Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage. Methods— A formal literature search of MEDLINE was performed. Data were synthesized with the use of evidence tables. Writing committee members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council’s Levels of Evidence grading algorithm was used to grade each recommendation. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statements Oversight Committee and Stroke Council Leadership Committee. It is intended that this guideline be fully updated in 3 years’ time. Results— Evidence-based guidelines are presented for the care of patients presenting with intracerebral hemorrhage. The focus was subdivided into diagnosis, hemostasis, blood pressure management, inpatient and nursing management, preventing medical comorbidities, surgical treatment, outcome prediction, rehabilitation, prevention of recurrence, and future considerations. Conclusions— Intracerebral hemorrhage is a serious medical condition for which outcome can be impacted by early, aggressive care. The guidelines offer a framework for goal-directed treatment of the patient with intracerebral hemorrhage.

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.

/pdf/guidelines-for-management-of-ischaemic-stroke-and-transient-1bttxqchx4.pdf

Guidelines for management of ischaemic stroke and transient ischaemic attack 2008

Loss of functional movement is a common consequence of stroke for which a wide range of interventions has been developed. In this Review, we aimed to provide an overview of the available evidence on interventions for motor recovery after stroke through the evaluation of systematic reviews, supplemented by recent randomised controlled trials. Most trials were small and had some design limitations. Improvements in recovery of arm function were seen for constraint-induced movement therapy, electromyographic biofeedback, mental practice with motor imagery, and robotics. Improvements in transfer ability or balance were seen with repetitive task training, biofeedback, and training with a moving platform. Physical fitness training, high-intensity therapy (usually physiotherapy), and repetitive task training improved walking speed. Although the existing evidence is limited by poor trial designs, some treatments do show promise for improving motor recovery, particularly those that have focused on high-intensity and repetitive task-specific practice.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(09)70150-4.pdf

Motor recovery after stroke: a systematic review

Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods—Writing group members were nominated by th...

Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association

http://ecuanst.weebly.com/uploads/6/0/6/0/60601319/cognitive_rehabilitation-_meta-analysis_and_review.pdf

Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008.

https://www.archives-pmr.org/article/S0003-9993(05)00319-9/pdf

A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury.

Background and Purpose . This case report describes a patient with upper-limb hemiparesis (ULH) who received a program combining physical therapy for the affected side with mental practice. Case Description . The patient was a 56-year-old man with stable motor deficits, including ULH, on his dominant side resulting from a right parietal infarct that occurred 5 months previously. He received physical therapy for an hour 3 times a week for 6 weeks. In addition, 2 times a week the patient listened to an audiotape instructing him to imagine himself functionally using the affected limb. The patient also listened to the audiotape at home 2 times a week. Pretreatment and posttreatment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment (Fugl-Meyer Scale), the Action Research Arm Test (ARA), and the Stroke Rehabilitation Assessment of Movement (STREAM). Outcomes . The patient exhibited reduction in impairment (Fugl-Meyer Scale) and improvement in arm function, as measured by the ARA and STREAM. Discussion . Mental practice may complement physical therapy to improve motor function after stroke.

/pdf/mental-practice-combined-with-physical-practice-for-upper-4jwkkauubf.pdf

Mental Practice Combined With Physical Practice for Upper-Limb Motor Deficit in Subacute Stroke

This case series examined the feasibility and efficacy of a modified constraint induced therapy (CIT) protocol administered on an outpatient basis. The Fugl-Meyer Assessment of Motor Recovery After Stroke (Fugl), Action Research Arm Test (ARA), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL) were administered to six patients between 2 and 6 months poststroke (CVA) exhibiting stable motor deficits and learned nonuse of the affected limb. Two patients then participated in half-hour physical and occupational therapy sessions three times/week for 10 weeks. During the same period, their unaffected arms and hands were restrained 5 days/week during 5 hours identified as times of frequent use. Two other patients received regular therapy and two control patients received no therapy. The ARA, Fugl, WMFT, and MAL were again administered after 10 weeks. Patients receiving modified CIT exhibited substantial improvements on the Fugl, ARA, and WMFT, as well as increases in amount and quality of use of the limb using the MAL. Patients receiving traditional or no therapy exhibited no improvements. Results suggest that modified CIT may be an efficacious method of improving function and use of the affected arms of patients exhibiting learned nonuse.

Modified constraint induced therapy: a randomized feasibility and efficacy study.

Objective:To determine the efficacy of a modified constraint-induced therapy (mCIT) administered to patients with subacute stroke.Design:Prospective, multiple-baseline, before-after, randomized cli...

Modified constraint-induced therapy after subacute stroke: a preliminary study.

https://www.archives-pmr.org/article/S0003-9993(95)80532-X/pdf

Mark V. Johnston

Papers

A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury.

Mental Practice Combined With Physical Practice for Upper-Limb Motor Deficit in Subacute Stroke

Modified constraint induced therapy: a randomized feasibility and efficacy study.

Modified constraint-induced therapy after subacute stroke: a preliminary study.

Shoulder subluxation after stroke: A comparison of four supports