GUEST EDITORIAL
■  by Sheena Irw in-C arruthers

Stroke is an area of m ajor concern to physiothera­
pists. It is of particular concern to physiotherapists in 
Africa w here patients are often discharged from  hospi­
tal after 48 hours, follow -up in rural areas and peri-ur­
ban inform al settlem ents is frequently difficult if not 
im possible, there are few physiotherapists and there is 
no finance for equipm ent or lengthy periods of rehabili­
tation.

As recently as 1994 it was stated at a m ajor congress 
that stroke is a condition that prim arily affects the eld­
erly1. A lthough this was a quote from  a decade earlier2, 
it was obvious that this was the opinion of the majority 
of delegates present. Yet we in south Africa are being 
challenged by an increasing population of people who 
suffer a stroke at a m uch earlier age -  in the twenty to 
forty year age-group. In  terms of econom ics this is a 
disaster, to the patient and his fam ily as w ell as to the 
com m unity and the country. H ow  can w e help these 
people to achieve functional independence and eco­
nom ic self-sufficiency? How can w e help the elderly 
person w ith hem iplegia to regain and retain dignity and 
independence w ithin their community?

All too often therapy, w hen it is available, is directed 
prim arily at fu nctional locom otion. Follow  up fre­
quently reveals that, although the person is m obile on 
his feet, he is not independent in all the activities which 
he needs for daily life in his w ork and at home. Often 
cognitive, social and em otional factors are ignored3. 
Even in the area of physical rehabilitation there m ay be 
uncertainty regarding the best approach to treatment. 
How can w e be sure that, in the often limited time 
available for rehabilitation, we are offering the best 
service possible?

W e have to adm it that w e d on 't really know. A l­
though convinced in our ow n m inds of the benefits of 
one or other approach, w e cannot prove these benefits 
to an unbiased outsider. W hen surveying the several 
hundred research articles on stroke w hich have ap­
peared in  the last two years, although I found many on 
epidem iology, etiology, m edical treatm ent and even 
assessm ent, there w ere only a handful on results of 
physiotherapy (see page 45 of this issue). The two re­
search articles and one abstract appearing in this issue 
of the South A frican Journal of Physiotherapy illustrate 
this trend, although they are in themselves an important 
indication that physiotherapists are starting to be w ill­
ing to undertake research and expose their m ethods and 
results to scrutiny. This is a good beginning and clini­
cians and academ ics should do everything in their

power to encourage and nurture such research.
The European Region of the W orld Confederation 

recognised the im portance of stroke to physiotherapists 
w hen they chose this as the subject of their very first 
international congress in 1994. A t the conclusion of the 
Congress the follow ing points em erged as being of 
great im portance to a person w ho has suffered a stroke4:
• Physiotherapy has to be com m enced early after 

stroke
• If at all possible the sam e physiotherapist should 

follow the treatm ent through, from  acute care to final 
rehabilitation. If that is not possible, there should

• then be a core physiotherapist w ith responsibility for 
overall management.

• There should be coordination of physiotherapy with 
other therapies.

• There needs to be a m uch better coordination of the 
m anagem ent of patients in transferring them from 
hospital to home. Services need to be in place in the 
community.

• Real rehabilitation begins w hen the patien t arrives 
home.
In  relation to these recom m endations, it is encourag­

ing to read the articles by Bakkes et al in this issue. 
Therapists in this country are increasingly com m itting 
them selves to com m unity h ealth  program m es and, 
where these have not yet been established, to outreach 
programm es from  existing hospital facilities. Have we 
perhaps reached the stage of developm ent w hen a con­
gress devoted to the problem s of stroke could be organ­
ised in this country? A recent, extrem ely successful, 
com bined congress on neurodevelopm ental therapy 
and sensory integration w as held in Cape Tow n and 
proved that theme congresses can be w ell supported. 
Perhaps the N eurological Rehabilitation Group of the 
SASP w ould like to take up this challenge and m ake the 
organisation of such a congress one of their short-term  
goals.

REFERENCES
1. A s h b u rn  A. A  re v ie w  o f c u r r e n t p h y s io th e ra p y  in the 

m a n a g e m e n t o f stro k e , in : H a rr is o n  M  A  (ed ) Physiotherapy 
in Stroke Management, E d in b u rg h , C h u rc h ill L iv in g s to n e , 
1995:3022.

2. A n d re w  K , B ro c k le h u rs t J , R ic h a rd s  B et al. T h e  in flu e n c e  of 
a g e  o n  th e clin ic a l p re s e n ta tio n  a n d  o u tco m e  o f stro k e , Int 
Rehab Med 19 8 4 :6;49-53.

3. F o r ste r A , Y o u n g  J. S tro k e  re h a b ilita tio n . C a n  w e  do b etter? 
BMJ 1 9 9 2 :3 0 5 ;1 4 4 6 -1 4 4 7 .

4. H a rr is o n  M . Physiotherapy in Stroke Management, E d in ­
b u rg h , C h u rch ill L iv in g s to n e  1 995:x ix .

B la d s y  2 6  M e i 1996 SA T y d s k rif F is io te r a p ie , D e e 1 5 2  N o  2

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