Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association

Carolee J. Winstein, Joel Stein, Ross Arena, Barbara Bates, Leora R. Cherney, Steven C. Cramer, Frank Deruyter, Janice J. Eng, Beth Fisher, Richard L. Harvey, Catherine E. Lang, Marilyn MacKay-Lyons, Kenneth Ottenbacher, Sue Pugh, Mathew J. Reeves, Lorie G. Richards, William Stiers, Richard D. Zorowitz

    Research output: Contribution to journalReview article

    383 Citations (Scopus)

    Abstract

    Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. Conclusions-As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts.

    Original languageEnglish (US)
    Pages (from-to)e98-e169
    JournalStroke
    Volume47
    Issue number6
    DOIs
    StatePublished - Jun 1 2016

    Fingerprint

    American Heart Association
    Stroke
    Guidelines
    Delivery of Health Care
    Rehabilitation
    Advisory Committees
    Subacute Care
    Communication
    Recreation
    Peer Review
    Aptitude
    Health Care Reform
    Nutritionists
    Manuscripts
    Physical Therapists
    Practice Guidelines
    Caregivers
    Survivors
    Language
    Joints

    Keywords

    • AHA Scientific Statements
    • exercise
    • paresis
    • recovery of function
    • rehabilitation
    • stroke

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Clinical Neurology
    • Advanced and Specialized Nursing

    Cite this

    Guidelines for Adult Stroke Rehabilitation and Recovery : A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. / Winstein, Carolee J.; Stein, Joel; Arena, Ross; Bates, Barbara; Cherney, Leora R.; Cramer, Steven C.; Deruyter, Frank; Eng, Janice J.; Fisher, Beth; Harvey, Richard L.; Lang, Catherine E.; MacKay-Lyons, Marilyn; Ottenbacher, Kenneth; Pugh, Sue; Reeves, Mathew J.; Richards, Lorie G.; Stiers, William; Zorowitz, Richard D.

    In: Stroke, Vol. 47, No. 6, 01.06.2016, p. e98-e169.

    Research output: Contribution to journalReview article

    Winstein, CJ, Stein, J, Arena, R, Bates, B, Cherney, LR, Cramer, SC, Deruyter, F, Eng, JJ, Fisher, B, Harvey, RL, Lang, CE, MacKay-Lyons, M, Ottenbacher, K, Pugh, S, Reeves, MJ, Richards, LG, Stiers, W & Zorowitz, RD 2016, 'Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association', Stroke, vol. 47, no. 6, pp. e98-e169. https://doi.org/10.1161/STR.0000000000000098
    Winstein, Carolee J. ; Stein, Joel ; Arena, Ross ; Bates, Barbara ; Cherney, Leora R. ; Cramer, Steven C. ; Deruyter, Frank ; Eng, Janice J. ; Fisher, Beth ; Harvey, Richard L. ; Lang, Catherine E. ; MacKay-Lyons, Marilyn ; Ottenbacher, Kenneth ; Pugh, Sue ; Reeves, Mathew J. ; Richards, Lorie G. ; Stiers, William ; Zorowitz, Richard D. / Guidelines for Adult Stroke Rehabilitation and Recovery : A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. In: Stroke. 2016 ; Vol. 47, No. 6. pp. e98-e169.
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    abstract = "Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. Conclusions-As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts.",
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    AU - Bates, Barbara

    AU - Cherney, Leora R.

    AU - Cramer, Steven C.

    AU - Deruyter, Frank

    AU - Eng, Janice J.

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    AU - Harvey, Richard L.

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