MULTIDISCIPLINARY APPROACH TO THE TREATMENT OF ISCHEMIC STROKE: DIAGNOSTICS, INTENSIVE THERAPY AND EARLY REHABILITATION WITH ORTHOTICS. LITERATURE REVIEW
DOI:
https://doi.org/10.31891/pcs.2025.1(1).124Keywords:
stroke, intensive care, diagnostic examination, rehabilitation, physical therapy, orthotics, localization of functions in the cortexAbstract
Ischemic stroke is caused by the cessation or reduction of perfusion of cerebral arterial vessels. Strokes are the main cause of severe and persistent disability, loss of health and significant economic costs to society. Treatment of ischemic stroke consists of therapy that improves cerebral perfusion in the area of ischemia and therapy that reduces the effects of stroke. An important role in the treatment process is played by diagnosis, early rehabilitation of patients, including nursing, physical therapy and orthotics. The aim of the study is to analyze various methods of treatment and rehabilitation of patients after ischemic stroke and their impact on improving the patient's functional capabilities. In acute ischemic stroke, the main goal of reperfusion therapy is to quickly restore cerebral blood flow to ischemic brain tissue that is at risk of cerebral infarction. Effective and safe interventions require early comprehensive diagnosis of the nature of the stroke and the patient's condition. In the modern era of stroke treatment, more and more patients are surviving with varying degrees of disability. A comprehensive rehabilitation program is critical to optimizing post-stroke outcomes. Understanding the natural course of stroke recovery and applying a multidisciplinary approach will increase the chances of successful rehabilitation. The aim of rehabilitation is, among other things, to improve motor function of the upper and lower extremities, reduce aphasia, improve respiratory muscle function, reduce pharyngeal and laryngeal muscle paresis, reduce or eliminate pain, and improve patient well-being. This article provides an overview of current advances in the treatment of acute ischemic stroke, starting with the prehospital stage and in the emergency department, followed by inpatient treatment and early rehabilitation. Early diagnosis, intensive care, and early and comprehensive rehabilitation are crucial in restoring the patient's ability to work, preventing recurrent stroke, developing complications, and improving the patient's quality of life.
References
Lozano, R.; Naghavi, M.; Foreman, K.; Lim, S.; Shibuya, K.; Aboyans, V.; Abraham, J.; Adair, T.; Aggarwal, R.; Ahn, S.Y.; et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380, 2095–2128.
Virani, S.S.; Alonso, A.; Aparicio, H.J.; Benjamin, E.J.; Bittencourt, M.S.; Callaway, C.W.; Carson, A.P.; Chamberlain, A.M.; Cheng, S.; Delling, F.N.; et al. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021, 143, e254–e743.
Virani, S.S.; Alonso, A.; Benjamin, E.J.; Bittencourt, M.S.; Callaway, C.W.; Carson, A.P.; Chamberlain, A.M.; Chang, A.R.; Cheng, S.; Delling, F.N.; et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020, 141, e139–e596.
Musuka, T.D.; Wilton, S.B.; Traboulsi, M.; Hill, M.D. Diagnosis and management of acute ischemic stroke: Speed is critical. Can. Med. Assoc. J. 2015, 187, 887–893.
Kwolek A. Rehabilitacja neurologiczna. W: Rehabilitacja medyczna. Elsevier Urban &Partner, Wrocław 2013; 19-59.
Grysiewicz RA, Thomas K, Pandey DK. Epidemiologia udaru niedokrwiennego i krwotocznego: częstość występowania, chorobowość, śmiertelność i czynniki ryzyka. Neurologia po dyplomie. 2009; 4(2): 18–30.
Feyissa, A.M.; Hasan, T.F.; Meschia, J.F. Stroke-related epilepsy. Eur. J. Neurol. 2019, 26, 18-e3.
Park, J.-H.; Ovbiagele, B. Optimal combination secondary prevention drug treatment and stroke outcomes. Neurology 2015, 84, 50–56.
Amarenco, P.; Lavallée, P.C.; Labreuche, J.; Albers, G.W.; Bornstein, N.M.; Canhão, P.; Caplan, L.R.; Donnan, G.A.; Ferro, J.; Hennerici, M.G.; et al. One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. N. Engl. J. Med. 2016, 374, 1533–1542.
Balami, J.S.; Hadley, G.; Sutherland, B.A.; Karbalai, H.; Buchan, A.M. The exact science of stroke thrombolysis and the quiet art of patient selection. Brain 2013, 136, 3528–3553.
Campbell, B.C.V.; Majoie, C.B.L.M.; Albers, G.W.; Menon, B.K.; Yassi, N.; Sharma, G.; van Zwam, W.H.; van Oostenbrugge, R.J.; Demchuk, A.M.; Guillemin, F.; et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: A meta-analysis of individual patient-level data. Lancet Neurol. 2019, 18, 46–55.
Saver, J.L. Time is brain–quantified. Stroke 2006, 37, 263–266.
Hasan, T.F.; Rabinstein, A.A.; Middlebrooks, E.; Haranhalli, N.; Silliman, S.L.; Meschia, J.F.; Tawk, R.G. Diagnosis and Management of Acute Ischemic Stroke. Mayo Clin. Proc. 2018, 93, 523–538.
Perez de la Ossa, N.; Carrera, D.; Gorchs, M.; Querol, M.; Millan, M.; Gomis, M.; Dorado, L.; Lopez-Cancio, E.; Hernandez-Perez, M.; Chicharro, V.; et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: The rapid arterial occlusion evaluation scale. Stroke 2014, 45, 87–91.
McMullan, J.T.; Katz, B.; Broderick, J.; Schmit, P.; Sucharew, H.; Adeoye, O. Prospective Prehospital Evaluation of the Cincinnati Stroke Triage Assessment Tool. Prehospital Emerg. Care 2017, 21, 481–488.
Kidwell, C.S.; Starkman, S.; Eckstein, M.; Weems, K.; Saver, J.L. Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke 2000, 31, 71–76.
Warlow C, Sudlow C, Dennis M, Wardlaw J, Sanercock P. Stroke. Lancet. 2003; 362(9391): 1211–1224.
Lin, C.B.; Peterson, E.D.; Smith, E.E.; Saver, J.L.; Liang, L.; Xian, Y.; Olson, D.M.; Shah, B.R.; Hernandez, A.F.; Schwamm, L.H.; et al. Emergency Medical Service Hospital Prenotification Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke. Circ. Cardiovasc. Qual. Outcomes 2012, 5, 514–522.
Casaubon, L.K.; Boulanger, J.-M.; Blacquiere, D.; Boucher, S.; Brown, K.; Goddard, T.; Gordon, J.; Horton, M.; LaLonde, J.; Larivière, C.; et al. Canadian Stroke Best Practice Recommendations: Hyperacute Stroke Care Guidelines, Update 2015. Int. J. Stroke 2015, 10, 924–940.
Coutts, S.B.; Wein, T.H.; Lindsay, M.P.; Buck, B.; Cote, R.; Ellis, P.; Foley, N.; Hill, M.D.; Jaspers, S.; Jin, A.Y.; et al. Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Guidelines, Update 2014. Int. J. Stroke 2014, 10, 282–291.
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., et al. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12), e344–e418.
Barber, A. P., Hill, M., Eliasziw, M., Demchuk, A. M., Pexman, J. H. W., Hudon, M. E., Tomanek, A., Frayne, R., & Buchan, A. (2005). Imaging of the brain in acute ischaemic stroke: Comparison of computed tomography and magnetic resonance diffusion-weighted imaging. Journal of Neurology, Neurosurgery & Psychiatry, 76(11), 1528–1533.
Wardlaw, J. M., & Mielke, O. (2005). Early signs of brain infarction at CT: Observer reliability and outcome after thrombolytic treatment – Systematic review. Radiology, 235(2), 444–453.
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. (1995). Tissue plasminogen activator for acute ischemic stroke. New England Journal of Medicine, 333(24), 1581–1587.
Sarraj, A., Hassan, A., Savitz, S. I., Grotta, J. C., Cai, C., Parsha, K., Farrell, C. M., Imam, B., Sitton, C. W., Reddy, S. T., et al. (2018). Endovascular thrombectomy for mild strokes: How low should we go? Stroke, 49(9), 2398–2405.
Zhu, H. F., Newcommon, N. N., Cooper, M. E., Green, T. L., Seal, B., Klein, G., Weir, N. U., Coutts, S. B., Watson, T., & Barber, P. A., et al. (2009). Impact of a stroke unit on length of hospital stay and in-hospital case fatality. Stroke, 40(1), 18–23.
Candelise, L., Gattinoni, M., Bersano, A., Micieli, G., Sterzi, R., & Morabito, A. (2007). Stroke-unit care for acute stroke patients: An observational follow-up study. Lancet, 369(9558), 299–305.
Belagaje, S. R. (2017). Stroke rehabilitation. Continuum, 23(1), 238–253.
Langhorne, P., Coupar, F., & Pollock, A. (2009). Motor recovery after stroke: A systematic review. Lancet Neurology, 8(8), 741–754.
van de Port, I. G., Wood-Dauphinee, S., Lindeman, E., & Kwakkel, G. (2007). Effects of exercise training programs on walking competency after stroke: A systematic review. American Journal of Physical Medicine & Rehabilitation, 86(11), 935–951.
Govender, P., & Kalra, L. (2007). Benefits of occupational therapy in stroke rehabilitation. Expert Review of Neurotherapeutics, 7(8), 1013–1019.
Kwakkel, G., Kollen, B., & Lindeman, E. (2004). Understanding the pattern of functional recovery after stroke: Facts and theories. Restorative Neurology and Neuroscience, 22(3–5), 281–299.
Murphy, T. H., & Corbett, D. (2009). Plasticity during stroke recovery: From synapse to behaviour. Nature Reviews Neuroscience, 10(12), 861–872.
Bernhardt, J., Thuy, M. N., Collier, J. M., & Legg, L. A. (2009). Very early versus delayed mobilisation after stroke. Cochrane Database of Systematic Reviews, 2009, CD006187.
Dromerick, A. W., Lang, C. E., Birkenmeier, R. L., Wagner, J. M., Miller, J. P., Videen, T. O., Powers, W. J., Wolf, S. L., & Edwards, D. F. (2009). Very early constraint-induced movement during stroke rehabilitation (VECTORS): A single-center RCT. Neurology, 73(3), 195–201.
Stroke Unit Trialists’ Collaboration. (2007). Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews, 2007, CD000197.
Fearon, P., Langhorne, P., & Early Supported Discharge Trialists. (2005). Services for reducing duration of hospital care for acute stroke patients. Cochrane Database of Systematic Reviews, 2005, CD000443.
Geerts, W. H., Pineo, G. F., Heit, J. A., Bergqvist, D., Lassen, M. R., Colwell, C. W., et al. (2004). Prevention of venous thromboembolism: The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest, 126(3), 338–400.
Soliman, H. M., Melot, C., & Vincent, J. L. (2001). Sedative and analgesic practice in the intensive care unit: The results of a European survey. British Journal of Anaesthesia, 87(2), 186–192.
Zenz, M., & Willweber-Strumpf, A. (1993). Opiophobia and cancer pain in Europe. Lancet, 341(8843), 1075–1076.
Backnoja, M. (2003). Defining neuropathic pain. Anesthesia & Analgesia, 97, 785–790.
Pop, T., Dudek, J., Drużbicki, M., & Zajkiewicz, K. (2006). Wpływ zmian zwyrodnieniowych w stawach barkowych u chorych po udarze mózgu na powrót funkcji kończyny górnej. Ortopedia Traumatologia Rehabilitacja, 6(6), 658–662.
Al-Hussain, F., & Yoo, W. K. (2013). Neural plasticity and hemispatial neglect in stroke. Journal of the Pakistan Medical Association, 63(10), 1299–1301.
Kwolek, A., & Zuber, A. (2002). Charakterystyka chodu osób z niedowładem połowiczym po udarze mózgu. Neurologia i Neurochirurgia Polska, 36(2), 337–347.
Kwolek, A. (1996). Możliwości zastosowania zastępczego sprzężenia zwrotnego w rehabilitacji chorych z uszkodzeniem ośrodkowego układu nerwowego. Fizjoterapia, 4(1–2), 30–34.
Olney, S. J., & Martin, C. S. (1997). Rehabilitation; physical therapy for stroke. In Cerebrovascular Diseases (pp. 747–750). San Diego: Academic Press.
Marangolo, P., & Caltagirone, C. (2013). Options to enhance recovery from aphasia by means of non-invasive brain stimulation and action observation therapy. Expert Review of Neurotherapeutics, 22, 456–463.
Mattioli, F., Ambrosi, C., Mascaro, L., Scarpazza, C., Pasquali, P., Frugoni, M., et al. (2013). Early aphasia rehabilitation is associated with functional reactivation of the left inferior frontal gyrus: A pilot study. Stroke, 5, 345–352.
Seniów, J., & Członkowska, A. (2003). Poznawcze i emocjonalne konsekwencje udaru mózgu w aspekcie procesu rehabilitacji. Rehabilitacja Medyczna, 7(1), 9–14.
Rahman, H. M., Kittel-Ouimet, T., Saad, M., Kenne, J. P., & Archambault, P. S. (2012). Development and control of a robotic exoskeleton for shoulder, elbow and forearm movement assistance. Applied Bionics and Biomechanics, 9(3), 275–292.
Zhu, Y., Yang, Y.-J., Gu, Y.-H., Xie, B., & Jin, H.-Z. (2013). Efficiency of repetitive transcranial magnetic stimulation on rehabilitation of motor function in patients with stroke: A systematic review. Chinese Journal of Tissue Engineering Research, 17(50), 8758–8768.
Abo, M. (2013). Repetitive transcranial magnetic stimulation and rehabilitation. Rinsho Shinkeigaku, 53(11), 1264–1266.
Hao, Z., Wang, D., Zeng, Y., & Liu, M. (2013). Repetitive transcranial magnetic stimulation for improving function after stroke. São Paulo Medical Journal, 131(6), 440–442.
Song, F. J., Jaing, S. H., Zheng, S. L., Ye, T. S., Zhang, H., et al. (2013). Electroacupuncture for post-stroke urinary incontinence: A multi-center randomized controlled study. Zhongguo Zhen Jiu, 33(9), 769–773.
Jung, J., Cho, K., Shim, S., Yu, J., & Kang, H. (2012). The effect of integrated visual and auditory stimulus speed on gait of individuals with stroke. Journal of Physical Therapy Science, 24(9), 881–883.
Heuschling, A., Gazagnes, M. D., & Hatem, S. M. (2013). Stroke: From primary care to rehabilitation. Revue Médicale de Bruxelles, 34(4), 205–210.
Зозуля, І. С., Зозуля, А. І., & Волосовець, А. О. (2017). Деякі напрямки поліпшення надання медичної допомоги при мозковому інсульті. Український вісник психоневрології, 25(1), 84–85.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Андрій ГОЛЯЧЕНКО, Ігор МИСУЛА, Микола МАЙСТРУК, Тетяна БАКАЛЮК
This work is licensed under a Creative Commons Attribution 4.0 International License.
