Bridging performance of adults with hemiparesis: sliding of the paretic limb.

BACKGROUND: Individuals with hemiparesis resulting from cerebrovascular accident often demonstrate uncontrollable sliding of the paretic lower extremity when attempting to lift their pelvis from a hook-lying position (bridging), during bed mobility. This disorder is often attributed to hypertonicity of the knee extensors, though this assumption has not been confirmed experimentally. PURPOSE: To determine the interaction of limb sliding during bridging with impairments of motor control, knee moments, and spasticity. METHODS: Twenty-seven adults with hemiparesis were assigned to 2 groups on the basis of their ability to perform bridging on a smooth surface. The association of the dichotomous parameter of bridging performance (success/failure) with the other parameters was determined by point biserial correlation, and the predictability of limb sliding was estimated from binary logistic regression. A 2-way repeated-measures analysis of variance was used to determine the differences between knee moments. RESULTS: The group that could perform bridging without sliding had higher moments of the paretic knee flexors and a higher level of motor control than the other group (P = .001). The moments of the paretic flexors and the level of motor control were also correlated with limb-sliding occurrence (r = 0.61 and 0.74, respectively) and served as the best predictors of bridging performance. The paretic knee's flexion moment was found to be more affected than the extension moment (P= .04). CONCLUSION: Low level of motor control and reduced strength of the knee flexors are 2 major deterrents of successful bridging in persons with hemiparesis. The predominant decline of the flexors' moment may reflect a more severe disruption of the flexors' cortical innervation or superior recovery of the extensors.

Assessment of spatial neglect using computerised feature and conjunction visual search tasks.

The purpose of this study was to assess the diagnostic sensitivity of tasks employing feature and conjunction visual searches in stroke patients with unilateral spatial neglect (USN). Seventy-two stroke patients (right/left hemispheric damage with/without USN) and 39 healthy controls participated in the study. Hit rate and reaction time measures of feature and conjunction searches were tested using a newly developed computerised programme for the assessment of visual spatial attention (VISSTA). In addition, subjects received a set of diagnostic paper-and-pencil tests, and were also assessed for the impact of neglect on activities of daily living. Results indicated that the computerised test clearly differentiated between stroke patients and healthy controls, and between the different patient groups. USN patients showed significant contralesional disadvantage in both feature and conjunction visual search tasks. It is proposed that computerised assessment of visual search capacity is a useful and sensitive adjunct to standard paper-and-pencil tests of USN, with the advantage of testing responses based on attention shifts under a time constraint. The learning effects that limit the usefulness of paper-and-pencil tests in longitudinal studies are less likely to affect a computerised test, making it more suitable for monitoring treatment-induced or natural recovery by way of repeated testing.

Neuroprosthesis for footdrop compared with an ankle-foot orthosis: effects on postural control during walking.

OBJECTIVES: We sought to compare the effects of a radio frequency-controlled neuroprosthesis on gait stability and symmetry to the effects obtained with a standard ankle-foot orthosis (AFO). METHODS: A total of 15 patients (mean age: 52.2 +/- 3.6 years) with prior chronic hemiparesis resulting from stroke or traumatic brain injury (5.9 +/- 1.5 year) whose walking was impaired by footdrop and regularly used an AFO participated in the study. There was a 4-week adaptation period during which participants increased their daily use of the neuroprosthesis, while using the AFO for the rest of the day. Gait was then assessed in a 6-minute walk while wearing force-sensitive insoles, by using the neuroprosthesis and the AFO in a randomized order. An additional gait assessment was conducted after using the neuroprosthesis for a further 4 weeks. Gait speed and stride time (inverse of cadence) were determined, as were gait asymmetry index and swing time variability. RESULTS: After the 4-week adaptation period, there were no differences between walking with the neuroprosthesis and walking with the AFO (P > .05). After 8 weeks, there was no significant difference in gait speed, whereas stride time improved from 1.48 +/- 0.21 seconds with the AFO to 1.41 +/- 0.16 seconds with the neuroprosthesis (P < .02). Swing time variability decreased from 5.3 +/- 1.6% with the AFO to 4.3 +/- 1.4% with the neuroprosthesis (P = .01). A gait asymmetry index improved by 15%, from 0.20 +/- 0.09 with the AFO to 0.17 +/- 0.08 with the neuroprosthesis (P < .05). CONCLUSIONS: Compared with AFO, the studied neuroprosthesis appears to enhance balance control during walking and, thus, more effectively manage footdrop.

Transient reversal of anoxic brain injury-related minimally conscious state after zolpidem administration: a case report.

Zolpidem is a unique nonbenzodiazepine sedative hypnotic drug that selectively binds to omega-1 gamma-aminobutyric acid receptors in the brain. Although used for years in Israel and abroad for insomnia, there have been periodic reports of unusual or remarkable neurologic effects in patients with various brain pathologies. Here, we report on a 50-year-old woman 18 months after severe anoxic brain injury in a minimally conscious state. Residual deficits included mutism, athetoid movements of the extremities, and complete dependence for all personal care. After the administration of 5 to 10mg of zolpidem, within 45 minutes, the patient's condition improved markedly, including the cessation of athetoid movements, regained speaking ability, and ability to perform various tasks including self-feeding. These effects lasted 3 to 4 hours, after which the patient returned to her former state. This effect was repeatable on a daily basis. Existing evidence and possible mechanisms to explain zolpidem's effects in brain injury are described.

Hospital disposition after stroke in a national survey of acute cerebrovascular diseases in Israel.

OBJECTIVE: To investigate predictive factors for disposition after acute stroke. DESIGN: A nationwide survey (2004 National Acute Stroke Israeli Survey). SETTING: All 28 primary general medical centers operating in Israel. PARTICIPANTS: Acute stroke patients (n=1583) admitted during February and March 2004 and discharged from the primary hospital. INTERVENTIONS: Data collected on baseline characteristics, stroke presentation, type and severity, in-hospital investigation and complications, discharge disability, acute hospital disposition, and mortality follow-up. MAIN OUTCOME MEASURE: Hospital disposition to home, acute rehabilitation, or nursing facility. RESULTS: Among patients, 58.9% (n=932) were discharged home, 33.7% (n=534) to rehabilitation departments, and only 7.4% (n=117) to nursing facilities. Admission neurologic status was a good predictor of hospital disposition. Patients with severe strokes were mostly discharged to rehabilitation facilities. Patients with significant functional decline before the index stroke, resulting from a previous stroke or another cause, were sent to inpatient rehabilitation less frequently. Disability level at discharge from acute hospitalization had high predictive value in hospital disposition after stroke. In the northern region of Israel, a higher proportion of patients were sent home and a lower proportion to rehabilitation and nursing facilities, probably because of lower availability of rehabilitation care in this region of Israel. CONCLUSIONS: This nationwide survey shows that most stroke survivors in Israel are discharged home from the acute primary hospital. Good functional status before the index stroke is an important predictor for being sent to acute inpatient rehabilitation. Severity of neurologic impairment and level of disability after the stroke at discharge from the primary hospital are strong predictors for disposition after stroke in Israel. Our data may be useful in discharge planning for stroke patients by policy-makers and health care providers in Israel.

Publishing in physical and rehabilitation medicine.

This paper presents the panel discussion from the "Meet the Editor" symposium held at the 4th World Congress of the International Society of Physical and Rehabilitation Medicine in Seoul in June 2007. It includes contributions by four Editors of international journals in rehabilitation. Some of the topics discussed are of a general nature, but will provide useful guidance for the more junior scientific author. Some specific information about the four journals is also presented. Topics discussed include the reasons for publishing in peer review journals, important considerations in submitting a manuscript, the peer review process, the effect of electronic publishing, which leads to shorter publication times and the opportunity to preview papers, and the trend towards more open access to journals. The discussion concludes that the field of physical and rehabilitation medicine will continue to expand, with an audience with a broader range of scientific and clinical interests. The International Classification of Functioning, Disability and Health (ICF) may be increasingly used as a framework in reporting. New journals may be started, particularly in regions of the world other than Europe and the USA, despite the fact that journals currently published in these regions are distributed worldwide.

Publishing in physical and rehabilitation medicine.

This paper presents the panel discussion from the 'Meet the Editor' symposium held at the 4th World Congress of the International Society of Physical and Rehabilitation Medicine in Seoul in June 2007. It includes contributions by four Editors of international journals in rehabilitation. Some of the topics discussed are of a general nature, but will provide useful guidance for the more junior scientific author. Some specific information about the four journals is also presented. Topics discussed include the reasons for publishing in peer review journals, important considerations in submitting a manuscript, the peer review process, the effect of electronic publishing, which leads to shorter publication times and the opportunity to preview papers, and the trend towards more open access to journals. The discussion concludes that the field of physical and rehabilitation medicine will continue to expand, with an audience with a broader range of scientific and clinical interests. The International Classification of Functioning, Disability and Health (ICF) may be increasingly used as a framework in reporting. New journals may be started, particularly in regions of the world other than Europe and the USA, despite the fact that journals currently published in these regions are distributed worldwide.

Return to work following traumatic brain injury: trends and challenges.

PURPOSE: The aim of this paper is to present the current knowledge regarding return to work (RTW) following traumatic brain injury (TBI). METHOD: Based on a Medline search, the authors reviewed the current TBI rehabilitation literature regarding (a) predictive factors for successful RTW, and (b) current concepts in rehabilitative strategies for successful RTW. RESULTS: The functional consequences to the victim of traumatic brain injury (TBI) can be severe. Intensive rehabilitative efforts typically emphasize the early phase and address mainly the accompanying functional deficits in the realm of basic activities of daily living and mobility. An otherwise successful medical rehabilitation may end unsuccessfully because of the failure to return to work, with profound consequences to the individual and family, both economic and psychosocial. Even mild TBI may cause lasting problems in tasks calling for sustained attention. There appears to be a complex interaction between pre-morbid characteristics, injury factors, post injury impairments, personal and environmental factors in TBI patients, which influences RTW outcomes in ways that make prediction difficult. Injury severity and lack of self-awareness appear to be the most significant indicators of failure to RTW. Several medical, psychosocial and rehabilitative therapies are currently being implemented in rehabilitation settings which improve the chances of returning to work. CONCLUSION: Accurate prediction of whether a particular TBI patient will successfully return to work is not feasible, with RTW rates in the 12 - 70% range. A significant proportion of TBI patients, including those who are severely injured, are able to return to productive employment if sufficient and appropriate effort is invested. A comprehensive approach - medical and psychosocial - eventually entailing adequate vocational rehabilitation with supported employment can improve outcomes.

Activities, participation and satisfaction one-year post stroke.

PURPOSE: To evaluate the chronic consequences of stroke in terms of activity limitations, restricted participation and dissatisfaction from life, and the relationship between these variables, in stroke survivors living in the community one-year post onset. METHOD: A total of 56 stroke patients (mean age: 57.7) who completed an in-patient rehabilitation programme, were evaluated one-year post onset in their homes, using the following instruments: Functional Independence Measure (FIM), Instrumental Activities of Daily Living Questionnaire (IADLq), Activity Card Sort (ACS), a work questionnaire, Life-Satisfaction Questionnaire (Li-Sat 9) and the Geriatric Depression Scale (GDS). RESULTS: One year post stroke onset the mean FIM motor score was 75.88 (max score: 91), yet more than 50% of the sample still required assistance (usually mild to moderate) in dressing, bathing and use of stairs. The majority of the sample required full assistance in some IADL domains, notably meal preparation (77%), housekeeping (70%) and laundry (82%). Only one subject returned to paid employment and the mean activity level (ACS), representing the percentage of leisure and IADL activities retained from before stroke, was 42.8%. Satisfaction ratings were generally low but varied between domains. Only 39% were satisfied from 'life as a whole'. The lowest satisfaction rates were noted for 'vocational situation' (14%), 'leisure situation' (34%) and 'ability in self-care' (43%), whereas the satisfaction rate from family life was high (84%). Significant correlations were found between overall life satisfaction scores and the overall FIM motor, IADLq, and ACS scores (Pearson r values: 0.32, 0.48 and 0.57, respectively). Activity level was found to be a significant predictor of satisfaction (p = 0.007) beyond that accounted for by demographic variables and depression. CONCLUSIONS: Stroke survivors dwelling in the community demonstrate long-standing dissatisfaction one-year post onset, correlating with activity limitation and restricted participation. The findings present a compelling need for rehabilitation services with a focus on participation in IADL and leisure activities, in order to improve the satisfaction of this population.

Survey on the use of function assessment and outcome measures in rehabilitation facilities in Israel (SUFA 2004).

BACKGROUND: Measurement of function is an essential component of routine rehabilitation work (mainly for quantifying function at different phases in the rehabilitation process), rehabilitation policy (admission and discharge criteria, length of stay in rehabilitation), goal setting, and outcome measurement. OBJECTIVE: To explore the scope of the scales used for function assessment by the various disciplines of rehabilitation medicine in rehabilitation facilities. METHOD: A structured questionnaire was sent to 36 rehabilitation facilities. Respondents were asked to specify the scales they use for functional assessment for each of 15 selected pathologies. Also examined were satisfaction with the scales, as well as the existence of a computerized database of routine function assessment in the facility and the willingness to create a national agreed "common data set" of the assessments. RESULTS: The general response rate was 86.1% (31 of 36 questionnaires were returned). For the sake of data presentation, rehabilitation facilities were classified into four categories: general, geriatric, pediatric, and community. Most facilities performed function assessment using a total of 125 scales. Heterogeneity was found between facilities and between pathologies. The highest number of scales was found in the area of neurologic pathologies. For most pathologies, assessment of impairment was used more than assessment of disability. Most facilities in the survey did not have a computerized database of function assessments. CONCLUSIONS: A common data set of function assessments in everyday clinical work would ensure standardization without necessarily limiting the use of additional scales and at the same time significantly minimize the current heterogeneity.

Use of medical technologies in rehabilitation medicine settings in Israel: results of the TECHNO-R 2005 survey.

BACKGROUND: With the development of computer technology and the high-tech electronic industry over the past 30 years, the technological age is flourishing. New technologies are continually being introduced, and questions regarding the economic viability of these technologies need to be addressed. OBJECTIVES: To identify the medical technologies currently in use in different rehabilitation medicine settings in Israel. METHODS: The TECHNO-R 2005 survey was conducted in two phases. Beginning in 2004, the first survey used a questionnaire with open questions relating to the different technologies in clinical use, including questions on their purpose, who operates the device (technician, physiotherapist, occupational therapist, physician, etc.), and a description of the treated patients. This questionnaire was sent to 31 rehabilitation medicine facilities in Israel. Due to difficulties in comprehension of the term "technology," a second revised standardized questionnaire with closed-ended questions specifying diverse technologies was introduced in 2005. The responder had to mark from a list of 15 different medical technologies which were in use in his or her facility, as well as their purpose, who operates the device, and a description of the treated patients. RESULTS: Transcutaneous electrical nerve stimulation, the TILT bed, continuous passive movement, and therapeutic ultrasound were the most widely used technologies in rehabilitation medicine facilities. Monitoring of the sitting position in the wheelchair, at the bottom of the list, was found to be the least used technology (with 15.4% occurrence). Most of the technologies are used primarily for treatment purposes and to a lesser degree for diagnosis and research. CONCLUSIONS: Our study poses a fundamental semantic and conceptual question regarding what kind of technologies are or should be part of the standard equipment of any accredited rehabilitation medicine facility for assessment, treatment and/or research. For this purpose, additional data are needed.

Orthostatic hypotension and cerebral blood flow velocity in the rehabilitation of stroke patients.

The objective of this study was to investigate the results of transcranial Doppler monitoring during tilt table tests in stroke patients with and without orthostatic hypotension. In stroke patients without orthostatic hypotension, the mean flow velocity was almost similar in both middle cerebral arteries and was stable during the test. In patients with orthostatic hypotension symptoms, a significant difference was found between the two hemispheres. Mean flow velocity in the damaged middle cerebral artery was lower in the supine position and stayed almost the same at 80 degrees standing. In the non-damaged middle cerebral artery, however, the mean flow velocity was much higher when supine and dropped in the standing position. These findings suggest that the appearance of orthostatic hypotension symptoms may be associated in post-stroke patients with decreased blood velocity in the damaged middle cerebral artery. Those patients are at a high risk of developing syncopal reactions and should be treated on the tilt table with caution, especially at the beginning of the rehabilitation.

Controlled study of neuroprosthetic functional electrical stimulation in sub-acute post-stroke rehabilitation.

OBJECTIVE: Assess the effects of daily neuroprosthetic (NESS Handmaster) functional electrical stimulation in sub-acute stroke. DESIGN: Controlled study, patients clinically stratified to 2 groups; no active finger movement, and partial active finger movements, and then randomized to control and neuroprosthesis groups. Observer blinded evaluations at baseline and completion of the 6-week study. SUBJECTS: 22 patients with moderate to severe upper limb paresis 3-6 months post-onset. METHODS: Patients in day hospital rehabilitation, receiving physical and occupational therapy 3 times weekly. The neuroprosthesis group used the device at home. RESULTS: The neuroprosthesis group had significantly greater improvements in spasticity, active range of motion and scores on the functional hand tests (those with partial active motion). Of the few patients with pain and oedema, there was improvement only among those in the neuroprosthesis group. There were no adverse reactions. CONCLUSION: Supplementing standard outpatient rehabilitation with daily home neuroprosthetic activation improves upper limb outcomes.

Cross-cultural validity of functional independence measure items in stroke: a study using Rasch analysis.

OBJECTIVE: To analyse cross-cultural validity of the Functional Independence Measure (FIM) in patients with stroke using the Rasch model. SETTINGS: Thirty-one rehabilitation facilities within 6 different countries in Europe. PARTICIPANTS: A total of 2546 in-patients at admission, median age 63 years. METHODS: Data from the FIM were evaluated with the Rasch model, using the Rasch analysis package RUMM2020. A detailed analysis of scoring functions of the 7 categories of the FIM items was undertaken prior to testing fit to the model. Categories were re-scored where necessary. Analysis of Differential Item Functioning was undertaken in pooled data for each of the FIM motor and social-cognitive scales, respectively. RESULTS: Disordered thresholds were found on most items when using 7 categories. Fit to the Rasch model varied between countries. Differential Item Functioning was found by country for most items. Adequate fit to the Rasch model was achieved when items were treated as unique for each country and after a few country-specific items were removed. CONCLUSION: Clinical collected data from FIM for patients with stroke cannot be pooled in its raw form, or compared across countries. Comparisons can be made after adjusting for country-specific Differential Item Functioning, though the adjustments for Differential Item Functioning and rating scales may not generalize to other samples.

Abnormal binocular rivalry in unilateral neglect: evidence for a non-spatial mechanism of extinction.

Unilateral spatial neglect (USN) is considered to be an attention deficit, which is primarily related to space. Recent evidence points to the relevance of non-spatially lateralized mechanisms, with impairments found in rapid stimulus presentation conditions. Here we used the phenomenon of binocular rivalry (BR) to explore a non-spatial deficit over long temporal intervals. Six right-hemisphere damaged (RHD) patients with contralesional neglect (USN+), five RHD patients without neglect (USN-) and six normal controls were tested on the basic properties of BR induced by dichoptic presentation of orthogonal gratings at fixation. USN+ patients had much slower perceptual alternations compared to the USN- and normal groups (factors 2.5 and 4, respectively), and were much more sensitive to inter-ocular changes in relative stimulus contrast, which, unlike normals, altered both the suppression and dominance phases. Most notably, a small advantage of one monocular stimulus caused a long-term extinction of the other stimulus in the USN+ group alone. We explain the results in terms of impaired habituation to dominant and attended stimuli, which normally prevents a winner-takes-all behavior and extinction of the weak. This impaired habituation may in turn contribute to inappropriate environmental monitoring and attenuated novelty-seeking behavior.

Awareness of deficits in stroke rehabilitation.

The aim of this study was to evaluate the awareness of deficit profiles of stroke patients undergoing rehabilitation, and examine the impact of unawareness on rehabilitation functional outcomes. Sixty first-event stroke patients, 36 after right hemisphere damage and 24 after left hemispheric damage were included. The Awareness Interview was administered at admission to rehabilitation, and patients' responses were compared with standardized cognitive and neurological evaluations. The FIM motor scale and a safety rating were used to measure functional outcomes at discharge from rehabilitation and at 1-year follow up. The frequency of unawareness for motor and sensory deficits was low, whereas unawareness of cognitive deficits was much higher. Unawareness was not associated with a specific lesion site, however a significant association was found with cortical involvement, and with lesion size. In the right hemispheric damage group a significant negative correlation was found between total unawareness scores and discharge functional outcomes. Multiple regression revealed that unawareness at admission was a significant predictor of discharge FIM motor scores in the right hemispheric damage group, beyond the contribution of cognitive and demographic variables. Findings delineate the multifaceted nature of unawareness phenomenon, and highlight the significance of unawareness in post-stroke rehabilitation.

Disability assessment by a single rater or a team: a comparative study with the Catz-Itzkovich spinal cord independence measure.

The Catz-Itzkovich Spinal Cord Independence Measure was found to be reliable and more sensitive than the FIM to functional changes, when used by a multidisciplinary team. This study was performed to find out whether assessment may be similar when done by a single rater. Twenty-eight patients with spinal cord lesions participated in the study, in which examinations performed within a week by a single nurse or a team were compared for correlation, differences and agreement. The team members scored their relevant fields. A significant correlation was found between the nurse's scoring and that of physiotherapists and occupational therapists (r = 0.82-0.94; p < 0.0001), and the differences between the mean scores were small. The agreement between raters was modest, however (total agreement 38-90%, Kappa 0.17-0.73). It was concluded that although disability assessment performed by a single nurse may not be as accurate as by a multidisciplinary team, it could be reliable and valid.

ICF Core Sets for stroke.

OBJECTIVE: To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of the Comprehensive ICF Core Set and the Brief ICF Core Set for stroke. METHODS: A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF and based on these preliminary studies relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. RESULTS: The preliminary studies identified a set of 448 ICF categories at the second, third and fourth ICF levels with 193 categories on body functions, 26 on body structures, 165 on activities and participation, and 64 on environmental factors. Thirty-nine experts from 12 different countries attended the consensus conference on stroke. Altogether 130 second-level categories were included in the Comprehensive ICF Core Set with 41 categories from the component body functions, 5 from body structures, 51 from activities and participation, and 33 from environmental factors. The Brief ICF Core Set included a total of 18 second-level categories (6 on body functions, 2 on body structures, 7 on activities and participation, and 3 on environmental factors). CONCLUSION: A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for stroke. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

Handgrip strength as a diagnostic tool in work-related upper extremity musculoskeletal disorders in women.

The aim of this study was to determine if handgrip strength might be used as a diagnostic tool in musculoskeletal disorders of the upper extremities in women working in an industrial environment. The setting was an electronic factory with four groups of women (n = 101) in a factory assembling electronic components. Handgrip strength was measured using a Jamar hydraulic hand dynamometer. The study investigated grip strength in managers-engineers, cable wiring, circuit board assembly, integrated circuits women at 90 degrees elbow flexion and 180 elbow extension. Women seeking or receiving medical care for musculoskeletal disorders of the upper extremities or neck showed significant declines (p < 0.01) in handgrip strength and these also related to the type of work and the level of perceived physical exertion. Women in the managerial-engineering group showed fewer musculoskeletal disorders of the upper extremity compared with the other groups and also had significantly stronger handgrip. Our findings encourage us to recommend hand dynamometer testing as a useful diagnostic tool to determine loss of handgrip strength.

Post-stroke follow-up in a rehabilitation center outpatient clinic.

BACKGROUND: Follow-up examinations in a rehabilitation center clinic after stroke are essential for coordinating post-acute services and monitoring patient progress. Of first-stroke patients discharged from our rehabilitation ward to the community 92% are invited for ambulatory check-up once every 6 months. OBJECTIVES: To review patient complaints at follow-up and the recommendations issued by the attending physical medicine and rehabilitation specialist at the outpatient clinic. METHODS: We extracted relevant data from the records and assessed the relationship between functional status on admission and discharge (measured by FIM), length of stay, and number of complaints. Patients were divided according to the side of neurologic damage, etiology, whether the stroke was a first or recurrent event, and main clinical syndrome (neglect or aphasia). RESULTS: Patients' complaints included: decreased hand function (in 40%), general functional deterioration (20%), difficulty walking (11%), speech dysfunction (10%), various pains (especially in plegic shoulder) (8%), urine control (2%), sexual dysfunction (3%), swallowing difficulties (2%), and cognitive disturbances (2%). Patients received the following recommendations: physiotherapy (for 52.5%), occupational therapy (37.5%), speech therapy (12.5%), different bracing techniques (22.5%), pain clinic treatment (12.5%), changing medication prescriptions (7.5%), psychological treatment (10%), sexual rehabilitation (5%), vocational counseling (2.5%), counseling by social workers (2.5%), and repeat neuropsychological diagnosis (2.5%). A reverse correlation was found between the number of complaints and FIM at admission (P = 0.0001) and discharge (P = 0.0003), and between LOS and FIM at admission (P = 0.0001) and discharge (P = 0.004). A direct correlation was found between the number of complaints and LOS (P = 0.029). No relation was found between age, type of stroke, first and recurrent event, and clinical syndromes and patient complaints in the outpatient rehabilitation. Community rehabilitation services met 58% of all recommendations in 62% of patients, mainly physiotherapy and occupational therapy, with 34% of patients waiting for implementation of the recommendations and 4% not available for follow-up. CONCLUSIONS: Follow-up examinations should be an integral part of post-stroke rehabilitation. Rehabilitation treatment in the community must be strengthened.