What are the recent treatments available for non-thrombolyzed ischemic Cerebrovascular Accident (CVA) rehabilitation?

Recent Treatments for Non-Thrombolyzed Ischemic Stroke Rehabilitation

Multidisciplinary rehabilitation is the cornerstone of treatment for non-thrombolyzed ischemic stroke patients and should be initiated within 24-48 hours after stroke onset (but not within the first 24 hours) to improve functional outcomes and reduce mortality. 1

Core Components of Modern Stroke Rehabilitation

Timing and Setting of Rehabilitation

• Early but not too early: Begin rehabilitation 24-48 hours after stroke onset 1
• Avoid very early mobilization: Intense mobilization within the first 24 hours is associated with poorer outcomes 1
• Early supported discharge: For patients with mild to moderate stroke severity, early supported discharge improves the likelihood of independent living at 3 months 1

Rehabilitation Approaches

1. Organized stroke unit care:

   • Multidisciplinary team approach with regular team meetings (at least weekly)
   • Structured assessment procedures
   • Coordinated care with planned discharge 1

2. Task-specific training:

   • Focused on functional activities relevant to the patient's daily life
   • Includes activities of daily living (ADL) training 1

3. Physical rehabilitation components:

   • Strength training
   • Aerobic training
   • Functional task training
   • Balance training 1

4. Goal-setting:

   • Collaborative process with patient and caregivers
   • Focus on realistic rehabilitation goals 1

Specialized Interventions

1. Cognitive rehabilitation:

   • For patients with specific cognitive deficits
   • Particularly important for lobar strokes 1

2. Depression management:

   • Screen and treat post-stroke depression
   • Note: Fluoxetine is NOT recommended solely to enhance post-stroke functional status 1

3. Community-based rehabilitation:

   • Continuation of rehabilitation in home setting
   • Caregiver training and support 1

Implementation Considerations

Assessment Tools

• Functional Independence Measure (FIM)
• Barthel Index
• Fugl-Meyer Assessment 1

Rehabilitation Intensity and Duration

• 30-60 minutes of therapy per day
• 5-7 days per week 2
• Rehabilitation may continue for many months after stroke 1

Cautions and Contraindications

• Avoid very early intense mobilization: Within first 24 hours after stroke 1
• Monitor for complications: Pressure ulcers, deep vein thrombosis, urinary tract infections 1

Special Considerations

Rehabilitation Team Members

• Physical therapists
• Occupational therapists
• Speech-language pathologists
• Rehabilitation physicians
• Nurses
• Social workers 1

Patient Education

• Secondary stroke prevention
• Lifestyle modifications
• Management of vascular risk factors 1

Pitfalls to Avoid

1. Delaying rehabilitation: Early rehabilitation (after 24 hours) is associated with better outcomes
2. Excessive early mobilization: Very early and intense mobilization within 24 hours worsens outcomes
3. Discontinuing rehabilitation at discharge: Continuing rehabilitation in the community setting is essential
4. Neglecting caregiver training: Caregiver support is crucial for successful rehabilitation
5. Overlooking depression: Post-stroke depression can significantly impair recovery

The evidence strongly supports a comprehensive, well-coordinated multidisciplinary approach to rehabilitation that begins early (but not too early) and continues seamlessly from the inpatient to community setting for optimal recovery after non-thrombolyzed ischemic stroke.