New recommendations released by the Heart and Stroke Foundation of Canada stroke guidelines team for physicians, nurses and allied health professionals, reinforce that stroke rehabilitation is not limited to a single location, but is an ongoing process that includes a range of activities in many settings taking place over months or years. This updated set of recommendations emphasizes all components of dedicated stroke rehabilitation services, from rehabilitation units, to outpatient clinics and programs in the community; taking a more holistic approach to stroke rehabilitation as being available ‘anywhere, anytime'.
"Stroke rehabilitation is a progressive, dynamic, goal-oriented process that works to restore neurological deficits occurring as a consequence of a stroke. Rehabilitation should begin immediately after a stroke and involves interdisciplinary teams working together to maximize the individual's recovery. Rehabilitation continues after the patient leaves hospital to ensure the patient achieves maximal recovery and is successfully reintegrated back into the community."says Dr. Robert Teasell, Professor of Physical Medicine and Rehabilitation, Schulich School of Medicine, Western University in London, and senior writer, Stroke Rehabilitation Writing Group.
The recommendations also highlight the need for an increase in early-supported discharge, which allows patients to return to their previous living setting as early as possible, where appropriate. The significant benefits to this approach include better quality of life for the patient and decreased burden on the health care system. In order for early supported discharge to be successful, it needs to be delivered within an organized system of stroke care to provide the best outcomes for patients.
Recent reports on the quality of stroke rehabilitation and recovery services reveal considerable variation in availability and access within Canada and across many developed countries. Access is considerably more variable and less available in developing countries that lack the expertise and resources for long-term rehabilitation. New strategies and the use of technology, such as telestroke, should be considered to bridge this gap.
“The evidence supporting the positive impact that rehabilitation plays in stroke recovery is both strong and growing. However, the key is the availability and accessibility to critical rehabilitation programs and services. On a system level there continues to be many gaps in terms of people being able to access timely and intensive rehabilitation in both inpatient and outpatient settings. Rehabilitation should clearly be an area of focused uptake for stroke care best practices as it will result in significant gains for both patients and the health system”says Mark Collison, Director, Advocacy & Stakeholder Relations, Heart and Stroke Foundation, British Columbia and Yukon.
Rehabilitation crosses all settings of care, and a broad range of providers and caregivers, and families and other informal caregivers play a critical role. The patient, their family and caregivers must be included in goal setting, planning for the types of rehabilitation required and selecting the most appropriate setting to receive the needed rehabilitation.
The Canadian Best Practice Recommendations for Stroke Care is a joint initiative of the Heart and Stroke Foundation and the Canadian Stroke Network.
Patty Lindsay
Patty Lindsay
Director Best Practices and Performance, Stroke
Heart and Stroke Foundation | Fondation des maladies du cœur et de l'AVC
