Hebrew)
- א. סיכוי י הגמילה מ- PEG דומים באוטם המיספרלי ובאוטם בגזע המוח
- ב. אבחנת דיספגיה איננה שכיחה לאחר אירוע מוחי עם המיפלגיה שמאלית
- ג. רוב הסיכויים שיוכל להיגמל מה- PEG
- ד. אין מקום ל תרגול בליעה כל עוד המטופל נושם דרך קנולה
מה נכון בנוגע להפרעות בתפקוד מערכת העיכול לאחר ?פגיעות מוחיות (the question as examined, in Hebrew)
- א. דיספגיה נוירוגנית הינה ממצא נדיר בתקופה האקוטית לאחר אירוע מוחי
- ב. בצקת מוחית היא גורם להופעת כיבים במערכת העיכול ולהפרעה בתנועתיות
- ג. אירועים מוחיים גורמים לעלייה בתנועתיות הקיבה
- ד. הפרעה בשליטה במתן צואה אינה בעיה משמעותית לאחר אירוע מוחי
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Sources
- AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery, 2016 — Rehabilitation settings, motor recovery and interventions
- AVERT trial: Efficacy and safety of very early mobilisation within 24 h of stroke onset, 2015 — Early mobilisation dose
- Braddom's Physical Medicine and Rehabilitation, 6th edition (2021) — Stroke Syndromes and Rehabilitation
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.