This chapter reviews the anatomic and physiological basis of sensory systems, the impact of stroke on vestibular and visual function, and rehabilitation approaches. In reviewing visual and oculomotor deficits, it describes the epidemiology, natural history, impairments, and the impact on visual ability, and rehabilitative and/or restorative therapies in stroke-related vision loss. Although therapies for speech, language, motor disorders, and cognitive dysfunction are universally accepted and implemented as part of stroke rehabilitation, vision-sensory and oculomotor disorders are still widely neglected. When a stroke impacts both the parietal and occipital lobe, an important distinction must be made in the continuum between homonymous visual field disorder (HVFD) with and without unilateral spatial inattention (USI). Measuring visual acuity (VA) in a stroke patient can be challenging, especially in the presence of aphasia and cognitive impairment, and at times it is necessary to deviate from standard Snellen acuity testing.

This chapter provides a general overview of the impact of stroke on the family, and explores existing literature regarding stroke caregiver interventions, which are designed to support families of stroke survivors through recovery and rehabilitation. Family caregivers have a variety of needs and concerns related to stroke care and also experience negative outcomes such as depression, declining health, and other life changes such as social and financial problems. Finding information about stroke is especially important for families because spouses and other family members are commonly the initiators of emergency care for stroke survivors. Current guidelines recommend management of hypertension, diabetes, and cholesterol in stroke survivors, along with counseling to avoid smoking, heavy alcohol consumption, and obesity. Managing emotional and behavioral reactions of the stroke survivor are among the most stressful aspects of providing care for family caregivers.

This chapter provides a comprehensive review of upper-and lower-limb clinical applications of neuromuscular electrical stimulation (NMES) specifically for the hemiparetic stroke survivor. NMES is applied in hemiplegia as either a therapy or an assistive device. The chapter provides an overview of the basic neurophysiologic principles that underlie all NMES applications. These include principles of electrical activation of muscle, modulation of muscle contraction, and safe delivery of electrical current. It describes basic NMES system components, which include the electrodes, neurostimulator, and controller. The chapter presents an overview of therapeutic applications of NMES, limited to upper- and lower-limb poststroke motor relearning. It reviews the clinical poststroke neuroprosthetic applications for upper-limb activities of daily living (ADLs) and lower-limb mobility. The chapter also presents a critical review of the stroke NMES literature and our perspective on promising research initiatives for future clinical NMES systems.

Task-oriented training has emerged as the dominant approach to motor restoration for stroke-induced motor impairments. This chapter provides the background for the emergence of a task-oriented/task-specific approach to promote functional recovery after stroke. After stroke, there is evidence to suggest that the emergent movement kinematics are organized differently for real objects compared with simulated or artificial objects. Considerable work using animal models of stroke suggest that functional brain remodeling may be critically contingent upon the behavioral demands of the training and the acquisition of motor skills associated with learning a novel task. In humans, the optimal therapeutic window after stroke for rehabilitation of the upper limb remains to be established. Imaging studies provide evidence of ongoing cortical reorganization of motor systems for several months after stroke. Most of the clinical research up until recently has been conducted in the chronic phase of stroke recovery.

This chapter provides an overview of current practice in the orthotic management of stroke for both upper and lower limbs, describing different orthotic treatments, when and why they are provided, and how they work. Orthoses play a role in preventing or correcting upper-extremity deformities in stroke that result from limited range of motion. Paresis following stroke can also contribute to the development of various abnormalities and deformities, especially when coupled with spasticity. Generally, upper-limb assistive devices, including plaster casts, slings, wheelchair attachments, and orthoses, are used following stroke to prevent or correct contracture, maintain limb position, and improve or assist function. Contracture management is important for both the upper and lower limb, as more than 50% of individuals develop contractures following stroke. Following stroke, shoe modifications may be used, alone or (more likely) in conjunction with lower-limb orthoses, to improve ankle-foot function.

Numerous investigations over the past 25 years have established important differences in the incidence, epidemiology, etiology, treatment, and outcomes of stroke in young adults compared to older populations. Women, as a group, experience an increase in stroke risk during their childbearing years because of the hazards of pregnancy and the puerperium as well as the use of oral contraceptive (OC) medications, particularly in combination with smoking. Population-based studies in American cities have documented a higher incidence of stroke in young blacks compared to whites. Advances in craniocervical imaging in the past two decades have improved detection of several important causes of stroke in young adults. Pregnancy and the puerperium are a time of increased risk of stroke for young women. A number of drugs of abuse and medications have been linked to stroke in young adults.

Deborah Mack underwent a few weeks of outpatient physical, occupational, and speech therapy to compensate for the minor physical deficits the stroke had caused. She was released from further care with a clean bill of health, after having an outpatient surgical procedure to close the atrial septal defect (ASD) in her heart. This hole between the atria had allowed a blood clot to reach her brain, thus causing the stroke. Between her husband’s and her efforts, they were able to find an acupuncture clinic that treated stroke and movement disorders right at the hospital where she was going for traditional medical care. She think coping with dystonia or any poststroke chronic condition is a matter of choosing to focus on the positive and testing the boundaries of one’s abilities. Learning to cope with poststroke dystonia has been and continues to be a process.

This chapter outlines the physical activity, sports, and recreation may greatly affect outcomes related to enhancing secondary stroke prevention, neurorecovery, and quality of life (QOL). Sports and recreation can be powerful tools to enhance the abilities of stroke survivors, rather than focusing on the impairments or functional loss incurred at the time of injury. Therapeutic exercise is a mainstay of stroke rehabilitation. A decline in aerobic fitness resulting from physical inactivity may increase the risk of cardiovascular disease and subsequent strokes or myocardial infarctions. Studies also implicate cardiovascular exercises in improving cerebral blood flow after stroke. Studies on stroke rehabilitation point to task repetition as a way to enhance brain remodeling and maintain long-term function. Recreational activities such as listening to or performing music, dancing, and participating in tai chi or yoga should also be considered as potential strategies in the rehabilitation of stroke survivors.

This chapter presents a discussion of special considerations in the management of stroke recovery and rehabilitation for older adults. It describes the incidence, prevalence, and economic impact of stroke in the aging population. The chapter discusses the management of common risk factors for recurrent stroke. It addresses challenges to successful rehabilitation in older adults with stroke, and suggests strategies to overcome barriers and optimize outcomes. Factors, such as onset stroke severity, preexisting disability, and atrial fibrillation (AF), are significant age-related independent predictors of prognosis after stroke. Poststroke guidelines recommend transfer to a stroke-specific rehabilitation unit as soon as possible to ensure early mobilization; availability of speech, physical, and occupational therapy; rehabilitation psychology; and the social support derived from interaction with other stroke survivors. A recent literature review indicated that most studies on economic impact of stroke emphasize the short-term costs associated with hospital and intensive care unit (ICU) care.