Stroke Rehabilitation: Multidisciplinary Perspectives

95 Social and scientific data support the growth of the field of stroke rehabilitation (and neurorehabilitation more broadly). From a societal perspective more people with stroke need rehabilitation. Worldwide, there are estimated to be 62 million stroke survivors (Strong, Mathers, & Bonita, 2007), with the proportion of disabled survivors increasing over time (Carandang et al., 2006). Scientifically, evidence from animal and human studies demonstrates the importance of skill training and learning on facilitating neural plastic changes (Carey & Seitz, 2007; Nudo, 2007). Our challenge is to translate our understanding of the brain and behaviour into clinical practice so that we can improve the quality of life of those we treat. These advances need to be implemented in the wider context of stroke rehabilitation as it affects individuals, the family, service provision, population health and productivity. In this special issue on stroke rehabilitation we sought to bring together a multidisciplinary perspective on issues that impact stroke rehabilitation. Authors come from a range of disciplines including geriatrics, neurology, occupational therapy, physiotherapy, speech pathology, nursing, epidemiology, experimental psychology and neuropsychology. Moreover, topics discussed in each article typically involve a contribution from more than one health professional, most of whom have both clinical and research expertise. Importantly, an international perspective is reflected with input from authors from the United Kingdom, Europe, the United States, and Australia. The articles include theoretical reviews and empirical studies. Topics discussed range from those that directly impact on an individual’s rehabilitation such as neural plasticity and motor learning, handgrip limitation, and treatment compliance, to the potential role of family members in rehabilitation and the relationship between social support and the informal caregiver role. The impact of stroke on return to work and communication outcomes is also discussed. Finally, future directions for aphasia therapy, conduct of clinical rehabilitation trials and the benefits and challenges of stroke research in developing countries provide direction for future rehabilitation and research. It is anticipated that many of these issues, as summarised below, will also be of direct relevance to rehabilitation of brain impairment in other patient groups. Professor Lindley in his stroke rehabilitation commentary provides a succinct overview of the main issues facing health care providers working in stroke. In particular, he highlights the interventions that are known to be effective, the evidence–practice gaps that exist in providing best practice care, the importance of conducting research in stroke units and the potential way forward in the advancement of stroke rehabilitation to maximise the potential for recovery. The value of rehabilitation and need to adopt approaches based on neuroscience has intensified over the past decade. Seitz, Matyas, and Carey review the literature on neural plasticity as a basis for motor learning and neurorehabilitation. Advances in our understanding of motor learning and neural plasticity, gained from behavioural and neuroimaging studies, provide direction for current and future rehabilitation of motor functions. The relationship between sensory discrimination of object slip and handgrip limitation is examined by Blennerhassett, Carey, and Matyas in a sample of 45 stroke survivors. The findings support the conclusion that impaired somatosensory processing may contribute to handgrip limitation following stroke, and recommend that attention be directed to processing of tactile cues arising between the object and skin when training handgrip ability. Adherence to treatment impacts on the likely success of rehabilitation programs. Coetzee, Andrewes, Khan, Hale, Jenkins, Lincoln, and Disler investigated factors that predict adherence to treatment (i.e., medication) in stroke patients, in comparison to amputee patients. Factors contributing to poor adherence included emotional and cognitive dysfunction, beliefs about medication, and social support.