From the Guidelines
Post-stroke rehabilitation in Colombia and globally requires immediate attention to prevent complications and improve outcomes, with a focus on early mobilization, multidisciplinary care, and continuous support. The standard recommendation for post-stroke care includes early mobilization within 24-48 hours after stroke stabilization, followed by a multidisciplinary approach involving physical therapy, occupational therapy, speech therapy if needed, and psychological support 1. Medications commonly prescribed include antiplatelet agents like aspirin or clopidogrel, antihypertensives to maintain blood pressure below 140/90 mmHg, and statins such as atorvastatin 1.
Some key aspects of post-stroke rehabilitation include:
- Early mobilization to prevent complications such as contractures, pressure ulcers, and increased dependency
- Multidisciplinary care involving physical therapy, occupational therapy, speech therapy, and psychological support
- Medications to prevent further stroke and manage risk factors
- Continuous support and monitoring to prevent complications and improve outcomes
The rehabilitation gap in Colombia and globally exists due to various factors, including:
- Healthcare infrastructure limitations
- Geographical barriers in rural areas
- Insufficient specialized professionals
- Economic constraints
Improving stroke rehabilitation outcomes requires policy changes to:
- Expand rehabilitation center networks
- Increase training programs for specialists
- Implement telemedicine solutions for remote areas
- Develop community-based rehabilitation programs that can provide continuous care after hospital discharge 1.
Recent guidelines, such as the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines, emphasize the importance of tailored and timely rehabilitative interventions for stroke survivors, starting as soon as clinically feasible to maximize functional outcomes 1.
From the Research
Post-Stroke Rehabilitation
- Post-stroke rehabilitation is a crucial aspect of the continuum of care in stroke, with the goal of optimizing post-stroke outcomes 2.
- Research has expanded our understanding of the mechanisms underlying stroke recovery, leading to the development of new treatment modalities 2.
- A comprehensive rehabilitation program is essential to optimize post-stroke outcomes, using three major principles of recovery: adaptation, restitution, and neuroplasticity 2.
Stroke Prevention
- Oral anticoagulation (OAC) remains the mainstay for prevention of ischemic stroke in atrial fibrillation, with new oral anticoagulants offering relative efficacy, safety, and convenience compared to warfarin 3.
- The choice of oral anticoagulant agent should be made by careful consideration of the benefit-to-risk ratio, taking into account the risk of bleeding and the potential benefits of stroke prevention 4.
- Direct-acting oral anticoagulants (DOACs) such as apixaban have been shown to be effective in reducing the risk of stroke or systemic embolism in people with subclinical atrial fibrillation and a history of stroke or transient ischemic attack 5.
Implementation of Research Evidence
- Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care 6.
- An international consensus process has identified priorities for implementing research evidence into stroke rehabilitation practice, including service delivery, screening and assessment, clinical practice guidelines, intensity, and family support 6.
- Health care providers, managers, and organizations should determine whether these priorities are gaps in their local practice and consider implementation solutions to address them and improve the quality of lives of people living with stroke 6.