Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery
A Guideline for Healthcare Professionals From the American Heart
Association/American Stroke Association
Endorsed by the American Academy of Physical Medicine and Rehabilitation and the
American Society of Neurorehabilitation
The American Academy of Neurology affirms the value of this guideline as an educational tool for
neurologists and the American Congress of Rehabilitation Medicine also affirms the educational value
of these guidelines for its members

Carolee J. Winstein, PhD, PT, Chair; Joel Stein, MD, Vice Chair;
Ross Arena, PhD, PT, FAHA; Barbara Bates, MD, MBA; Leora R. Cherney, PhD;
Steven C. Cramer, MD; Frank Deruyter, PhD; Janice J. Eng, PhD, BSc; Beth Fisher, PhD, PT;
Richard L. Harvey, MD; Catherine E. Lang, PhD, PT; Marilyn MacKay-Lyons, BSc, MScPT, PhD;
Kenneth J. Ottenbacher, PhD, OTR; Sue Pugh, MSN, RN, CNS-BC, CRRN, CNRN, FAHA;
Mathew J. Reeves, PhD, DVM, FAHA; Lorie G. Richards, PhD, OTR/L; William Stiers, PhD, ABPP (RP);
Richard D. Zorowitz, MD; on behalf of the American Heart Association Stroke Council, Council
on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on
Quality of Care and Outcomes Research

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.

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