From the Guidelines
The best approach for optimal stroke recovery involves a comprehensive rehabilitation program that begins as soon as medically stable, typically within 24-48 hours after stroke, with a focus on early mobilization, task-specific therapy, and interdisciplinary care. This approach is supported by the Canadian Stroke Best Practice Recommendations, which emphasize the importance of early rehabilitation therapy, including physical therapy, occupational therapy, and speech therapy, as well as the need for patient-centered, culturally appropriate care 1.
Key components of an effective stroke rehabilitation program include:
- Early mobilization, with patients starting to be mobilized between 24 and 48 hours after stroke onset, if there are no contraindications 1
- A minimum of three hours per day of direct task-specific therapy, five days a week, delivered by an interprofessional stroke team 1
- Rehabilitation therapies that are tailored to meet the individual needs of the patient, with a focus on repetitive and intense use of novel tasks to challenge the patient and promote functional recovery 1
- Patient-centered care, with a focus on shared decision-making, cultural appropriateness, and incorporation of the patient's goals and preferences into the rehabilitation plan 1
In addition to these components, community-based rehabilitation programs have been shown to be effective in improving outcomes for stroke survivors, with benefits including reduced costs, decreased length of stay in hospitals or institutional settings, and increased patient and family satisfaction 1. Family caregiver education and support are also essential, with interventions that combine skill building with psycho-educational strategies, and are tailored to the individual needs of the caregiver, being particularly effective 1.
Overall, the goal of stroke rehabilitation is to promote optimal recovery, adaptation, and quality of life for patients, families, and caregivers, and to support seamless transitions across the continuum of care 1. By prioritizing early, intensive, and patient-centered rehabilitation, stroke survivors can achieve the best possible outcomes, with significant improvements in functional ability, mobility, and overall quality of life.
From the Research
Best Approach for Optimal Stroke Recovery
The best approach for optimal stroke recovery involves a combination of medical treatments and rehabilitation therapies. Some key aspects of stroke recovery include:
- Antithrombotic therapy: Antiplatelet and anticoagulant agents play a crucial role in secondary stroke prevention 2, 3.
- Reperfusion therapy: Intravenous recombinant tissue plasminogen activator (IV TPA) and/or endovascular thrombectomy can help restore cerebral blood flow to salvageable ischemic brain tissue 4, 5.
- Dual antiplatelet therapy (DAPT): Short-term DAPT with aspirin and a P2Y12 inhibitor can reduce the risk of recurrent stroke, but may increase the risk of major bleeding events 2, 6.
- Comprehensive stroke rehabilitation program: A multidisciplinary approach to rehabilitation can help optimize post-stroke outcomes and improve chances for successful rehabilitation 4.
Medical Treatments for Stroke Recovery
Some medical treatments that may be used for stroke recovery include:
- Aspirin: A commonly used antiplatelet agent for secondary stroke prevention 2, 3.
- Clopidogrel: Another antiplatelet agent that may be used in combination with aspirin for DAPT 2, 6.
- Ticagrelor: A P2Y12 inhibitor that may be used in combination with aspirin for DAPT 2, 6.
- Anticoagulants: Such as warfarin or direct oral anticoagulants (DOACs), which may be used for secondary stroke prevention in patients with non-valvular cardioembolic strokes 2.
Rehabilitation Therapies for Stroke Recovery
Some rehabilitation therapies that may be used for stroke recovery include: