stroke

New Guidelines for Stroke Rehabilitation Released

The US Department of Veterans Affairs and the US Department of Defense have released new guidelines including 42 recommendations for rehabilitation following stroke.

The new guidelines serve as an update to those released by the groups in 2010. They convened a multidisciplinary panel including specialists in physical medicine and rehabilitation, neurology, psychology, neuropsychology, nursing, social work, vocational rehabilitation, pharmacy, physical therapy, occupational therapy, case management, and speech language pathology.

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The 42 recommendations are broken into 6 topic sections including 11 subtopics. Topics include motor therapy, approach and timing, dysphagia therapy, cognitive, speech, and sensory therapy, mental health therapy, and other functions.

Among the recommendations:

  • Rehabilitation should begin as soon as the patient is medically stable.
  • Cardiovascular exercise, particularly walking, is associated with improvements in walking speed post-stroke.
  • Selective serotonin reuptake inhibitors or serotonin–norepinephrine reuptake inhibitors are effective for treating depression following stroke but are not recommended for preventing depression.
  • Task-specific practice is recommended for the improvement of upper- and lower-extremity motor function, gait, posture, and activities of daily living.

“Poststroke rehabilitation requires an interdisciplinary holistic approach to the management, treatment, and rehabilitation of poststroke sequelae, with the patient and family as vital members of the team. We recommend using these guidelines as an adjunct to the AHA/ASA for Adult Stroke Rehabilitation and Recovery,” the authors concluded.

—Michael Potts

Reference:

Sall J, Eapen BC, Tran JE, et al. The management of stroke rehabilitation: a synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline [published online November 19, 2019]. Ann Intern Med. doi:10.7326/M19-1695.