Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein CJ, Stein J, Arena R, et al., on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research.
Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke 2016;May 4:[Epub ahead of print].

The following are 10 key points to remember about the Guidelines for Adult Stroke Rehabilitation and Recovery for healthcare professionals:

  1. Each year, stroke affects nearly 800,000 individuals, with many survivors experiencing persistent difficulty with daily tasks as a direct consequence.
  2. The intensity of rehabilitation care varies widely, depending on the setting, with the most intensive rehabilitation care provided in inpatient rehabilitation facilities, followed by skilled nursing facilities, which provide “subacute” rehabilitation.
  3. Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (e.g., personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others.
  4. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation.
  5. It is recommended that all individuals with stroke be provided a formal assessment of their activities of daily living (ADLs) and instrumental ADLs (IADLs), communication abilities, and functional mobility before discharge from acute care hospitalization, and that the findings be incorporated into the care transition and the discharge planning process.
  6. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential.
  7. An offer to patients and their partners to discuss sexual issues may be useful before discharge home and again after transition to the community. Discussion topics may include safety concerns, changes in libido, physical limitations resulting from stroke, and emotional consequences of stroke.
  8. Individuals, who appear to be ready to return to driving, as demonstrated by successful performance on fitness-to-drive tests, should have an on-the-road test administered by an authorized person.
  9. As systems of care evolve in response to healthcare reform efforts, postacute 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.
  10. 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.

Clinical Topics: Prevention

Keywords: Activities of Daily Living, Caregivers, Depression, Health Care Reform, Libido, Nutritionists, Primary Prevention, Patient Discharge, Patient Transfer, Recovery of Function, Rehabilitation, Rehabilitation Centers, Risk, Skilled Nursing Facilities, Speech Therapy, Stroke, Survivors, Vascular Diseases

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