Julia Castleberry, MS PT, DPT, CLT, GCS, NCS (Term 2014-2017)
Heather Hayes, DPT, NCS, PhD (Term 2016-2017)
Jamie Haines, PT, DScPT, NCS (Term 2016-2019)
Maureen Whitford, PT, PhD, NCS (Term 2015-2018)
Nominating committee chair
Rachel Tran, PT, DPT, NCS (Term 2014-2017)
Alexandra Borstad, PT, PhD, NCS (Term 2015-2018)
Mark Stephens, PT, DPT, NCS (Term 2016-2019)
Karen Zacharewicz, PT, DPT, NCS
News and Research
Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Winstein CJ, Stein J, Arena R, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98-e169.
PURPOSE: The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Repetitive Training Can Help With Walking After Stroke
Repetitive training that simulates everyday leg function can help people walk more easily after stroke, according to a news article from Health Behavior News Service, reporting on a new review of studies in The Cochrane Library. Practicing everyday tasks resulted in modest gains in walking speed, walking distance, and patients' ability to stand up, the review found.
The therapy typically lasted for 1-hour sessions, three to five times a week for 6 to 8 weeks. Researchers tested both arm and leg mobility in the studies, but the review only found significant improvements for lower limb function. Moreover, it is not clear if the gains in leg mobility were permanent. The analyzed studies included a mix of patients, people who had had a stroke recently and those who had a stroke years in the past. Both groups of patients experienced similar health gains.
"People who had repetitive task training were able to go 50 meters farther in 6 minutes compared to people who hadn't," said lead review author Beverley French, a senior research fellow at the University of Central Lancashire in England. In the real world that distance equates to being able to cross an intersection while the walk sign remains lit or to go from a parking lot into a grocery store, she said.
The review gathers evidence from 14 trials with more than 650 study participants. In the studies, patients repeatedly practiced everyday tasks or the movements associated with the tasks, like buttoning clothes, walking up steps, reaching for items on shelves or standing up from sitting. "The idea of repeatedly practicing tasks is based on the thought that you can re-pattern the damaged brain," French said.
The analysis found that repetitive task training is effective -- and does result in health gains for stroke patients -- but did not determine whether the approach is better than other rehabilitation interventions. French said that repetitive task training is not a method of therapy; rather, many therapies can incorporate the technique as "an underpinning for everything a therapist does with a patient."
APTA Issue Brief: Stroke
The Issue Brief Series provides brief background on particular issues and highlights a PT's role for each topic covered as well as particular policy challenges.
APTA Issue Brief: Healthcare Needs for Prevention of and Recovery from Stroke
AHA Physical Activity and Exercise Recommendations for Stroke Survivors
Physical activity remains a cornerstone in the current armamentarium of risk-reduction therapies for the prevention and treatment of stroke. [Read More]
Julia Castleberry, MS PT, DPT, CLT, GCS, NCS
Heather Hayes, DPT, PhD, NCS