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Clinical Pathways in Stroke Rehabilitation

Edited by Thomas Platz (Ed.)

This is a World Federation for NeuroRehabilitation (WFNR) educational initiative, bridging the gap between the rapidly expanding clinical research in stroke rehabilitation and clinical practice across societies and continents.
Open access, with free and unlimited access. Download at 

Evidence-based Clinical Practice Recommendations

Focusing on practical clinical problems that are frequently encountered in stroke rehabilitation, this book provides evidence-based clinical practice guidelines for stroke rehabilitation.  It discusses clinical problems and evidence, comments on assessment, therapy and technical aids.

Consequences of diseases, e.g. impairments and activity limitations, are addressed in rehabilitation with the overall goal to reduce disability and promote participation. Based on the available best external evidence, clinical pathways are described for stroke rehabilitation bridging the gap between clinical evidence and clinical decision-making.

The clinical pathways answer the questions which rehabilitation treatment options are beneficial to overcome specific impairment constellations and activity limitations and are well acceptable to stroke survivors, as well as when and in which settings to provide rehabilitation over the course of recovery post stroke. Each chapter starts with a description of the clinical problem encountered. This is followed by a systematic, but concise review of the evidence (RCTs, systematic reviews and meta-analyses) that is relevant for clinical decision-making, and comments on assessment, therapy (training, technology, medication), and the use of technical aids as appropriate.

Based on these summaries, clinical algorithms / pathways are provided and the main clinical-decision situations are portrayed. The book will be invaluable for all neurorehabilitation team members, clinicians, nurses, and therapists in neurology, physical medicine and rehabilitation, and related fields.

It can be used for both clinical decision-making for individuals and as well as clinical background knowledge for stroke rehabilitation service development initiatives.

Obituary Dr Mario Patricolo

Mario, a man larger than life, left us on 19th October 2019. He was born in Rome to Angelo Patricolo and Antonietta Bianchi on 30/06/1960. His father was an eminent Neurosurgeon of his times and it was this exposure to medicine and surgery that nurtured an early keenness in him to be a medic and a surgeon. He studied his medicine in Rome where he also trained as paediatric surgeon. From early stage in his medical career he was drawn to academics including teaching and research. He moved to United Kingdom in 2003 and worked for the most part in Norfolk and Norwich Hospital in Norwich. He got married to the love of his life, Karen in 2004.

He decided to move to Abu Dhabi in 2007 and remained here for the rest of his living years. It was here that he thoroughly blossomed as an advocate for academia and worked tirelessly to promote education and learning. Although a paediatric urologist, he became interested in rehabilitation as part of management of children with neuropathic bladder and bowel. Throughout, he was an active member of International Children Continence Society and joined Word Federation for Neurorehabilitation to promote internationally the multidisciplinary care of children with neuropathic bladder and bowel. His passion for spreading the message was immense. He organized several national and international conferences, symposia and teaching courses. Right up to his last days he was actively engaged in organizing such events and even from his sick bed he consistently sent emails and whattsApp messages in this pursuit. Mario was a very caring physician, who looked after his patients and their families with utmost diligence and dedication.  

Mario is survived by his wife Karen, two daughters Bianca and Charlotte and two sons, Alex and Giorgio as well as 6 grandchildren.   

Mario will be very much missed by his family and friends as well as those who looked up to him for support in academic pursuits and indeed his patient and their families.  


Obituary Prof. Franz Gerstenbrand


In Memoriam

Prof. Dr. med. Dr. h.c. mult. Franz Gerstenbrand

Em. Professor of Neurology at the University of Innsbruck


The World Federation of Neurorehabilitation is very sad to announce that our Honorary President Prof. Dr. Dr. h. c. mult. Franz Gerstenbrand passed away the evening of June 30th 2017 at age 92, after a brief illness. He was accompanied at the end by his family and friends.


Prof. Franz Gerstenbrand was, for many decades, one of Europe’s most eminent neurologists, and a “Founding Father” of the modern field of neurorehabilitation.  He was a dedicated supporter of WFNR and all its activities since its formation.


Prof. Franz Gerstenbrand was born on September 6th 1924 in Hof, Moravia, today the Czech Republic, as the son of a general practice physician.  He took his medical training with Prof. Hans Hoff in Vienna and worked as a consulting neurologist in Vienna for many years, including work in neuropediatric institutions. His great intellect and curiosity led him to make important contributions to many areas of neurology.  Very early in his career, Franz developed an interest in aspects of what we now call “neurorehabilitation”, e.g., working on disorders of motor function with Prof. Tischler in the orthopedic hospital in Speising, close to Vienna.  During this time, Franz also developed an interest in neurological intensive care, seeing many patients with diminished states of consciousness. His skills in clinical observation prompted him to analyze these cases more deeply, in order to understand their phenomenology and underlying pathophysiology.  In 1967, he coined the term “apallic syndrome” and published a very influential book on this previously-neglected entity.


In1976, Franz left Vienna for Innsbruck University, where he was appointed full professor and chairman of the department of neurology. Over many years, he developed it into one of the major neurology institutions in Austria.  He also was very influential in encouraging professional interactions between neurologist in eastern and western Europe, resulting in the creation of the Danube Symposia. At that time, the existence of the “iron curtain” made it particularly important to have in Franz Gerstenbrand, a pragmatist who could forge scientific friendships and thus bridge the gaps that had separated regions of Europe for so long. As part of this legacy, Franz helped found the European Federation of Neurological Societies (EFFNS), now a part of the European Academy of Neurology (EAN), and greatly contributed to the effectiveness of these organizations in promoting scientific progress and education.

Franz maintained a lifelong interest in the creative aspects of neurology, promoting the application of innovative strategies and concepts to the field.  For example, Franz was one of the first neurologists to use oral levodopa in Parkinson’s disease and one of the first to see HIV infection as a primarily neurological problem .Through his interest in applying neuromodulatory techniques to spinal cord injury, he founded the Ludwig Boltzmann Institute for Restorative Neurology. He also had a lifelong appreciation of the importance of proprioception in human performance, and by application of his indefatigable enthusiasm for neuroscientific innovation, extended this to the field of space neurology.

Franz could not have had as great an impact as he did, had his abilities been narrowly professional. Fortunately for the field of neurology, he had a strong practical streak, and was a good friend to many politicians and decision makers, using this influence to promote the field. He certainly was one of the first neurologists in Europe to understand how great an impact the concept of neurorehabilitation could have on applied neuroscience.

Franz Gerstenbrand was a very talented neurological teacher, training many distinguished neurologists during his active career.  Even after his formal retirement, he remained vigorously active in advancing neurological science, neurological services, and especially NeuroRehabilitation.  He adapted neuroethics also as an important new field.  He continued to be sought after as a speaker, discussant and critic at major neurological meetings into his nineties, until shortly before his death.

In recognition of Franz’ countless contributions to the field of neurorehabilitation, in 2014 the WFNR created the” Franz Gerstenbrand Award”, which is given for outstanding clinical or basic research in the field of neurological rehabilitation.

We will never forget how, after presenting this prize for the first time at our 2014 world congress in Istanbul, Franz Gerstenbrand gave the closing lecture of the meeting, providing  a summary of his philosophy of neurology and rehabilitation.

We thank Prof. Franz Gerstenbrand for his continuous support of WFNR knowing that the world of neurology has lost a most significant person and hero in the field. We will never forget him as an eminent neurologist, a dear friend, a dedicated teacher, and a politically astute and effective supporter. We will miss him greatly, and express our profound condolences to his wife, daughters, and to all of his relatives and many friends.


The World Federation for NeuroRehabilitation.

Closing remarks  by Prof. Franz Gerstenbrand


Good afternoon everybody


It is a great pleasure and honour for me to give some closing remarks after the  8.

World congress of neuro rehabilitation here in Istanbul after an exciting week.

When I started to become interested in clinical neurology  this discipline  was at that time a newer  but still somewhat  neglected field in medicine . Certainly it  was already at that time one of the intellectually most appealing areas of medicine but its impact on patients cure  and health was rather limited.

Neurologist  at that time  were notoriously looked at as being people who admittedly  knew  a lot about brain anatomy and physiology and from that could derive diagnoses from clinical examination and history taking  but  after that there was little else they could offer  to  their patients.

I  early on became interested in the field between neurology and psychiatry realising that dealing with patients´ behaviour was one of the key issues in neurology.

Starting my work  with professor Hoff in Vienna I  became interested especially in the field of disorders of consciousness and studying, observing and examining  these patients I realised certain patterns and  prompted the term  “apallic syndrome”  for a particular type of clinical phenomenology .  Dealing with these patients prompted my further interest in intensive care ,a field  which so far had  remained exclusively in the hands of internal medical people, anesthesiologist and what we call today intensivists.


It became clear to me that neurologists had to become involved in this field to blend in their knowledge about the nervous system and when I later set up my first own department at the University of Innsbruck it soon turned out that this department had one of the biggest intensive care units of all neurology departments in Europe. Many colleagues also present on this WCNR  meeting as Professors Binder and Saltuari were trained we me there.

From this it was only a small step to become interested in a field  today  called neurological rehabilitation and I am proud probably to have been  one of the first neurologists to see the importance and chances of this new field  - at that time sometimes looked upon by other leading neurologists as a somewhat peculiar person. 

Since  our knowledge in neurorehabilitation  along with the enormous progress in the neurosciences  has advanced  dramatically and today we can proudly say that neurorehabilitation can be conceived as applied neuroscience. This meeting again has elegantly demonstrated which  enormous advancements in  the field of neuro- rehabilitation have been  made.

 The use of neuroimaging along with the development of more refined  training techniques , the use of mechanical devices such as robots, better thinking about structures for long term care and also some pharmacological findings have all contributed to the high standing neuro-  rehabilitation  to  help patients  gain better participation in society.


 Neurorehabilitation as a discipline  has ,facing society ,also  politically   contributed to a better understanding of the world  beyond  disability and handicap corroborating the  view  that much can be done for people after  brain brain damage and then there is no need for frustration or despair. I want to emphasize that neurorehabilitation has widely kept  the ethics of humanistic medicine: people working with people and not relying just in giving drugs: For me it is  somewhat bitter to see that many big  neurology meetings today  are converted into pharma- marketing fairs where the newest and most expensive drug regiments ( look at the most recent developments in the fields of oral anticoagualnts in stroke  or so called disease modifying drugs in MS) .I am happy that WFNR to the contrary stresses the aspect of multidimensional care from people for people ( at times may be supported by a robot colleague)


The further progress in neurorehabilitation  has definitely  to be supported by better and innovative ways for education in the field of  not only in developed countries but worldwide. I was happy that on this meeting You have discussed many possible solutions for this problem.

Especially a concept like neuro modulation can be helpful in future how to design even better strategies for  brain  improvement.Many of you know that I  believe very much in  the idea of of proprioceptive facilitation   to improve  brain recovery.

I was glad to see on the meeting that the WFNR   very much emphasizes the field  of paediatric neurology.  Starting work with Prof. Rosencrantz who was a pediatrician in Vienna

I became fascinated by this field . Unfortunately  at that time  it had not really  been realised that neurological problems in childhood are an important target for neurology.  I am  very happy that today you have very much adapted this  idea.

Let me at the end give some  critical remarks on the current philosophy and epistemology in our field:
We are talking a lot about evidence based medicine and best practice guidelines derived from a certain epistemological framework which as You know was originally  designed for the proper application of pharmaceutical studies .It is for me really questionable if this approach is useful for the future in our field: Also beyound randomized controlled trials there is an  ocean of truth, chances  and.innovation which we should not spoil making us slaves.of a not really always  applicable epistemology.

It is the open mind of the rehabilitative Neurologist and all people working in this field  ,it is their appreciation of the advances in neurosciences and behavioral sciences and their creativity which will bring this field forward and this creativity should not be hindered by a not really useful statistical framework.

After a long life as an active neurologist i am.grateful to what we have achieved but I never become tired to express that we can achieve even much more keeping our brains switched on.


 Cecil Rhodes said
“So little done so much to do”

In this sense I thank all for contributing to this  phantastic and stimulating 8. World congress of neurorehabilitation  and hope we see each other in Philadelphia in two years time.