the first HAS recommendations on rehabilitation during the chronic phase

In France, half a million people live with the after-effects of a stroke. As we know, the survival of the patient and the possible repercussions depend on the speed of the initial treatment. Then, a serious follow-up during the months and years after the stroke is also essential to limit its long-term consequences.

Until now, there was no recommendation concerning the rehabilitation to be implemented during the chronic phase of the stroke, that is to say beyond 6 months after the occurrence of the accident. . To overcome this lack, HAS has drawn up recommendations on the relevance, indications and methods of rehabilitation during this phase of the pathology.

Improve autonomy by re-educating motor function
Impairment of motor function following a stroke is very common and has a strong impact on the patient’s daily life and autonomy.

It must therefore be the subject of a rehabilitation followed and adapted, by the re-educator, to the specific profile of the patient concerned. This motor rehabilitation of the upper and lower limbs is carried out by therapeutic methods practiced manually or with instruments.

Motor function rehabilitation also includes physical activity programs, including exercise and walking. After a stroke, a lack of physical activity has adverse consequences on cardio-respiratory function, muscle function and can also have a psychological impact on patients.

It is of course essential to carry out these exercises within the framework of a medicalized care with an accompaniment adapted by a rehabilitator. Certain techniques such as virtual reality are also recommended, but must be combined with other methods for optimal effectiveness.

Finally, other techniques such as robotic-assisted rehabilitation or balneotherapy cannot currently be the subject of recommendations, for lack of available data to scientifically support their benefits.

Relearning to live on a daily basis by re-educating cognitive function
Cognitive rehabilitation helps the patient and his family learn to manage the cognitive disorders induced by the brain damage caused by the stroke. Here again, the objective is to improve the patient’s quality of life and reduce the impact of the after-effects on his daily life and that of his loved ones.

Among the cognitive disorders observed following a stroke, memory disorders are frequent and can persist for several years after the onset of the accident. 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.

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 make it possible to recommend methods such as acupuncture or music therapy.

The HAS specifies that the symptoms observed and their sequelae are so different from one patient to another that it is difficult to obtain similar results.

It is important to note that the scientific literature available on rehabilitation methods following a stroke is sometimes limited, or even non-existent. The work of the HAS on rehabilitation during the chronic phase of stroke will therefore have to be supplemented and adapted according to the new data available…

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