Vandcr"traclcn / Rdiabilitacija - ktn IX. -,upi. 1 (:!0/0/ 
THE NEED FOR ACUTE 
REHABILITATION IN STROKE AND 
SPINAL CORD INJURY 
Prof. Guy Vanderstraeten, MD, PhD 
Oepartment of Physical and rehabilitation Medicine, University Hospital, Gent, Belgium 
eywords 
stroke units, spina} cord Iesions, evidence-based rehabilitation 
Acute rehabilitation and stroke 
Stroke units contribute to a significant reduction in death, 
a significant decrease in dependency and a decrease in the 
need for institutional care. Ali types of patients, irrespective 
of gender, age, stroke subtype and stroke severity, appear to 
benefit from treatment in stroke units. Although stroke unit 
care is more costly than treatment in general neurological 
or medica! wards, it reduces post-acute inpatient care costs 
and is cost-effective. In general, stroke units improve the 
acute stroke survival, the short-term functional status and 
the greater likelihood of discharge home. 
Stroke unit setting 
The setting should be organized in a dedicated stroke ward. 
Acute stroke patients are more likely to survive, return home 
and regain independence if they receive organized inpatient 
(stroke unit) care. Stroke units should aim to replicate those 
core service characteristics identified in the randornized 
trials. The absolute benefits of organized inpatient (stroke 
unit) care appear to be sufficiently large to justify the reor­
ganization of services. There is some controversy about the 
number and diversity of disciplines that n.eed to be involved 
in stroke care. 
Acute rehabilitation and spinal cord 
lesions 
The standard in the classification of SCI is the application 
of the International Standards for Classification of Spina! 
Cord Injury, written by the Neurological Standards Com­
rnittee of the American Spina! Injury Association. Persons 
with SCI are among the most physically deconditioned of ali 
humans. As levels of injury, types of injury and the extent 
of organ system dysfunction vary among persons with SCI, 
careful attention must be paid to accurate classification of 
individuals before entry into clinical treatment or study. 
As the foundation of rehabilitation involves exercise, it is 
surprising that so little evidence is available to support its 
use. Substantial research is needed to document the benefits 
of exercise interventions post-SCI. 
New approach to study the contents 
and outcomes of spinal cord injury 
rehabilitation: the SCIRehab project 
The literature provides clear evidence of the success of 
modem medica} rehabilitation for SCI, but also highlights 
that much more research into the nature, quality, and effec­
tiveness of inpatient rehabilitation is needed. Application of 
the criteria of the evidence-based medicine movement has 
exposed the fact that little high-quality evidence, produced 
using RCTs or other rigorous research designs, exists to show 
the effectiveness of rehabilitation or even specific rehabilita­
tion treatments. Severa! studies concluded that longer stays 
.in rehabilitation facilities were associated with increased 
functional gains, but variations in improvement rates were 
seen in different impairment groups. A number of studies 
have found that early SCI rehabilitation is beneficial. 
References 
l. Kaira, L. and P. Langhorne (2007). Facilitating re­
covery: evidence for organized stroke care. J Rehabil
Med 39(2): 97-102.National Guidelines Clearinghouse
(Canada)
2. Quinn, T. J., S. Paolucci, et al. (2009). Evidence-based
stroke rehabilitation: an expanded guidance document
from the European stroke organization (ESO) guidelines
for management of ischernic stroke and transient isch­
ernic attack 2008. J Rehabil Med 41(2): 99-111.
3. Rodin, M., D. Saliba, et al. (2006). Guidelines abstracted
from the Department of Yeterans Affairs/Department of

Vandcrslractcn / Rchahilitacip - kt n. IX. -.upi. J / 20/0J 
Defense clinical practice guideline for the management 
of stroke rehabilitation. J Am Geriatr Soc 54(1): 158-
62. 
4. Bernhardt, J., M. N. Thuy, et al. (2009). Very early versus
delayed mobilisation after stroke. Cochrane Database
Syst Rev(l): CD006187.
5. Stroke Unit Trialists' Collaboration. Organized inpa­
tient (stroke unit) care for stroke. Cochrane Database of
Systematic Reviews 2007, lssue 4. Art. No.: CD000197. 
DOi: l0.l002/14651858.CD000197.pub2. 
6. Teasell, R., M. J. Meyer, et al. (2009). Stroke rehabilita­
tion: an international perspective. Top Stroke Rehabil
16(1): 44-56.
7. lndredavik, B. (2009). Stroke unit care is beneficiat both
for the patient and for the health service and should be
widely implemented. Stroke 40(1 ): 1-2.