Stroke Rehabilitation

Publication Date: July 1, 2024
Last Updated: July 9, 2024

Transitions to Community

We suggest using case management services at time of discharge from the acute care hospital or post-acute care facility to improve activities of daily living and functional independence.

(Weak for)
315659
We suggest the following interventions for patients and their caregivers
  • Behavioral health/psychosocial interventions to improve patient and caregiver depression
  • Psychoeducation to improve family function, patient functional independence, and quality of life
(Weak for)
315659
There is insufficient evidence to recommend for or against implementing transitional care rehabilitation interventions (e.g., home-based services after hospital discharge) or early supported discharge to improve activities of daily living or functional disability following stroke. (Neither for or against)
315659

There is insufficient evidence to recommend for or against community participation interventions to improve community engagement for survivors of stroke.

(Neither for or against)
315659

Motor Therapy

General

We recommend task-specific practice (also known as taskoriented practice or repetitive task practice) to improve motor function, gait, posture, and activities of daily living. (Strong for)
315659
We suggest mirror therapy to improve motor outcomes and activities of daily living. (Weak for)
315659

We suggest mirror therapy to improve unilateral spatial neglect

(Weak for)
315659
There is insufficient evidence to recommend for or against body-weight support treadmill training to improve motor outcomes. (Neither for or against)
315659
We suggest rhythmic auditory stimulation as an adjunct intervention to improve motor outcomes. (Weak for)
315659
There is insufficient evidence to recommend for or against the use of high intensity interval training over moderate intensity continuous training to enhance gait recovery. (Neither for or against)
315659
There is insufficient evidence to recommend for or against constraint-induced movement therapy to improve upper extremity motor outcomes for individuals with some movement in the paretic limb. (Neither for or against)
315659
There is insufficient evidence to recommend for or against selective serotonin reuptake inhibitors to improve motor outcomes in patients with or without depression. (Neither for or against)
315659

There is insufficient evidence to recommend for or against aquatic therapy, as compared with land-based therapy, to improve mobility, balance, and activities of daily living.

(Neither for or against)
315659
There is insufficient evidence to recommend for or against biofeedback as an adjunct intervention to improve motor outcomes. (Neither for or against)
315659
There is insufficient evidence to recommend for or against motor imagery to improve motor function. (Neither for or against)
315659
There is insufficient evidence to recommend for or against acupuncture to improve motor function. (Neither for or against)
315659

Technology Assisted Physical Rehabilitation

We suggest neuromuscular electrical stimulation to improve motor outcomes. (Weak for)
315659

There is insufficient evidence to recommend for or against robot-assisted therapy to improve upper or lower extremity motor outcomes.

(Neither for or against)
315659
There is insufficient evidence to recommend for or against virtual reality to improve balance or enhance gait recovery. (Neither for or against)
315659
There is insufficient evidence to recommend for or against the use of virtual reality/serious gaming to improve upper extremity motor outcomes, activities of daily living, or quality of life. (Neither for or against)
315659
There is insufficient evidence to recommend for or against contralaterally controlled functional electrical stimulation to improve upper extremity motor outcomes and activities of daily living. (Neither for or against)
315659
There is insufficient evidence to recommend for or against noninvasive brain-computer interface to improve upper extremity motor outcomes and activities of daily living. (Neither for or against)
315659
There is insufficient evidence to recommend for or against vagus nerve stimulation as an adjunct intervention for rehabilitation of acute and chronic motor deficits. (Neither for or against)
315659

Spasticity

We suggest botulinum toxin for patients with focal spasticity depending on patient characteristics and preferences. (Weak for)
315659
There is insufficient evidence to recommend for or against the use of acupuncture or dry needling for spasticity management. (Neither for or against)
315659
There is insufficient evidence to recommend for or against whole body or localized muscle vibration for spasticity management. (Neither for or against)
315659

There is insufficient evidence to recommend for or against extracorporeal shock wave therapy for spasticity management.

(Neither for or against)
315659

Dysphagia, Cognition, and Aphasia

Dysphagia

We suggest chin tuck against resistance exercises for patients with dysphagia. (Weak for)
315659
We suggest respiratory muscle strength training for dysphagia in patients without a tracheostomy. (Weak for)
315659
There is insufficient evidence to recommend for or against tongue pressure resistance training for dysphagia. (Neither for or against)
315659
There is insufficient evidence to recommend for or against neuromuscular electrical stimulation and pharyngeal electrical stimulation for dysphagia. (Neither for or against)
315659
There is insufficient evidence to recommend for or against surface electromyography for dysphagia. (Neither for or against)
315659

Cognition

There is insufficient evidence to recommend for or against the use of selective serotonin reuptake inhibitors to improve cognitive outcomes.

(Neither for or against)
315659
There is insufficient evidence to recommend for or against computer assisted cognitive rehabilitation to improve cognitive outcomes. (Neither for or against)
315659

Aphasia

There is insufficient evidence to recommend for or against a specific intensity of language therapy for aphasia. (Neither for or against)
315659

Spatial Neglect Therapy

There is insufficient evidence to recommend for or against hemifield eye patching in addition to traditional therapy to improve functional outcomes in patients with unilateral spatial neglect. (Neither for or against)
315659
There is insufficient evidence to recommend for or against the use of prism adaptation therapy for patients with unilateral spatial neglect. (Neither for or against)
315659

Mental Health

Prevention of Depression

There is insufficient evidence to recommend for or against solution-focused psychological interventions (e.g., motivational interviewing, problem-solving therapy) to prevent the development of depression. (Neither for or against)
315659

We suggest against the use of antidepressants for the prevention of post-stroke depression.

(Weak against)
315659
We suggest a selective serotonin reuptake inhibitor or a serotonin norepinephrine reuptake inhibitor for depression symptoms. (Weak for)
315659
We suggest psychotherapy (e.g., cognitive behavioral therapy) for depression following stroke. (Weak for)
315659
We suggest mindfulness-based therapies for treatment of depression following stroke. (Weak for)
315659
There is insufficient evidence to recommend for or against acupuncture, either alone or as an adjunct to pharmacotherapy, for depression following stroke (Neither for or against)
315659

Telehealth

We suggest either face-to-face therapy or telerehabilitation, depending on patient characteristics and preferences. (Weak for)
315659

There is insufficient evidence to recommend for or against the use of telerehabilitation and technology-based interventions to improve stroke-related dysphagia or aphasia outcomes or both.

(Neither for or against)
315659
There is insufficient evidence to recommend for or against technology-based caregiver support/education interventions to improve caregiver quality of life. (Neither for or against)
315659

Non-invasive Brain Stimulation

There is insufficient evidence to recommend for or against noninvasive brain stimulation (e.g., repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and continuous theta burst stimulation) for patients in stroke rehabilitation. (Neither for or against)
315659

Recommendation Grading

Overview

Title

Management of Stroke Rehabilitation

Authoring Organization

Veterans Health Administration / Department of Defense

Publication Month/Year

July 1, 2024

Last Updated Month/Year

July 15, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Target Patient Population

Adult patients (18 years and older) who have experienced a stroke and are eligible for care in the VA or DoD health care delivery system

Target Provider Population

VA and DoD providers and others on the healthcare team assessing and managing patients who have experienced a stroke and are receiving rehabilitation services

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Home health, Long term care, Medical transportation, Outpatient

Intended Users

Nurse, nurse practitioner, physical therapist, physician, physician assistant

Scope

Treatment, Management, Prevention, Rehabilitation

Diseases/Conditions (MeSH)

D000071939 - Stroke Rehabilitation

Keywords

physical therapy, Stroke Rehabilitation

Supplemental Methodology Resources

Methodology Supplement

Methodology

Number of Source Documents
275
Literature Search Start Date
July 1, 2018
Literature Search End Date
May 2, 2023