Rehabilitation in the chronic phase of adult stroke: Relevance, indications and modalities
Stroke often leaves motor and cognitive after-effects beyond the first few months of recovery. The chronic phase of stroke is defined as the period beyond 6 months post-stroke.
These recommendations for good practice (RBP) cover :
- indications and relevance of rehabilitation activities in relation to impairments, activity limitations and participation restrictions;
- practical rehabilitation methods based on these indications.
The objectives of these recommendations and their implementation are to improve the rehabilitation of adult patients, in particular :
- harmonize practices ;
- promote appropriate rehabilitation orientations and modalities.
These PGR exclude drug treatments, surgical treatments and physical agents used exclusively for medical purposes.
It is recommended́ that rehabilitators adapt their treatment to the specificities of the person concerned, based on clinical practice recommendations and proven knowledge.
Motor function rehabilitation
Stroke rehabilitation is defined as the application of manual or instrumental therapeutic methods aimed at the secondary prevention, preservation, restoration, optimization or replacement of motor function disorders following an established stroke.
People with the after-effects of initial paralysis more than six months after a stroke must be offered an appropriate rehabilitation program for both the upper and lower limbs.
Rehabilitation of cognitive functions
Cognitive disorders can affect attentional, memory, executive and language functions in particular, thus impacting on the functional abilities of sufferers.
After a detailed cognitive assessment, it is necessary to offer patients suffering from cognitive disorders appropriate, ongoing rehabilitation.
Whatever the type of intervention and the cognitive function(s) concerned, the aim is to achieve changes that are relevant to patients' daily lives.
Cognitive rehabilitation encompasses aspects of psycho-education, cognitive training to improve function, and learning how to use aids and strategies to compensate.
Recommended rehabilitation methods to improve motor function
| Rehabilitation interventions | Recommendation | Level of scientific evidence |
| Balneotherapy | Not enough evidence of effectiveness | |
| Adhesive bandages | Not enough evidence of effectiveness | |
| Biofeedback | Recommended | B |
| Induced upper limb stress | Recommended | C |
| Stretching | Not enough evidence of effectiveness | |
| Walking exercises | Recommended | A |
| Motor mental imagery | Recommended in combination with another method | C |
| Orthotics | Recommended for the lower limb | B |
| Physical activity and exercise programs | Recommended | A |
| Virtual reality | Recommended in combination with another method | B |
| Robotic-assisted rehabilitation | Not enough evidence of effectiveness | |
| Posture and balance rehabilitation | Recommended | C |
| Neuromuscular electrical stimulation | Not enough evidence of effectiveness | |
| Bimanual intensive therapy (BIT), bimanual intensive hand-arm training (HABIT) and bimanual intensive hand-arm training including lower limbs (HABIT-ILE) | Not enough evidence of effectiveness | |
| Mirror therapy | Recommended for the upper limb | B |
| Vibration therapy and the use of vibration platforms | Not enough evidence of effectiveness | |
| Neurodevelopmental, proprioceptive neuro-facilitation and sensomotor integration therapies | Not enough evidence of effectiveness | |
| Botulinum toxin | Recommended in combination with another method | C |
Rehabilitation methods to improve cognitive function
| Rehabilitation interventions | Recommendation | Level of scientific evidence |
| Memory disorders | ||
| Aerobic physical activity | Recommended | B |
| Compensation | Recommended | B |
| Rehabilitation and compensation for working memory disorders | Recommended | B |
| Restoration and reorganization | Not enough evidence of effectiveness | |
| Cognitive and behavioral dysexecutive syndrome - executive function disorder | ||
| Compensation | Recommended | AE |
| Occupational care (CO-OP) | Recommended | C |
| Catering | Not enough evidence of effectiveness | |
| Unilateral spatial neglect | ||
| Prismatic fitting | Recommended | C |
| Induced stress | Not enough evidence of effectiveness | |
| Virtual reality | Not enough evidence of effectiveness | |
| rTMS | Not enough evidence of effectiveness | |
| Smooth pursuit | Not enough evidence of effectiveness | |
| Optokinetic stimulation | Not enough evidence of effectiveness | |
| Theta-burst stimulation | Not enough evidence of effectiveness | |
| Visual Scanning Training | Recommended | C |
| Attention deficit disorder | ||
| Rehabilitation of attentional subcomponents | Not enough evidence of effectiveness | |
| Time Pressure Management | Recommended | B |
| Aphasia and communication disorders | ||
| Acupuncture | Not enough evidence of effectiveness | |
| Technological aids for compensation | Recommended | B |
| Induced stress | Recommended for improving naming | B |
| Information, therapeutic education, involvement and training of caregivers/communication partners in communication strategies | Recommended | A |
| Music therapy | Not enough evidence of effectiveness | |
| Rehabilitation to be continued at high intensity, high dose and over a long period of time | Recommended | A |
| Rehabilitation of dysarthia | Not enough evidence of effectiveness | |
| Rehabilitation of alexias and agraphias | Not enough evidence of effectiveness | |
| Computer-assisted language rehabilitation with a therapist | Recommended for improving naming | A |
| rTMS | Recommended | A |
| Epidural cortical stimulation | Not enough evidence of effectiveness | |
| tDCS | Recommended in conjunction with rehabilitation | B |
| Multimodal therapies | Recommended for improving naming | B |
| Agnosias | ||
| Rehabilitation | Not enough evidence of effectiveness | |
| Gestural apraxia | ||
| Rehabilitation | Recommended | C |
| Using virtual reality | ||
| Virtual Reality Rehabilitation | Recommended as a complement to conventional congenital rehabilitation | AE |