Cleland, J.A.

Mafi, H.

Moradi, V.

Nakhostin Ansari, N.

Savari, S.

Shariat, A.

eprints Iran University of Medical Sciences

  Iran J Public Health, Vol. 50, No.1, Jan 2021, pp.209-210                                           Letter to the Editor                                           Copyright © 2021 Moradi et al. Published by Tehran University of Medical Sciences. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited. 209                                                                                                       Available at:    http://ijph.tums.ac.ir    Neurorehabilitation, the Practical Method of Returning to Work after Stroke  Vahide MORADI 1, Hossein MAFI 2, *Ardalan SHARIAT 3, Joshua A. CLELAND 4, Noureddin NAKHOSTIN ANSARI 3,5, Sahar SAVARI 2  1. Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran 2. Department of Motor Behavior, Faculty of Physical Education and Sport Science, University of Tehran, Tehran, Iran 3. Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran 4. Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, USA 5. Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran  *Corresponding Author: Email: ardalansh2002@gmail.com  (Received 10 Jul 2019; accepted 27 Jul 2019)  Dear Editor-in-Chief  Stroke is one of the most common causes of death and disability worldwide. Every year, 16 million individuals suffer a stroke in the world (1). Despite the strong association between the age and major risk factors of stroke, the inci-dence is increasing among young people. Ap-proximately 20–30% of patients who suffer a stroke are younger than 65 yr (2).  Stroke affects not only the health of individuals but also greatly affects their activities of daily living (ADL), fi-nancial situation and their jobs. Complications after  stroke are very debilitating and the morbidi-ties affect general health status of the patients (3).  Having a job solves the financial, social, and per-sonal needs of individuals including patients post-stroke. Returning to work (RTW) is one of the main factors improving quality of life, finan-cial status and satisfaction of work among this population. Success in returning to work after a stroke is associated with increased self-esteem and quality of life (2,4). Hence, returning to work should be among the main goals of rehabilitation in young patients post stroke.  According to a 6-yr follow up the rate of return on work was 48.3% after one year of suffering a stroke and 74.7% within the 6 yr of its onset. In addition,  RTW could happened even up to three years af-ter stroke (3). Despite the importance of RTW in patients post stroke, there are limited rehabilitation programs with a focus on this aim. Recognizing the factors impacting RTW is the basis of designing a neu-rorehabilitation program. Improvements in the ability of walking and muscle weakness have been introduced as effective factors in facilitating RTW. The increase in physical activity level is the first key factors in returning to work (5). Accord-ingly, as long as individuals do have dependency in daily activities (such as walking, sitting, etc.), they cannot return to work (5). The key to designing a stroke treatment plan and preventing its long-term complications is to have a multidisciplinary approach. Recently, neu-rorehabilitation programs concentrate on differ-ent tasks to helping patients with neurological problems including post-stroke.  There are various forms of treatments targeting the post stroke complications. The existing treatments are divided into pharmacological and non-pharmacological categories. There are many non-pharmacological treatments such as muscle stretching, inpatient or outpatient occupational therapies, gait training and electrical stimulation Moradi et al.: Neurorehabilitation, the Practical Method of Returning …  Available at:    http://ijph.tums.ac.ir                                                                                                        210 (6). Among such treatments, functional electrical stimulation (FES) which is a form of electrical stimulation that can improve motor control. FES could enhance individual’s function and ability to walk even in the chronic stage after stroke. Un-like the claims based on the effectiveness of aforementioned neurorehabilitation interventions in returning to work (6), there is a lack of studies that have been designed specifically to evaluate their efficiency on RTW. FES combined with other established modes of rehabilitation, such as cycling or gait training, has the potential to im-prove muscle recruitment and motor outcomes post-stroke and as such, potentially lead to in-creased performance and participation in ADLs. Considering the positive effect of FES and cy-cling on increasing the level of physical function in returning to work after  stroke (6) it seems that planning a structural therapeutic package based on the use of FES in these people is essential.  The purpose of this package is to improve the ability to walk and accelerate the process of re-turning to work in patients post-stroke. The ap-propriate time to complete this therapy is a three sessions weekly for 5 weeks; each session time varies from 15 to 45 min depending to the initial walking ability for each patient. For this process, eight FES electrodes can be used on the quadri-ceps muscle, gluteus maximus, hamstring and tibialis anterior. We suggested that the FES should be set with pulse width of 200-400 μs, stimulation frequency of 25-50 Hz, and the am-plitude should produce muscle activity (based on the patients’ acceptable tolerance). Functional electric stimulation should begin in the supine position and while recumbent cycling progressing to walking in the parallel bars. The last rehabilita-tion phase can be the use of FES while walking on the treadmill. As a take-home message, neurorehabilitation af-ter stroke containing FES training for the aim of returning to work is new and designed to im-prove their quality of life. This type of step by step concurrent electrical stimulation and muscle training in rehabilitation can improve the ability to walk, enhance the individual’s independency in their ADLs. It can also reduce the fatigue, physi-cal disabilities and improves cardiovascular health after stroke. Reducing the muscle spasticity, normalizing gait patterns and cognitive im-provements are other positive effects of this mentioned neurorehabilitation method. All these improvements can enhance not only the quality of life for the affected people, but also financial benefits for governments and employers (7,8).   Conflict of interest  The authors declare that there is no conflict of interest.   References  1. Di Carlo, A (2009). Human and economic burden of stroke. Age Aging, 38(1):4–5.  2. Larsen LP, Biering K, Johnsen SP, et al (2016). Self-rated health and return to work after first-time stroke. J Rehabil Med, 48(4):339–45.  3. Westerlind E, Persson HC, Sunnerhagen KS (2017). Return to work after a stroke in working age persons; a six-year follow up. PLoS One, 12(1):e0169759.  4. Arwert HJ, Schults M, Meesters JJL, et al (2017). Return to Work 2–5 Years After Stroke: A Cross Sectional Study in a Hospital-Based Population. J Occup Rehabil, 27(2):239–246.  5. Edwards JD, Kapoor A, Linkewich E, et al (2018). Return to work after young stroke: A systematic review. Int J Stroke,13(3):243–256.  6. Shariat A, Ansari NN, Shaw BS, et al (2018). Cycling training and functional electrical stimulation for post-stroke patients. Rev Brasil de Med Esport, 24(4):300–302.  7. Shariat A, Najafabadi MG, Ansari NN, et al (2019). The effects of cycling with and without functional electrical stimulation on lower limb dysfunction in patients post-stroke: a systematic review with meta-analysis. NeuroRehabilitation, 44(3), 389-412. 8. Hakakzadeh A, Shariat A, Honarpishe R (2019). Concurrent impact of bilateral multiple joint functional electrical stimulation and treadmill walking on gait and spasticity in post-stroke survivors: a pilot study. Physiother Theory Pract ,1-9.  

Neurorehabilitation, the practical method of returning to work after stroke

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Neurorehabilitation, the practical method of returning to work after stroke

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