by Reuters

Rehabilitation after a stroke requires “a sustained and coordinated effort” by a large team of professionals, and the best place to get that is an inpatient rehabilitation facility, according to a joint statement from the American Heart Association and American Stroke Association. Without communication and coordination among these team members, “efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential,” the authors write in the journal Stroke.

“The very first post-stroke rehab guidelines were published in 1995,” but these are the first commissioned by the AHA in collaboration with the ASA, said lead author Carolee J. Winstein, professor of biokinesiology and physical therapy at the University of Southern California-Los Angeles.

“A lot of the focus has been on how do we deal with this single event in the early stages, getting people to the ER quick enough to bust those clots,” Winstein told Reuters Health. “Many still end up with residual disability for the rest of their lives, and rehab after this event needs to be treated as a chronic disease,” she said. “It’s very important for future life, the quality of life, and independence,” she added.

The new scientific statement also recommends that stroke patients not be discharged from the hospital until they have taken part in a structured fall-prevention program. It should include home safety measures like removing throw rugs and improving lighting, minimizing the fall risk that results from the side effects of medication and training in the safe use of wheelchairs, walkers and canes.

Patients should also receive mobility-task training, a tailored exercise program, and engage in cognitive activities like using a computer, reading and listening to music. “Basically rehab needs to get people on the right track and educate them and their families about what they can do to reduce the risk of a second stroke and to engage in meaningful activities,” Winstein said.

Inpatient rehab includes a multidisciplinary team working together on medical, physical, occupational, neuropsychological and speech therapy, and patients can focus on eye exercises, balance training or other areas based on their needs, she said. “You have a team working with you and your family, and you don’t get that in a skilled nursing facility,” she said.

Inpatient therapy requires a minimum of three hours of therapy per day, and not every stroke patient will be able to handle that workload initially, Winstein said. “If you don’t have that endurance at this point you could go to a skilled nursing facility with the goal of building up your endurance and then be reevaluated for an inpatient rehab unit,” she said.

Most insurance, including Medicare, covers inpatient rehab when recommended by a physician, she said. “The evidence says you get better outcomes if you get your rehab at an inpatient facility,” Winstein said.

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