Stroke: first HAS recommendations on rehabilitation in the chronic phase

Stroke: first HAS recommendations on rehabilitation in the chronic phase

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The High Authority for Health (HAS) publishes its first recommendations concerning rehabilitation during the chronic phase of cerebrovascular accident (CVA), that is to say from six months after the occurrence of the accident. The publication comprehensively reviews all available methods to indicate whether they are recommended or not.

“In France, stroke affects 150,000 people every year and is the leading cause of acquired disability in adults”, recalls the HAS. While 500,000 people live with sequelae, these have long been considered irreversible. However, the rehabilitation of motor and cognitive functions pursued over the long term can improve the quality of life of patients. »highlights the health agency.

These recommendations, intended for the healthcare professionals involved (prescribing physicians and physiotherapists, physiotherapists, occupational therapists, speech therapists), list the interventions used for motor and cognitive functions, but do not address drug treatments or therapeutic education.

During the chronic phase, a large number of stroke patients present with multiple functional disorders, “such as cognitive, motor or sensory deficiencies, fatigue, psycho-affective disorders, etc. », lists the HAS. It is therefore essential to offer them “adapted rehabilitation follow-up, over time” and supplemented by psychological support if necessary.

Improve autonomy

“The impairment of motor function following a stroke is very common and has a strong impact on the patient’s daily life and autonomy”, it is underlined. Among the methods recommended, first come walking exercises and programs of physical activity and physical exercises (level of evidence A) then biofeedback, orthoses and mirror therapy for the upper limb (level of evidence B ).

For virtual reality, it is recommended but associated with other methods for optimal efficiency (level B). Can also be proposed, but with a lower level of proof (level C), induced constraint of the upper limb, motor mental imagery (associated with another method), rehabilitation of posture and balance or toxin botulinum (combined with another method).

As for robotic-assisted rehabilitation or balneotherapy, for example, “they cannot currently be the subject of recommendations, for lack of available data to scientifically support their benefits”estimates the HAS.

Compensation measures for cognitive disorders

Cognitive rehabilitation helps the patient and his entourage to learn to manage the cognitive disorders induced by the cerebral lesions caused by the AVC. “Memory disorders are frequent and can persist for several years after the occurrence of the accident”, he is reminded. They can aggravate the patient’s dependence, cause psychological distress and even jeopardize his safety. Patients may also have difficulty planning and carrying out two joint tasks or even attention disorders. In this context, the learning of compensation measures, thanks to internal or external aids (lists, diaries, alarms, human aids, etc.), and the acquisition of adaptation skills are part of the rehabilitation process.

In addition, the HAS recommends the practice of a so-called “aerobic” physical activity, that is to say not very intense but maintained, in particular with the aim of improving the speed of information processing.

Aphasia

Concerning the treatment of communication disorders and in particular aphasia, namely the total or partial loss of the ability to communicate by language, the method of repetitive transcranial magnetic stimulation (rTMS) and computerized language rehabilitation accompanied by a therapist are also recommended. The involvement of the caregiver or partner through information and therapeutic education is also indicated. “On the other hand, the current state of scientific knowledge does not allow us to recommend methods such as acupuncture or music therapy”we read.

The HAS points out that the scientific literature available on rehabilitation methods following a stroke is “sometimes limited, even non-existent”. These recommendations may be supplemented and adapted according to new data.

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