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In Africa, rehabilitation services are insufficient and marred with inadequate political commitments and collaborations of stakeholders. Infrastructures and expertise for rehabilitation are scarce and poorly coordinated. Community-based rehabilitation programs are fragmented and fractured and lack working partnership with rehabilitation services in health care systems. Locally responsive policy frameworks, service delivery models, and health governance practices are prerequisites for meeting rehabilitation needs of the ever-increasing number of persons with chronic disabling conditions. Concerted global efforts are required for equitable and accessible coordinated continuum of rehabilitation care at various levels of health services and the community in most Sub-Saharan African countries.

Objective To evaluate language deficits after acute stroke and their association with post–acute care at a setting other than home. We hypothesized that deficits in language comprehension would be associated with discharge to a setting other than home after adjustment for physical/occupational therapy (PT/OT) needs. Design Secondary analysis of prospectively collected data. Discharge location, demographic characteristics (age, sex, race), and the presence of PT/OT recommendations were abstracted from the medical record. Setting Acute stroke unit at a tertiary medical center. Participants Left hemispheric stroke patients (N=152) within 24 hours of event. Interventions The following tasks were administered: (a–b) oral and written naming of pictured objects, (c) oral naming with tactile input (tactile naming), (d–f) oral reading, oral spelling, and repetition of words and pseudowords, (g) written spelling to dictation, (h) spoken word-picture verification (ie, auditory comprehension), and (i) written word-picture verification (ie, written word comprehension). Main Outcome Measure Discharge to a setting other than home. Results Of 152 cases, 88 were discharged home and 64 to another setting. Among stroke subjects discharged to a setting other than home, 63.6% had auditory comprehension deficits compared with 42.9% of those discharged home ( P =.03). Deficits in auditory and reading comprehension and oral spelling to dictation were significantly associated with increased odds of discharge to a setting other than home after adjustment for age and PT/OT recommendations. Conclusions Cases with deficits in auditory comprehension, reading comprehension, and oral spelling to dictation had increased odds of being discharged to settings other than home. Early evaluation of these language deficits and prompt treatment may allow patients who would otherwise be discharged to an institution to go home. Further research is needed to design and evaluate individualized treatment protocols and their effect on discharge recommendations.

Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this population are discussed.

Purpose : This study describes a cross-sectional assessment of infrastructure, human resources, and types of rehabilitation interventions provided in a sample of healthcare facilities in Ghana. The objectives were to (a) develop and pilot a questionnaire assessing rehabilitation capacity in LMICs, and (b) provide initial data regarding available rehabilitation care in rural Ghana. Methods : Data was collected from a sample of rehabilitation workers at 9 facilities, comprised of 5 regional and 4 district hospitals, located in seven of the ten geographical regions of Ghana. Participants completed a modified version of the World Health Organisation's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, adapted to reflect core indicators of rehabilitation infrastructure. Participating facilities were mailed questionnaires and agreed to subsequent site visits from the first author. Results : There were several limitations associated with basic rehabilitation infrastructure. Consistent with previous research, significant human resources limitations were observed as hospital-based rehabilitation services were primarily rendered by 20 physiotherapists and 21 physiotherapy assistants across the 9 participating sites. No rehabilitation physicians were identified at any of the surveyed facilities. With regard to therapeutic interventions, management of musculoskeletal impairments was generally consistent with current evidence-based practices, whereas rehabilitative approaches for neurologic conditions were limited to physical rather than sensory-motor modalities. Conclusions : For the first time there is study data which details the rehabilitation infrastructure, human resources, and interventions in Ghana. This study furthers the field through the adaptation and initial piloting of a rehabilitation assessment instrument that can be used in LMIC contexts. Limitations : The questionnaire used for the study was modified from the questionnaire for assessing surgical care in resource poor countries, and has not yet been validated. Since the study was conducted in a convenience sample of rehabilitation/physiotherapy centres in Ghana, generalisability may be limited.