New Guidelines for Stroke Rehabilitation

If you work in a nursing home, then the chances are high that you care for a senior who has suffered a stroke.

Learn more about the new guidelines for stroke rehabilitation and recovery, to properly manage the disease over time.

Guidelines for Stroke Rehabilitation

According to the American Stroke Association, almost “three-quarters of all strokes occur in people over the age of 65 and the risk of having a stroke more than doubles each decade after the age of 55.”

Advances in research surrounding the cause and treatment of strokes has meant that many people who have had a stroke are surviving and living longer lives. However, the years they live after their stroke are not always of high quality.

“In fact, stroke is a leading cause of long-term disability and the leading preventable cause of disability,” the American Stroke Association reports.

Although it’s great news that stroke sufferers are living longer lives, their extra years are often not quality years, which is why the American Stroke Association (ASA) and the American Heart Association (AHA) have released new guidelines for stroke rehabilitation which are focusing more on rehabilitation and recovery than ever before.

These guidelines are based on a change in mindset; one that looks at stroke not as an acute event, but as a chronic disease that should be properly managed over time.

“The need to reverse stroke damage and restore function to the extent possible has prompted the release of [these] new guidelines,” Today’s Geriatric Medicine reports.

Recommendations for Inpatient Rehab Facilities

Each year, approximately 795,000 people in America suffer a stroke. About 600,000 of these are first attacks, and 185,000 are recurrent attacks, the American Stroke Association reports.

Currently, many of the people who have a stroke receive post-hospital care in a nursing home setting, however the ASA and AHA’s new guidelines are now recommending that post-stroke patients receive treatment from an inpatient rehab facility instead, whenever possible.

The reason for this new recommendation is because studies have shown that patients who have received stroke rehabilitation in an inpatient rehab facility achieve greater functional recovery and are more likely to return to community living than those who don’t.

Today’s Geriatric Medicine concludes that some of the factors that may play a role in the improved recovery at inpatient rehab facilities include:

Increased frequency of physician involvement
More access to specialized therapy services including physical, occupational and speech therapy
More coordinated, multidisciplinary care for patients
Specialization of physicians and nursing staff

The ASA and ASH guidelines concede that there are many nursing homes out there that provide a superior standard of stroke rehabilitation and recovery, offering many of the aforementioned amenities to patients. However not all do, and those that are superior in their rehabilitative care tend to share similar care models with inpatient rehab facilities.

It is important to differentiate that the type of care provided to people recovering from a stroke is by far more critical to positive outcomes than the type of facility providing the care.

Especially considering that patients need to be qualified to enter inpatient rehabilitation, and their acceptance to such facilities is often determined by their condition prior to their stroke. Additionally, not all cities across the United States have these types of inpatient rehabilitation facilities, and in these cases nursing home care may be the only option.

Practically speaking, not all seniors who have suffered a stroke will have access to inpatient stroke rehabilitation, which means that the onus is on nursing homes to provide the necessary rehabilitation and recovery focused care that the ASA and ASH guidelines recommend. These recommendations suggest offering a number of programs, including:

Depression Screening Programs

Depression affects 33% of all stroke survivors. Some people may believe that depression following a stroke is a normal emotional response, but not treating depression is actually doing the senior a disservice, Today’s Geriatric Medicine states.

The new stroke guidelines recommend that health care providers evaluate patients for depression in their post-stroke follow up visits. “Failure to treat [depression] can result in a less optimal functional outcome,” reports Today’s Geriatric Medicine’s Jamie Santa Cruz.

Fall Prevention, Mobility and Safety

Fall prevention programs should be mandatory for all stroke patients and their families. Following a stroke, some seniors may have balance concerns and many seniors are at an increased risk of falling. In fact, studies have found that a high number of patients have serious falls after their stroke and that these falls are preventable. A balance training program can be an ideal solution for seniors who need to improve their balance.

Seniors who have mobility issues following their stroke, including navigating stairs and getting up or down from a chair should be provided with additional intensive, repetitive mobility-task training, Today’s Geriatric Medicine reports.

Mental Stimulation

It’s important that anyone recovering from a stroke has access to enriched environments that are designed to increase and improve cognitive function.

This includes art, computers, music and “anything that will stimulate engagement and challenge the brain in a constructive way should be incorporated,” Cruz reports.

Nutritional Care

The guidelines also recommend that anyone who is recovering from a stroke be evaluated for calcium and vitamin D supplementation.

Physical Exercise

Physical exercise has been a big factor in stroke prevention, but is sometimes neglected when it comes to rehabilitation after a stroke. “Since stroke is primarily a cardiovascular disease, it makes perfect sense that addressing [exercise] head on is extremely beneficial,” says Dr. Carolee Winstein, a professor of biokinesiology and physical therapy at the University of Southern California. “Patients often assume that their limitations following a stroke mean that they can no longer be active,” she tells Cruz. “But exercise has multiple benefits in terms of cognition and mood, and providers should educate patients on which forms of activity are available to them.”

Nursing homes that can successfully implement these stroke rehabilitation and recovery recommendations are more likely to play a positive, transformational role in their patient’s recovery – increasing quality of life and helping to change our collective understanding of life after a stroke.

How have you incorporated these guidelines for stroke rehabilitation in your life to properly manage the disease over time? Share your suggestions with us in the comments below.

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