Improving long-term rehabilitation

The long-term problems of stroke are both physical and mental. Rehabilitation (active promotion of recovery), maintenance (active prevention of deterioration), and care (support for those with disabilities) are intertwined elements of service provision aimed at reducing these problems. Over time, the prevention of deterioration becomes dominant. Currently there is interest in 'intermediate care'--services aiming to provide choices other than inadequate care at home, inappropriate care in hospital, or expensive care in long-term institutions. There is also interest in 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 approaches such as generic workers and co-workers. There is interest too in examining ways in which the social and built environment can be altered to increase the participation of disabled people in society.