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AHA/ASA Stroke Rehabilitation Guidelines Call for Intensive, Multidisciplinary Care
Intensive, multidisciplinary treatment is needed in the rehabilitative care of adults recovering from stroke, according to guidelines released by the American Heart Association/American Stroke Association (AHA/ASA). This is the first set of guidelines to be issued on rehabilitation after stroke.
Along with the patient and family and friends, a team of physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others is needed in stroke rehabilitation. Strong communication, according to the guidelines, is key to maximizing success. “Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential,” the authors wrote in the guidelines, published online in Stroke.
The AHA/ASA guidelines recommend that patients should be sent to inpatient rehabilitation, which produces better outcomes than nursing homes or skilled nursing facilities. Fall prevention programs, discussions about medication side effects, and instructions on how to use medical devices, should begin while the patient is still hospitalized.
“This recommendation will probably change medical practice. Even the top stroke centers may not have a formal falls-prevention program, but it is very important because a high percentage of patients end up falling after a stroke,” the lead author of the new guidelines, Carolee Winstein, said in a statement.
Other recommendations include individually tailored exercise programs, cognitive activities during rehabilitation, speech therapy, eye exercises for patients with trouble focusing on near objects, and balancing programs for those at risk for falls.
“As systems of care evolve in response to health care reform efforts, post-acute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts,” the authors of the guidelines concluded.
The guidelines have been endorsed by the American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation, American Physical Therapy Association, American Occupational Therapy Association, American Society of Neurorehabilitation, and American Congress of Rehabilitation Medicine.
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