The key to successful stroke rehabilitation is a well-organized, multidisciplinary approach that includes the patient's family and caregivers, according to the latest practice guidelines.

The American Heart Association and the American Stroke Association, which endorsed the new practice guidelines, said early initiation and an organized strategy are essential to a stroke patient's recovery.

"Better clinical outcomes are achieved when post-acute stroke patients who are candidates for rehabilitation receive coordinated, multi-disciplinary evaluation and intervention," wrote Pamela Duncan, Ph.D., of the University of Florida in Gainesville and colleagues. She was co-chair of the committee that wrote the guidelines, which were published in the September issue of Stroke.

The guidelines reflect a review of the literature through 2002, using criteria from the U.S. Preventative Services Task Force. The recommendations were based on randomized clinical trials, uncontrolled studies, and consensus expert opinion.

Dr. Duncan and colleagues recommended that:

* Stroke rehabilitation begins at the beginning, as soon as a stroke diagnosis has been made.

* Post-stroke rehabilitation care can occur in a stroke unit or in a rehabilitation setting where care will be formally coordinated and organized. If an organized rehabilitation team is not available on-site, patients with moderate to severe symptoms should be referred to an appropriately equipped facility. The team may consist of a physician, a nurse, a physical therapist, a speech pathologist, a psychologist, an occupational therapist, a recreational therapist, and a kinesiotherapist.

* Patients should undergo an early assessment using the National Institutes of Health Stroke Scale to determine stroke severity.

* Rehabilitation therapies should begin as early as possible; for example, testing for swallowing ability.

* Steps be taken to prevent recurrent stroke.

* Patients walk 50 feet daily to prevent deep vein thrombosis.

* There is implementation of anticoagulant therapy in ischemic strokes to prevent deep vein thrombosis.

* Treatment for depression or any mood disorders is included.

* A speech-and-language pathologist conduct an evaluation of the patients' communication and cognitive skills.

The investigators also noted that the patient's loved ones need to be involved in the rehabilitation process.

"Recognizing the stroke survivor, caregiver and family members are essential members of the rehabilitation team and should be involved in all phases of the rehabilitation process," they wrote.

Stroke is one of the leading causes of death in the U.S. Up to 70% of stroke patients are left with moderate to severe physical and emotional disabilities.

"In addition to providing state-of-the-art direction for clinicians," the authors concluded, "the guidelines can also help researchers to identify areas for further investigation. In turn, this research can result in more effective procedures and more efficient technology." CME Teaching Brief - MedPage Today