Improving long-term rehabilitation

The long-term problems of stroke are both physical and mental. Rehabilitati on (active promotion of recovery), maintenance (active prevention of deteri oration), and care (support for those with disabilities) are intertwined el ements of service provision aimed at reducing these problems. Over time, th e prevention of deterioration becomes dominant. Currently there is interest in 'intermediate care' - services aiming to pro vide choices other than inadequate care at home, inappropriate care in hosp ital, or expensive care in long-term institutions. There is also interest i n stroke coordinators to manage community services. These developments have exposed problems of inequity (e.g. minority groups) and service provision (e.g. a shortage of trained staff). This had led to experiments in novel ap proaches such as generic workers and co-workers. There is interest too in examining ways in which the social and built envir onment can be altered to increase the participation of disabled people in s ociety.