Clinical Practice Guidelines Updated for Management of Stroke Rehab
TUESDAY, Jan. 21, 2025 -- In clinical practice guidelines jointly issued by the U.S. Department of Veterans Affairs and U.S. Department of Defense and published online Jan. 21 in the Annals of Internal Medicine, updated recommendations are presented for the management of stroke rehabilitation.
Blessen C. Eapen, M.D., from the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues in a guideline development workgroup, developed 47 recommendations and an algorithm for stroke rehabilitation in both inpatient and outpatient settings. The group identified the strongest evidence to support guidelines in areas that are relevant to primary care: transition to community; motor therapy; dysphagia, aphasia, and cognition; and mental health.
Recommendations include using case management services at time of discharge to improve activities of daily living and functional independence, as well as task-specific practice to improve motor function, gait, posture, and activities of daily living. Suggestions include use of interventions to improve patient and caregiver depression; psychosocial education to improve family function, patient functional independence, and quality of life; mirror therapy; neuromuscular electrical stimulation to improve motor outcomes; botulinum toxin for focal spasticity; and a selective serotonin reuptake inhibitor or a serotonin norepinephrine reuptake inhibitor, psychotherapy, or mindfulness-based therapies for depression.
"Poststroke rehabilitation requires an interdisciplinary, holistic approach to the management, treatment, and rehabilitation of stroke sequelae, with the patient and caregivers as vital members of the team," the authors write.
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