Efficacy of stroke rehabilitation.

There are several methodological difficulties in the assessment of the effe ctiveness of rehabilitation in stroke patients. Obviously, double-blind stu dies are not possible, and only single-blind procedures can be used. It is difficult to control for non specific effects, such as spontaneous recovery , patient's and therapist's motivation, social environement. It is necessar y to assess the effect non only at the level of impairments, but also on di sability and handicap. However, there are now accumulating data in the lite rature suggesting that stroke rehabilitation has a significant, although mi ld, effectiveness. Patients treated in specialized stroke rehabilitation un its obtain a better outcome, in terms of independence in daily-life activit ies, than those treated in general wards. They also have shorter hospitalis ation durations and are more frequently able to return home. Treatment effe ctiveness is related to intensity and duration of rehabilitation, and also to stroke severity. Patients with moderate impairments seem to benefit more from treatment than patients with mild or severe deficits. However, signif icant improvements can still be obtained in very severe cases, and even lat e (up to two years) post stroke. Similarly, rehabilitation of cognitive def icits (aphasia and unilateral neglect) has also been found efficient in mos t studies, even if the beneficial effect is relatively small. Aphasic patie nts treated by speech therapists improve more than patients treated by non specialized therapists or by family members who received a short training. One limitation of neglect rehabilitation is the inconsistent generalisation of treatment effects to daily-life situations. These data are encouraging but further research is needed to find out what precisely works, and how, i n the "black box" of rehabilitation.