New stroke guideline mandates personalized and early rehabilitation
· News-MedicalA stroke can happen to anyone at any age, and the severity and impact of a stroke can vary. After a stroke, damage to the brain can affect movement, strength, thinking, communication and other physical and mental functions. These challenges can make everyday activities harder, including walking, eating, speaking, bathing, dressing, working, driving, socializing or participating in recreational activities.
The new guideline, which replaces the 2016 version, reflects the latest science in assessing and implementing stroke rehabilitation needs. It also emphasizes the important benefits of a comprehensive recovery journey to improve both the physical and emotional wellbeing of an individual who has experienced a stroke.
"Stroke rehabilitation is complicated. A stroke can affect many of the skills people rely on for daily living, and even the most routine activities involve multiple physical, cognitive and communication abilities working together," said Lorie Gage Richards, Ph.D., FAHA, who led the volunteer guideline writing group as chair, is an associate professor at the University of Utah and a licensed occupational therapist.
"Developing rehabilitation guidelines is equally complex because every stroke is unique. Each person faces a different set of challenges. Recovery doesn't look the same for everyone, and care should be personalized to fit each person's needs. The goal is to help individuals gain as much independence as possible to perform everyday activities while improving their overall quality of life," Richards said.
Recovery involves more than physical rehabilitation
While stroke rehabilitation is essential for improving mobility, restoring everyday skills and reducing long-term disability, the guideline emphasizes that the recovery journey involves more than physical healing.
- Mental health screening: Emotional well-being is an important part of recovery after a stroke. Post-stroke depression, while common and treatable, can make physical recovery and rehabilitation more challenging. Regular screenings for depression, anxiety and other mental health concerns are recommended to help identify emotional struggles early and connect individuals with the support and treatment they need.
"Joining a support group, journaling and learning to process what had happened to me helped me heal in ways physical therapy alone couldn't," Kutzle said. "I had to stop comparing my recovery to everyone else's and focus on my own progress. Understanding that mental health is part of recovery changed everything for me."
- Adapting to life after stroke: Scientific advances in early diagnosis and treatment are helping more people survive and live longer after having a stroke. Additionally, strokes among people under age 50 are increasing. Stroke rehabilitation can support the needs of survivors of all ages, such as returning to the workforce, parenting young children, addressing sleep and pain issues and even adapting to changes in sexual function. Recovery may also include adjusting to unexpected changes in relationships, independence and future plans.
For Kutzle, rebuilding her life post-stroke meant navigating challenges that other 40-year-olds were not facing. "Rehabilitation was difficult, but one of the hardest parts was accepting that my life might look different than I planned," Kutzle said. "My friends were thriving in their careers and building families, while I was learning how to navigate a completely different reality. Recovery meant discovering who I could become, not trying to return to who I was before."
- Considerations for caregivers: There are about 2.7 million caregivers of people with stroke in the U.S. helping survivors of stroke with daily activities, household tasks and physical needs. Many caregivers experience stress, depression and/or anxiety requiring their own support. The guideline emphasizes that caregivers should be included in rehabilitation planning, education and support efforts across the stroke rehabilitation process.
When should stroke rehabilitation begin?
Rehabilitation after a stroke should begin in the hospital as soon as the person is medically stable, ideally within 48 hours of the stroke. Studies have shown that beginning rehabilitation therapy early leads to better outcomes. However, moderate to high-intensity exercise and task practice should not be performed in the first 24 hours after a stroke.
Where does stroke rehabilitation take place?
Where an individual receives care after leaving the hospital depends on the severity of their stroke. Some survivors of stroke may go home from the hospital shortly after a stroke to receive outpatient rehabilitation and caregiving from a loved one, while others may need additional care in a skilled nursing facility, inpatient rehabilitation facility or long-term care hospital.
Telehealth plays a growing role in supporting stroke recovery, improving access to care and increasing the cost-effectiveness of care.
Who provides stroke rehabilitation care?
A coordinated multidisciplinary care team is crucial for effective post-stroke rehabilitation. The team could potentially include neurologists, rehabilitation nurses, occupational therapists, physical therapists, speech-language pathologists, social workers, psychologists and other healthcare professionals. Recreational therapists play an important role in post-stroke recovery by helping individuals regain confidence and reconnect with their communities through leisure, social and recreational activities that support a successful transition back to daily life.
How long should stroke rehabilitation last?
The guideline notes that stroke recovery can be ongoing over months to years without a clearly defined endpoint. Recovery varies widely, as some people regain full independence, while others have functional limitations and need ongoing support from healthcare professionals, family members or other caregivers. Ongoing rehabilitation may require periodic reassessment of the survivor's goals, progress and skills.
"Recovery after a stroke is about more than getting stronger physically and regaining abilities. It's an ongoing process that includes coping with emotional changes after a major health event, adjusting to new challenges and moving forward with a renewed sense of purpose and resilience," Richards said.
This guideline was prepared by the volunteer writing group on behalf of the American Heart Association's Stroke Council and the American Stroke Association. Since 1990, the American Stroke Association has translated scientific evidence into clinical practice guidelines with recommendations to improve cerebrovascular health.
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