The evidence for rehabilitation after severely disabling stroke

Six months after stroke around 9–21% of survivors are severely disabled, fully dependent in self-care tasks and live in institutions. The cost of stroke is huge and a large proportion is spent on residential care. Little is known about the potential for recovery in this group and the effects of physiotherapy and rehabilitation. Methodological problems exist, as measures routinely used with more able patients may not detect change. Studies of small groups of severely disabled patients suggest that recovery may take place more slowly and for longer than in less affected patients. Two descriptive studies and one randomized control trial have demonstrated that there may be potential for improvement with rehabilitation. Other trials of physiotherapy and rehabilitation with chronic stroke have demonstrated improvements in both impairments and disabilities. The evidence suggests that there are reasonable grounds for developing improved measures, evaluating carefully focused interventions, and for targeting those areas which incur the greatest costs.