http://journals.lww.com/neurotodayonline/Fulltext/2016/06090/New_AHA_ASA_Guidelines__A_Road_Map_for_Improving.2.aspx
Samson, Kurt
ARTICLE IN BRIEF
New guidelines on stroke rehabilitation care
suggest the best evidence supports offering stroke patients a formal
fall prevention program during hospitalization, a balance training
program, assessments for calcium and vitamin D supplementation for
stroke survivors living in long-term care facilities, and speech and
language therapy for individuals with aphasia.
Citing what has become a varied and sometimes
substandard approach toward post-stroke rehabilitative care, new
guidelines issued by the American Heart Association/American Stroke
Association (AHA/ASA) stress the need to coordinate an interdisciplinary
team approach to treatment, directed and monitored by physicians
trained in stroke neurology and/or physiatrists.
That care should ideally be provided in an inpatient
rehabilitation facility, rather than a skilled nursing facility,
according to the guidelines, which were published online May 4 ahead of
the June edition of Stroke.
Among their other recommendations, the guidelines
authors said the best evidence supports offering stroke patients a
formal fall prevention program during hospitalization, a balance
training program, assessments for calcium and vitamin D supplementation
for stroke survivors living in long-term care facilities, and speech and
language therapy for individuals with aphasia.
Patients who have residual deficits after a stroke
should receive a functional assessment from a clinician with expertise
in rehabilitation, the guidelines authors wrote, noting that some people
who have a stroke are not necessarily evaluated by an expert,
especially if their symptoms are relatively mild, leading to
rehabilitation at a lesser level of intensity than is appropriate, or
for not as long as required.
“Post-stroke rehabilitation care(NOT RESULTS) in the US is at its
best when delivered by a multidisciplinary team,” guidelines author
Steven C. Cramer, MD, professor of neurology and clinical director of
the Sue & Bill Gross Stem Cell Research Center at the University of
California, Irvine, told Neurology Today.
Depending on the nature of each patient's deficits, that
team should include nurses, physical and occupational therapists,
speech-language pathologists, recreation therapists, psychologists,
nutritionists, social workers, and others, he said.
Dr. Cramer noted that the amount of rehabilitative care
stroke survivors receive has been declining steadily year after year.
“In fact,” he said, “the average length-of-stay in inpatient rehab has
dropped by more than 30 percent over the last 10 years alone.”
This decline in rehabilitative care is due in part to
changes in the federal reimbursement fee structure for both inpatients
and those seeking post-acute care, according to the guidelines.
“Post-acute stroke rehabilitation is often considered an
area to be trimmed,” Dr. Cramer said, “without complete recognition of
its value, such as reducing the risk of downstream medical morbidity
resulting from immobility, depression, loss of autonomy, and reduced
functional independence,” he explained.
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