Guidelines for Adult Stroke Rehabilitation and Recovery
Tóm tắt
The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke.
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.
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.
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. (
Từ khóa
Tài liệu tham khảo
World Health Organization. ICF: International Classification of Functioning, Disability and Health. Geneva, Switzerland: World Health Organization; 2011.
Management of Stroke Rehabilitation Working Group. Management of Stroke Rehabilitation. Washington, DC: Veterans Affairs/Department of Defense; 2010.
American Heart Association. Stroke statements & guidelines. http://professional.heart.org/professional/GuidelinesStatements/UCM_316885_Guidelines-Statements.jsp. Accessed March 5 2016.
National Quality Forum. Measurement Framework: Evaluation Efficiency Across Patient-Focused Episodes of Care. Washington, DC: National Quality Forum; 2009.
MedPAC. Healthcare Spending and the Medicare Program: A Data Book. Washington, DC: Medicare Payment Advisory Commission; 2008.
Liu K BC, Wissoker D, Maxwell S, Haley J, Long S. Long-term care hospitals under Medicare: facility-level characteristics. Health Care Financ Rev. 2001;23:1–8.
Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients. Cochrane Database Syst Rev. 2005:CD000443.
Olson DM, Bettger JP, Alexander KP, Kendrick AS, Irvine JR, Wing L, Coeytaux RR, Dolor RJ, Duncan PW, Graffagnino C. Transition of care for acute stroke and myocardial infarction patients: from hospitalization to rehabilitation, recovery, and secondary prevention. Evid Rep Technol Assess (Full Rep). 2011:1–197.
Buntin MB, Escarce JJ, Hoverman C, Paddock SM, Totten M, Wynn BO. Effects of Payment Changes on Trends in Access to Post-Acute Care. Baltimore, MD: Centers for Medicare & Medicaid Services, US Department of Health and Human Services; 2005. TR-259-CMS.
Kramer A, Holthaus D, Goodrish G, Epstein A. A Study of Stroke Post-Acute Care Costs and Outcomes: Final Report. Washington. DC: US Department of Health and Human Services; 2006.
Gage B, Morley M, Spain P, Ingber M. Examining Post Acute Care Relationships in an Integrated Hospital System. Waltham, PA: US Department of Health and Human Services; 2009.
Liu K, Wissoker D, Rimes C. Determinants and costs of Medicare post-acute care provided by SNFs and HHAs. Inquiry. 1998;35:49–61.
Report to Congress: Variations and Innovation in Medicare. Washington, DC: Medicare Payment Advisory Commission (MedPAC); 2003.
Report to Congress: Medicare Payment Policy. Washington, DC: Medicare Payment Advisory Commission (MedPAC); 2003.
Blewett LA, Kane RL, Finch M. Hospital ownership of post-acute care: does it increase access to post-acute care services? Inquiry. 1995–1996;32:457–467.
Bronskill SE, Normand SL, McNeil BJ. Post-acute service use following acute myocardial infarction in the elderly. Health Care Financ Rev. 2002;24:77–93.
Ellis C, Breland HL, Egede LE. Racial/ethnic differences in utilization of post-stroke rehabilitation services: a systematic review. Ethn Dis. 2008;18:365–372.
Shatto A. Comparing Medicare beneficiaries, by type of post-acute care received: 1999. Health Care Financ Rev. 2002;24:137–142.
Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2007:CD000197.
Zhuangl LX, Xu SF, D’Adamo CR, Jia C, He J, Han DX, Lao LX. An effectiveness study comparing acupuncture, physiotherapy, and their combination in poststroke rehabilitation: a multicentered, randomized, controlled clinical trial. Altern Ther Health Med. 2012;18:8–14.
Pressure Ulcer Prevention and Treatment Protocol: Health Care Protocol. Bloomington MN; Institute for Clinical Systems Improvement (ICSI); 2012.
Deleted in proof.
National Clinical Guideline for Stroke. 3rd ed. London, UK: Royal College of Physicians Intercollegiate Stroke Working Party; 2008.
Sandercock PA, Counsell C, Tseng MC. Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke. Cochrane Database Syst Rev. 2008:CD000119.
McGarry LJ, Thompson D, Weinstein MC, Goldhaber SZ. Cost effectiveness of thromboprophylaxis with a low-molecular-weight heparin versus unfractionated heparin in acutely ill medical inpatients. Am J Manag Care. 2004;10:632–642.
Centers for Disease Control and Prevention. Guidelines for prevention of catheter-associated urinary tract infections: CDC Guidelines. 2009. http://www.cdc.gov/hicpac/cauti/001_cauti.html. Accessed March 5 2016.
National Institute of Health National Institute of Diabetes and Digestive and Kidney Disease. Fecal incontinence. 2013. http://www.digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/. Accessed July 13 2013.
Management of Patients With Stroke: Rehabilitation, Prevention and Management of Complications, and Discharge Planning: A National Guideline. Edinburgh, Scotland: Scottish Intercollegiate Guidelines Network; 2010.
Cassinari V, Pagni CA. Central Pain: A Neurological Survey. Cambridge, UK: Harvard University Press; 1969.
Pellicane A, Harvey RL. Central poststroke pain. , Stein J, Harvey RL, Winstein CJ, Zorowitz RD, Wittenberg GF. In: Stroke Recovery and Rehabilitation. 2nd ed. New York, NY: Demos Medical; 2014:249–266.
Agnew DC, Goldberg VD. A brief trial of phenytoin therapy for thalamic pain. Bull Los Angeles Neurol Soc. 1976;41:9–12.
Eng HS, Das S. Response to Commentary on Watt E, Murphy M, Pascoe E, Scanlon A & Gan S (2011) An evaluation of a structured learning programme as a component of the clinical practicum in final year bachelor of nursing programme: a pre-post test analysis. Journal of Clinical Nursing 20, 2286–2293. J Clin Nurs. 2012;21:297–298.
Vuletić V, Sapina L, Lozert M, Lezaić Z, Morović S. Anxiety and depressive symptoms in acute ischemic stroke. Acta Clin Croat. 2012;51:243–246.
Pluskiewicz W. Skeletal consequences in patients after stroke. Endokrynol Pol. 2011;62:48–50.
Gresham G, Duncan P, Stason W, Adams H, Adelman A, Alexander D, Bishop D, Diller L, Donaldson N, Granger C, Holland A, Kelly-Hayes M, McDowell F, Myers L, Phipps M, Roth E, Siebens H, Tarvin G, Trombly C. Post-Stroke Rehabilitation. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1995.
World Health Organization. ICF: International Classification of Functioning, Disability and Health. Geneva, Switzerland: World Health Organization; 2008.
Wunderlich G. Improving the Measurement of Late-Life Disability in Population Surveys: Beyond ADLs and IADLs: Summary of a Workshop. Washington, DC: National Academies Press; 2009.
Butler M, Kane R, Larson S, Jeffery M, Grove M. Quality Improvement Measurement of Outcomes for People With Disabilities: Closing the Quality Gap: Revisiting the State of the Science. Rockville, MD: Agency for Healthcare Research and Quality; 2012. Evidence report/technology assessment No. 208.
Patient Protection and Affordable Care Act. PL 111–148. 111th Congress (2010).
Teasell R. Challenges in the implementation of evidence in stroke rehabilitation. Top Stroke Rehabil. 2012;19:93–95. doi: 10.1310/tsr1902-93.
Canadian Partnership for Stroke Recovery. Evidence-Based Review of Stroke Rehabilitation. http://www.ebrsr.com/index.php. Accessed March 5 2016.
Canadian Partnership for Stroke Recovery. http://www.ebrsr.com/evidence-review/21-outcome-measures. Evidence-based review of stroke rehabilitation. http://www.EBRSR.com. Accessed March 5 2016.
Fitzpatrick R, Davey C, Buxton M, Jones D. Evaluating patient-based outcome measures for use in clinical trials. Health Technology Assessment. 1998;2:i–iv, 1–74.
Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66:69–74.
Deleted in proof.
Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–65.
Kwakkel G, Kollen B, Lindeman E. Understanding the pattern of functional recovery after stroke: facts and theories. Restor Neurol Neurosci. 2004;22:281–299.
National Institute of Deafness and Other Communication Disorders. Aphasia. http://www.nidcd.nih.gov/health/voice/aphasiahtm. Accessed March 5 2016.
Deleted in proof.
Pambakian A, Currie J, Kennard C. Rehabilitation strategies for patients with homonymous visual field defects. J Neuroophthalmol. 2005;25:136–142.
Mountcastle V. The Sensory Hand: Neural Mechanisms of Somatic Sensation. Boston, MA: Harvard University Press; 2005.
Mousavi Hondori H, Khademi M, Dodakian L, Cramer SC, Lopes CV. A spatial augmented reality rehab system for post-stroke hand rehabilitation. Stud Health Technol Inform. 2013;184:279–285.
Kasten E, Poggel DA, Müller-Oehring E, Gothe J, Schulte T, Sabel BA. Restoration of vision II: residual functions and training-induced visual field enlargement in brain-damaged patients. Restor Neurol Neurosci. 1999;15:273–287.
National Collaborating Centre for Chronic Conditions. Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischemic Attack (TIA). London, UK: Royal College of Physicians, 2008.
Geeganage C, Beavan J, Ellender S, Bath PM. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst Rev. 2012;10:CD000323.
Toniolo S. Neuropsychological interventions in stroke survivors: implications for evidence based psychological practice. G Ital Med Lav Ergon. 2011;33(suppl A):A29–A36.
das Nair R, Lincoln N. Cognitive rehabilitation for memory deficits following stroke. Cochrane Database Syst Rev. 2007:CD002293.
Salter K Teasell R Bitensky J Foley N Bhogal SK Mahon H McClure JA. Cognitive disorders and apraxia: evidence based review of stroke rehabilitation version 15. 2012. http://www.ebrsr.com/evidence-review/12-cognitive-disorders-and-apraxia. Accessed March 5 2016.
Man DW, Soong WY, Tam SF, Hui-Chan CW. A randomized clinical trial study on the effectiveness of a tele-analogy-based problem-solving programme for people with acquired brain injury (ABI). NeuroRehabilitation. 2006;21:205–217.
Deleted in proof.
Bowen A, Lincoln N. Cognitive rehabilitation for spatial neglect following stroke (review). In: The Cochrane Collaboration. Vol 4. New York, NY: John Wiley & Sons, Ltd; 2008.
Wilson B, Cockburn J, Halligan P. Development of a behavioral test of visuospatial neglect. Arch Phys Med Rehabil. 1987;68:98–102.
Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. , Eisenberg MG, Grzesiak RC. In: Advances in Clinical Rehabilitation. Vol 2. New York: Springer; 2987:6–18.
Deleted in proof.
Warlow CP, Dennis MS, Van Gijn J, Hankey GJ, Sandercock PAG, Bamford JG, Wardlaw J. Stroke: A Practical Guide to Management. Oxford, UK: Blackwell Scientific; 2000.
Wambaugh JL, Duffy JR, McNeil MR, Robin DA, Rogers MA. Treatment guidelines for acquired apraxia of speech: treatment descriptions and recommendations: second of two reports. J Med Speech Lang Pathol. 2006b;14:xxxv–Ixvii.
Yorkston KM, Hakel M, Beukelman DR, Fager S. Evidence for effectiveness of treatment of loudness, rate, or prosody in dysarthria: a systematic review. J Med Speech Lang Pathol.2007;15:XI–XXXVI.
Sellars C, Hughes T, Langhorne P. Speech and language therapy for dysarthria due to non-progressive brain damage. Cochrane Database Syst Rev. 2005:CD002088.
West C, Hesketh A, Vail A, Bowen A. Interventions for apraxia of speech following stroke. Cochrane Database Syst Rev. 2005:CD004298.
Wenke RJ, Theodoros D, Cornwell P. A comparison of the effects of the Lee Silverman voice treatment and traditional therapy on intelligibility, perceptual speech features, and everyday communication in nonprogressive dysarthria. J Med Speech Lang Pathol. 2011;19:1–24.
Hanson E, Yorkston K, Beukelman D. Speech supplementation techniques for dysarthria: a systematic review. J Med Speech Lang Pathol. 2004;12:IX–XXIX.
Whitehill TL, Ma EPM, Tse FCM. Environmental barriers to communication for individuals with dysarthria. J Med Speech Lang Pathol. 2010;18:141–144.
American Speech-Language Hearing Association. Speech-language pathologists providing clinical services via telepractice [position statement]. 2005. http://www.asha.org/policy. Accessed August 4 2014.
Department of Veterans Affairs, Department of Defense, American Heart Association/American Stroke Association. VA/DoD Clinical Practice Guideline for the Management of Stroke Rehabilitation. Washington, DC: Veterans Affairs/Department of Defense; 2010.
Santamato A, Micello MF, Panza F, Fortunato F, Pilotto A, Giustini A, Testa A, Fiore P, Ranieri M, Spidalieri R. Safety and efficacy of incobotulinum toxin type A (NT 201-Xeomin) for the treatment of post-stroke lower limb spasticity: a prospective open-label study. Eur J Phys Rehabil Med. 2013;49:483–489.
Katrak PH, Cole AM, Poulos CJ, McCauley JC. Objective assessment of spasticity, strength, and function with early exhibition of dantrolene sodium after cerebrovascular accident: a randomized double-blind study. Arch Phys Med Rehabil. 1992;73:4–9.
Medaer R, Hellbuyk H, Van Den Brande E, et al.. Treatment of spasticity due to stroke: a double-blind, cross-over trial comparing baclofen with placebo. Acta Ther. 1991;17:323–331.
Bronstein AM, Pavlou M. Balance. , Barnes MP, Good DC. In: Handbook of Clinical Neurology, Neurological Rehabilitation. New York, NY: Elsevier; 2013;110:189–208.
Shumway-Cook A, Woolacott MH. Motor Control: Translating Research Into Clinical Practice. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
Deleted in proof.
Stoykov ME, Stojakovich M, Stevens JA. Beneficial effects of postural intervention on prehensile action for an individual with ataxia resulting from brainstem stroke. NeuroRehabilitation. 2005;20:85–89.
French B, Thomas LH, Leathley MJ, Sutton CJ, McAdam J, Forster A, Langhorne P, Price CI, Walker A, Watkins CL. Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev. 2007:CD006073.
Miyai I, Reding R. Effects of antidepressants on functional recovery following stroke: a double blind study. J Neuro Rehab. 1998;12:5–13.
Martinsson L, Hardemark H, Eksborg S. Amphetamines for improving recovery after stroke. Cochrane Database Syst Rev. 2007:CD002090.
Woodford H, Price C. EMG biofeedback for the recovery of motor function after stroke. Cochrane Database Syst Rev. 2007:CD004585.
Deleted in proof.
Gresham GE, Duncan PW, Stason WB, Adams HP, Adelman AM, Alexander DN, Bishop DS, Diller L, Donaldson NE, Granger CV. Post-stroke rehabilitation. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Healthcare Policy and Research; 1995.
Bonaiuti D, Rebasti L, Sioli P. The constraint induced movement therapy: a systematic review of randomised controlled trials on the adult stroke patients. Eura Medicophys. 2007;43:139–146.
Taub E, Miller NE, Novack TA, Cook EW, Fleming WC, Nepomuceno CS, Connell JS, Crago JE. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil. 1993;74:347–354.
Pomeroy VM, King LM, Pollock A, Baily-Hallam A, Langhorne P. Electrostimulation for promoting recovery of movement or functional ability after stroke: systematic review and meta-analysis. Cochrane Database Syst Rev. 2006;(2):CD003241.
Deleted in proof.
Clinical Trials.gov. Efficacy of Virtual Reality Exercises in STroke Rehabilitation: A Multicentre Study (EVREST Multicentre). https://clinicaltrials.gov/ct2/show/NCT01406912?term=NCT01406912&rank=1. Accessed August 27 2015.
Deleted in proof.
Deleted in proof.
United Nations. Convention on the Rights of Persons with Disabilities. http://www.un.org/disabilities/convention/facts.shtml. 2006. Accessed March 5 2016.
Legg LA, Drummond AE, Langhorne P. Occupational therapy for patients with problems in activities of daily living after stroke. Cochrane Database Syst Rev. 2006:CD003585.
Rehabilitation Engineering and Assistive Technology Society of North America. RESNA Wheelchair Service Provision Guide. 2011. http://www.resna.org/dotAsset/22485.pdf. Accessed June 28 2013.
Deleted in proof.
Deleted in proof.
Deleted in proof.
Mackay-Lyons M, Thornton M, Ruggles T, Che M. Non-pharmacological interventions for preventing secondary vascular events after stroke or transient ischemic attack. Cochrane Database Syst Rev. 2013;3:CD008656.
Management of Stroke Rehabilitation Working Group. VA/DOD clinical practice guideline for the management of stroke rehabilitation. J Rehabil Res Dev. 2010;47:1–43.
American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 9th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2013.
Deleted in proof.
Deleted in proof.
Durstine JL. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. Champaign, IL: Human Kinetics; 2009.
Deleted in proof.
Campos de Oliveira B, Garanhani ML, Garanhani MR. Caregivers of people with stroke: needs, feeling and guidelines provided. Acta Paulista de Enfermagem. 2011;24:43–49.
White CL, Korner-Bitensky N, Rodrigue N, Rosmus C, Sourial R, Lambert S, Wood-Dauphinee S. Barriers and facilitators to caring for individuals with stroke in the community: the family’s experience. Can J Neurosci Nurs. 2007;29:5–12.
Gianotten WL Bender JL Post MW. Training in sexology for medical and paramedical professionals: a model for the rehabilitation setting. Sex Relationship Ther. 2006; 21:303–317. http://dx.doi.org/10.1080/14681990600754559. Accessed December 29 2014.
Schwarzenegger A, Chrisman M, Coleman R. The Health and Social Benefits of Recreation. Sacramento, CA: California State Parks; 2005.
Deleted in proof.
Deleted in proof.
Deleted in proof.
Yale SH Hansotia P Knapp D Ehrfurth J. Neurologic conditions: assessing medical fitness to drive. Clin Med Res. 2003;1:177–188.
American Stroke Association. Driving after stroke. http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/Driving/Driving-After-Stroke_UCM_311016_Article.jsp#.Vtu80BjiTY8. Accessed March 5 2016.
Deleted in proof.