Author :  Muhammad Naveed Babur

There is a clear evidence that death and disability rate of stoke patient can be reduced by treating them with multidisciplinary approach in stroke care centers. Male and female patients of different age groups can be successfully treated in stroke care unit and there results are always good when we compare multidisciplinary team approach with conventional care in first 1-4 weeks after incidence of stroke. These results are achieved because of early and more intensive protocol of patient management addressing medical problems and focusing on physical rehabilitation. The treatment of acute stroke is more aggressive. Further effective researches are needed to manage and treat acute stroke patient.(1)The rehabilitation of stroke patients in a stroke care unit system is a difficult task as well as difficult in evaluation of the patient. Clinical protocol gives us information about different domains of patient care. There was no clear evidence from randomized trial achieved. New systemic researches shows that those patient who received proper care in stroke unit  have more chances of recovering earlier and perform their daily living activity independently  then those who receive care in general ward.(2)

Evidences provide information that well designed multidisciplinary team unit have beneficent results on motor control and movements which is gained by constraint-induced movement and robotic therapy. Different techniques have different useful effects on gait, balance, coordination and transfer functions. Occupational therapist can also improve activity; cognitive rehabilitation can help in thinking process so all team members work together to get  better results(3). Cochrane Stroke Group has reviewed all randomized and quasi-randomized trials for indoor patients in stroke unit in 2011. The purpose of this review was to gain information of the effectiveness of stroke unit care as compare to other types of treatments for stroke patients. Two reviewers did the assessment independently. The principal reviewer takes interview of the unpublished trials. Outcomes were not dependent on patient’s age, sex and stroke severity but the result outcomes were better in patients who receive treatment in stroke care unit with less hospital stay as compare to other convention treatment. Authors' concluded that indoor Stroke patients who received care in a stroke unit were more improved and live independent at home one year after having stroked.  (4)

A study was randomized control in which 71 patients were included having poor prognosis two groups were made. One is treated with stroke rehabilitation unit and other is treated   in general ward then results of both grouped were compared. Results shows that those patients who received treatment in specialized stroke rehabilitation unit have significant improvement in their outcomes as compare to other group. Many  studies focus or  mild moderate stroke but  this study was conducted on most severe stroke patients that will be helpful for caregiver to manage the severely effective stroke patients at home  (5). A programmed systemic review was designed to evaluate the outcomes of a Specialized Team on Stroke unit within the 24 months of the Yale Stroke Program. They have reviewed different historical and experimental studies done over the past 6 year’s period from 1987 to 1992. Most of the patients were from academic medical centers. The main variables were duration of stay and mortality of the patients. They have concluded through the review that if multidisciplinary team approach is used, the duration of stay and morbidity due to stroke can be reduced. (6)

 Above mentioned studies showed that multidisciplinary team approach in stroke patients has significance improvement in their motor, sensory and cognition hence improve overall health status as well as decrease the death rate. Acquisition of team skills in multidisciplinary team and establishment of stroke units in tertiary care hospitals in Pakistan can reduce the hospital stay and decrease the economic burden upon patients and family.

 

Reference

1.        Sinha S, Warburton E. The evolution of stroke units—towards a more intensive approach? QJM. 2000;93(9):633-8.

2.        Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-8.

3.        Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. The Lancet.377(9778):1693-702.

4.        Trialists’Collaboration SU. Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews. 2001;3.

5.        Kalra L, Eade J. Role of stroke rehabilitation units in managing severe disability after stroke. Stroke. 1995;26(11):2031-4.

 

6.        Webb DJ, Fayad PB, Wilbur C, Thomas A, Brass LM. Effects of a Specialized Team on Stroke Care The First Two Years of the Yale Stroke Program. Stroke. 1995;26(8):1353-7