Stroke-unit treatment: Long-term effects

Abstract

Since the 1990s, stroke units have emerged as core elements in effective acute stroke treatment. Consistent adherence to key processes of stroke care, primarily based on efficient organisational structures, has been the cornerstone of success. On the basis of huge datasets of high quality there is now conclusive evidence of the significant contribution of stroke unit care to diminished mortality and functional dependency in the long term. In the subjective awareness of the affected individuals quality of life has improved considerably. Meanwhile the concept has emerged as a platform for new ideas and research promoting stroke care and early neurorehabilitation. This dynamic process includes exploring specific treatment of comorbidities and the prevention of early recurrence of stroke, as well as the contribution of occupational and speech and language therapy in the acute phase and their interaction with long-term outcome. Current issues include strategies in assessment and treatment of atrial fibrillation, hypertension and diabetes mellitus at hyperacute and acute stage, models of prognostic value in dysphagia used to prevent its inherent risks, and concepts of early language and speech therapy to enhance functional communication. In neurorehabilitation, targeted treatment referred to pathophysiological mechanisms and perception of idiosyncratic in addition to common aspects of functional impairment are major concerns.