The American Heart Association (AHA) and the American Stroke Association (ASA) just released a 2026 update for the guideline, Adult Stroke Rehabilitation and Recovery. The 2026 update replaces the 2016 version and provides clinicians with an up-to-date set of 248 recommendations regarding postacute rehabilitation care, prevention and medical management of comorbidities (prevention of skin breakdown, venous thromboembolism, etc.), mental health assessment, and more. The primary focus of the guideline is codifying the elements of stroke rehabilitation and it is founded on published evidence and expert opinion when literature gaps were identified.  

Today, we’re taking a look at what's been updated in the 2026 guideline. To view the complete 2026 AHA/ASA Adult Stroke Rehabilitation and Recovery guideline, view the full-text version.

What's New in the 2026 Adult Stroke Rehabilitation and Recovery Guideline

The following is a rundown of what the AHA and ASA noted as being new and practice-changing in the 2026 guideline. The AHA and ASA noted that it is not a comprehensive list of all updates. 

Rehabilitation Across the Continuum

  • Rehabilitation is conceptualized as a longitudinal process with no defined endpoint, supporting assessment and engagement across the lifespan.
  • Early supported discharge with coordinated multidisciplinary care is emphasized for appropriate patients.

Technology and Telerehabilitation

  • Increased emphasis on technology-enabled interventions, including telehealth, to improve access, continuity, and efficiency of care.

Medical Management of Comorbidities

  • New section on sleep and poststroke fatigue, including behavioral interventions.
  • Expanded recommendations for central poststroke pain, including standardized diagnostic criteria and pharmacologic management.
  • Expanded fall prevention strategies, including structured programs, dual-task training, and tai chi.

Mental Health and Behavioral Health

  • Routine and longitudinal screening for depression and anxiety is recommended.
  • Expanded mental health recommendations to include both depression and anxiety.

Bladder and Bowel Function

  • Expanded assessment and management strategies, including bladder scanning, timed voiding, pelvic floor training, and electrical stimulation.

Hemiplegic Shoulder Pain

  • Expanded multimodal treatment approach, including neuromodulation, botulinum toxin injections, and adjunct therapies.
  • Explicit recommendation against the use of overhead pulley exercises due to harm.

Assessment

  • Greater emphasis on standardized, validated assessment tools across motor, cognitive, communication, and sensory domains.
  • Expanded assessment to include vision, hearing, and perceptual impairments.

Sensorimotor Rehabilitation and Function

  • Updated recommendations on types of task practice and adjuvant techniques.
  • Expanded guidance on adaptive equipment, orthotics, assistive technology, and lifestyle management.

Cognition and Communication

  • Expanded nonpharmacological approaches for cognitive rehabilitation.
  • Enhanced recommendations for management of communication disorders, motor speech disorders, and spatial neglect.

Transitions of Care and Community Rehabilitation

  • Strengthened recommendations to ensure continuity of care across settings and into the community.
  • Expanded focus on caregiver engagement, education, and support.
  • Increased emphasis on referral to community resources and long-term support services.

Participation and Reintegration

  • Expanded recommendations for return to driving with structured safety evaluation.
  • Expanded section addressing recreational, leisure, and social participation.
  • Expanded recommendations for return to work, including individualized vocational rehabilitation.

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