Practice guidelines on stroke rehabilitation are updated

  • Sall J & al.
  • Ann Intern Med
  • 19.11.2019

  • von Susan London
  • Clinical Essentials
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Takeaway

  • The US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) have updated their joint guidelines on stroke rehabilitation.

Why this matters

  • Stroke sequelae such as disability and spasticity can be improved by early, appropriate rehabilitation.
  • New evidence has emerged since the guidelines were last published almost a decade ago.

Key results

  • Guidelines focus on acute and long-term rehabilitation of the stroke patient, apply to clinicians in both primary care and rehabilitation.
  • 6 topic areas:
    • Timing and approach.
    • Motor therapy.
    • Dysphagia.
    • Cognitive, speech, and sensory therapy.
    • Mental health therapy.
    • Other functions (e.g., returning to work, driving).
  • Guidelines include 2 management algorithms and 42 recommendations.
  • Highlights of recommendations:
    • Follow a team-based approach in an organized inpatient unit to improve patients’ likelihood of discharge to home.
    • Start rehabilitation as soon as patients medically stable.
    • Use:
      • Task-specific practice to improve outcomes such as extremity motor function, activities of daily living.
      • Cardiovascular training to improve walking speed.
    • Treat focal spasticity that is painful or limiting with botulinum toxin.
    • Offer selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors and cognitive behavioral therapy to patients with poststroke depression.

Study design