Well what do you expect? The ASA would recommend in-patient because their constituency(doctors and therapists) would have more employment this way.
http://newsroom.heart.org/news/in-patient-rehab-recommended-over-nursing-homes-for-stroke-rehab
Statement Highlights
- The American Heart Association/American Stroke Association has
issued its first guidelines on adult stroke rehabilitation calling for
intensive, multidisciplinary treatment.
- Before leaving the hospital, patients and caregivers should receive
a formal falls-prevention program to prevent accidents at home.
- Whenever possible, initial rehabilitation should take place in an inpatient rehabilitation facility rather than a nursing home.
Embargoed until 3 p.m. CT / 4 p.m. ET Wednesday, May 4, 2016
DALLAS, May 4, 2016 — For the first time, guidelines have been
developed by the American Heart Association/American Stroke Association
for rehabilitation after a
stroke.
“Previous guidelines have focused on the medical issues involved in
the initial management of stroke, but many people survive a stroke with
some level of disability. There is increasing evidence that
rehabilitation can
have a big impact on the survivors’ quality of life, so the time is
right to review the evidence in this complex field and highlight
effective and important aspects of rehabilitation,” said Carolee J.
Winstein, Ph.D., P.T., lead author of the new scientific statement
published in the American Heart Association journal
Stroke.
Whenever possible, the American Stroke Association strongly
recommends that stroke patients be treated at an in-patient
rehabilitation facility rather than a skilled nursing facility. While in
an in-patient rehabilitation facility, a patient participates in at
least three hours of rehabilitation
(a pathetic amount of time) a day from physical therapists,
occupational therapists, and speech therapists. Nurses are continuously
available and doctors typically visit daily. An in-patient
rehabilitation facility may be a free-standing facility or a separate
unit of a hospital.
“If the hospital suggests sending your loved one to a skilled nursing
facility after a stroke, advocate for the patient to go to an
in-patient rehabilitation facility instead – unless there is a good
reason not to – such as being medically unable to participate in rehab.
There is considerable evidence that patients benefit from the team
approach in a facility that understands the importance of rehabilitation
during the early period after a stroke,” said Winstein, who is a
professor of biokinesiology and physical therapy at the University of
Southern California in Los Angeles, California.
Caregivers should also insist that a stroke survivor not be
discharged from the hospital until they have participated in a
structured program on preventing falls. This includes education about
changes to make the home safer (such as removing throw rugs and
improving lighting), minimizing the fall risk resulting from the side
effects of medication, and safely using assistive devices such as
wheelchairs, walkers and canes.
“This recommendation will probably change medical practice. Even the
top stroke centers may not have a formal falls-prevention program, but
it is very important because a high percentage of patients end up
falling after a stroke,” Winstein said.
Other recommendations include:
- Intense mobility-task training after stroke for all survivors with
walking limitations to relearn activities such as climbing stairs.
- Individually tailored exercise program so survivors can safely
continue to improve their cardiovascular fitness through the proper
exercise and physical activity after formal rehabilitation is complete.
- An enriched environment (which might include a computer, books,
music and virtual reality games) to increase engagement and cognitive
activities during rehabilitation. There is not yet enough research to
determine whether specific promising new techniques, such as activity
monitors and virtual reality games, are effective at helping patients.
- Speech therapy for those with difficulty speaking following a stroke.
- Eye exercises for survivors with difficulty focusing on near objects.
- Balance training program for survivors with poor balance, or who are at risk for falls.
“For a person to fulfill their full potential after stroke, there
needs to be a coordinated effort and ongoing communication between a
team of professionals as well as the patient, family and caregivers,”
Winstein said.
The new scientific statement is the eighth set of stroke guidelines
from the American Stroke Association, completing the association’s
recommendations for the continuum of care for stroke patients and their
families.
Co-authors are Joel Stein, M.D., vice-chair; Ross Arena, Ph.D., P.T.;
Barbara Bates, M.D., M.B.A.; Leora R. Cherney, Ph.D.; Steven C. Cramer,
M.D.; Frank Deruyter, Ph.D.; Janice J. Eng, Ph.D., B.Sc.; Beth Fisher,
Ph.D., P.T.; Richard L. Harvey, M.D.; Catherine E. Lang, Ph.D., P.T.;
Marilyn MacKay-Lyons, B.Sc.; M.Sc.P.T., Ph.D.; Kenneth J. Ottenbacher,
Ph.D., O.T.R.; Sue Pugh, M.S.N., R.N., C.N.S.-B.C.; Mathew J. Reeves,
Ph.D., D.V.M.; Lorie G. Richards, Ph.D., O.T.R./L.; William Stiers,
Ph.D., A.B.P.P. (R.P.); Richard D. Zorowitz, M.D.; on behalf of the
American Heart Association Stroke Council, Council on Cardiovascular and
Stroke Nursing, Council on Clinical Cardiology, and Council on Quality
of Care and Outcomes Research. Author disclosures are on the manuscript.
Additional Resources:
###
The American Heart Association/American Stroke Association
receives funding mostly from individuals. Foundations and corporations
donate as well, and fund specific programs and events. Strict policies
are enforced to prevent these relationships from influencing the
association’s science content. Financial information for the American
Heart Association, including a list of contributions from pharmaceutical
companies and device manufacturers, is available at www.heart.org/corporatefunding.
For Media Inquiries: (214) 706-1173
Darcy Spitz: (212) 878-5940;
Darcy.Spitz@heart.org
Julie Del Barto (national broadcast): (214) 706-1330;
julie.delbarto@heart.org
For Public Inquiries: (800)-AHA-USA1 (242-8721)
heart.org and
strokeassociation.org
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