Stroke Rehabilitation

Publication Date: July 1, 2019

Recommendations

Approach and Timing

We recommend a team-based approach in an organized inpatient unit that encompasses comprehensive rehabilitation in order to improve likelihood of discharge to home after acute stroke. (Strong for)
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We recommend that rehabilitation therapy should start as soon as medical stability is reached. (Strong for)
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There is insufficient evidence to recommend for or against implementing very early mobilization (within 24-48 hours) to improve functional outcomes. ()
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There is insufficient evidence to recommend for or against early supported discharge. ()
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Motor Therapy

Upper and Lower Limbs Rehabilitation

We recommend task-specific practice (also known as taskoriented practice or repetitive task practice) for improving upper and lower extremity motor function, gait, posture, and activities of daily living. (Strong for)
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We recommend cardiovascular exercise to increase maximum walking speed after stroke. (Strong for)
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We suggest offering body-weight support treadmill training as an adjunct to gait training in the non-ambulatory patient. (Weak for)
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We suggest offering rhythmic auditory cueing as a modality to include in multimodal interventions to improve walking speed. (Weak for)
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We suggest offering Constraint-Induced Movement Therapy or modified Constraint-Induced Movement Therapy for individuals with at least 10 degrees of active extension in two fingers, the thumb, and the wrist. (Weak for)
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There is insufficient evidence to recommend for or against mirror therapy for improvements in limb function. ()
315659

Technology-Assisted Physical Rehabilitation

We suggest offering functional electrical stimulation, neuromuscular electrical stimulation, or transcutaneous electrical nerve stimulation as an adjunctive treatment to improve upper and lower extremity motor function. (Weak for)
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We suggest offering functional electrical stimulation to manage shoulder subluxation. (Weak for)
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For patients with foot drop, we suggest offering either functional electrical stimulation or traditional ankle foot orthoses to improve gait speed, as both are equally effective. (Weak for)
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We suggest offering robot-assisted movement therapy as an adjunct to conventional therapy in patients with deficits in upper limb function to improve motor skill.. (Weak for)
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There is insufficient evidence to recommend for or against the use of robotic devices during gait training. ()
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We suggest offering virtual reality to enhance gait recovery. (Weak for)
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There is insufficient evidence to recommend for or against the use of virtual reality for improving activities of daily living and non-gait motor function. ()
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There is insufficient evidence to recommend for or against the use of transcranial direct current stimulation to improve activities of daily living. ()
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There is insufficient evidence to recommend for or against repetitive transcranial magnetic stimulation to improve upper or lower extremity motor function. ()
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Pharmacological Treatment

In patients with motor deficits, there is insufficient evidence to recommend for or against starting a selective serotonin reuptake inhibitor within 30 days of stroke to improve motor recovery and functional outcomes. ()
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We recommend botulinum toxin for patients with focal spasticity that is painful, impairs function, reduces the ability to participate in rehabilitation, or compromises proper positioning or skin care. (Strong for)
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We suggest offering intrathecal baclofen treatments for patients with severe chronic lower extremity spasticity that cannot be effectively managed by other interventions. (Weak for)
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Dysphagia Therapy

We suggest offering Shaker or chin tuck against resistance exercises in addition to conventional dysphagia therapy. (Weak for)
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We suggest offering expiratory muscle strength training for treatment of dysphagia in patients without a tracheostomy. (Weak for)
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There is insufficient evidence to recommend for or against tongue to palate resistance training for treatment of dysphagia. ()
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There is insufficient evidence to recommend for or against neuromuscular electrical stimulation for treatment of dysphagia. ()
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There is insufficient evidence to recommend for or against pharyngeal electrical stimulation for treatment of dysphagia. ()
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In patients with dysphagia in the post-acute phase of stroke who require tube feeding, we suggest offering gastrostomy tube over nasogastric tube for maintenance of optimal nutrition. (Weak for)
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Cognitive, Speech, and Sensory Therapy

Cognitive Therapy

There is insufficient evidence to recommend for or against the use of any specific cognitive rehabilitation methodology or pharmacotherapy to improve cognitive outcomes. ()
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Speech Therapy

There is insufficient evidence to recommend for or against the use of intensive language therapy for aphasia. ()
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Spatial Neglect Therapy

There is insufficient evidence to recommend for or against hemifield eye patching in addition to traditional therapy for patients with unilateral spatial neglect following stroke. ()
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Among patients with unilateral spatial neglect, there is insufficient evidence to recommend for or against the use of prisms. ()
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Visual Therapy

Among patients with hemianopsia, there is insufficient evidence to recommend for or against the use of prisms or visual search training. ()
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Mental Health Therapy

Prevention of PostStroke Depression

For the prevention of post-stroke depression, there is insufficient evidence for or against the universal use of selective serotonin reuptake inhibitor or a serotonin norepinephrine reuptake inhibitor due to the risk of fractures. ()
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Treatment of Post-Stroke Depression

We suggest offering a selective serotonin reuptake inhibitor or a serotonin norepinephrine reuptake inhibitor for treatment of post-stroke depression. (Weak for)
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We suggest offering cognitive behavioral therapy for treatment of post-stroke depression. (Weak for)
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There is insufficient evidence to recommend for or against treatment with a combination of pharmacotherapy (selective serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor) and psychotherapy (cognitive behavioral therapy) for treatment of post-stroke depression. ()
315659

Treatment of PostStroke Anxiety

There is insufficient evidence to recommend for or against pharmacotherapy or psychotherapy for the treatment of poststroke anxiety. ()
315659

Adjunctive Treatment

We suggest offering exercise as adjunctive treatment for poststroke depression or anxiety symptoms. (Weak for)
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We suggest offering mind-body exercise (e.g., tai chi, yoga, qigong) as adjunctive treatment for post-stroke depression or anxiety symptoms. (Weak for)
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Other Functions

There is insufficient evidence to recommend for or against any specific assessments or interventions regarding return to work. ()
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There is insufficient evidence to recommend for or against using any specific assessments or interventions to facilitate return to driving. ()
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Recommendation Grading

Disclaimer

Overview

Title

Management of Stroke Rehabilitation

Authoring Organization

Endorsing Organizations

Publication Month/Year

July 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Home health, Long term care, Medical transportation, Outpatient

Intended Users

Physical therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Rehabilitation, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D000071939 - Stroke Rehabilitation

Keywords

physical therapy, Stroke Rehabilitation

Supplemental Methodology Resources

Methodology Supplement

Methodology

Number of Source Documents
180
Literature Search Start Date
April 1, 2009
Literature Search End Date
July 5, 2018