Rehabilitation: Lone hope for stroke survivors

Dear Sir,

Stroke is the brain equivalent of a heart attack and is the leading cause of acquired disability in adults. ^[1] Stroke is the third most common cause of death in developed countries, exceeded only by coronary heart disease and cancer. ^[1] Annually, 15 million people worldwide suffer a stroke. Of these, 5 million die and another 5 million are left permanently disabled, placing a burden on the family and community. ^[1] If similar trends continue, it is estimated that there will be 23 million first ever strokes and 7.8 million stroke deaths in 2030. ^[2] Currently, the overall stroke incidence rates in low and middle income countries exceed the level of stroke incidence seen in high-income countries, by about 20%. ^[3] Despite of such high incidence, majority of stroke mishaps can be prevented through population-based primary prevention strategy through control of modifiable risk factors. ^[4],[5] Even where advanced technology and facilities are available, 60% of those who suffer a stroke; die or become dependent. Considering the extensive morbidities because of stroke and high cost of treatment, preventive strategies needs special attention. ^[1]

For most of the stroke survivor’s, rehabilitation is vital to become economically active and to participate in social life. In developed countries the recovery process of stroke survivors is supported with stroke rehabilitation services. These rehabilitative services not only reduce the disability, but also increase the chances of a person returning to their own home early. Starting rehabilitation ‘as soon as possible’ is a widely accepted principle of care for people affected by stroke. ^[6] The primary goal of early stroke rehabilitation is to prevent post stroke complications; to minimize impairments and maximize functions. ^[6] Measures like early mobilization and constraint-induced movement therapy have been incorporated as a part of stroke unit care in different settings with the help of physiotherapist or occupational therapist. ^[7],[8] However, many individuals post stroke, especially those living in under-served urban and rural settings, do not have access to comprehensive stroke rehabilitation programs or teams, thereby limiting functional recovery while contributing to long-term disability. ^[9] This could be because of either financial or logistic barriers such as lack of insurance, difficulty with transportation, and/or the inadequate stroke rehabilitation programs. ^[10] Home-based telerehabilitation, in which a healthcare professional oversees the rehabilitation process from a remote location, has also found its utility for patients with limited access to traditional rehabilitation. ^[11]

To benefit all the stroke victims by rehabilitation, need of the hour is to prepare an action plan specific to the country’s resources with the help of engagement of different sectors (viz. health, education, social protection, labor, transport, and housing) and involvement of all the stakeholders (viz. governments, civil society organizations, professionals, the private sector, nongovernmental organizations, and people with disabilities). All the above suggested measures should be well supported with a framework for international cooperation for technical assistance and capacity building for improving the healthcare services and coverage.

All patients who survive a stroke episode show some degree of spontaneous recovery over the weeks and months that follow; rehabilitation helps drive and shape this recovery. For the millions of people who experience a disabling stroke each year, and for their families; stroke rehabilitation offers hope.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.140267