The Clinical Guidelines for Stroke Management – Part 2

//The Clinical Guidelines for Stroke Management – Part 2

The Clinical Guidelines for Stroke Management – Part 2

By |2019-05-26T12:37:57+00:00July 14th, 2019|Practice Tips|Comments Off on The Clinical Guidelines for Stroke Management – Part 2

By Simone Dorsch and Coralie English

Associate Professor Coralie English is a physiotherapist and a stroke clinical trialist. Her research focuses on understanding the health benefits of physical activity and sedentary behaviour for people after stroke, as well as optimal models of improving walking and arm function early after stroke.

This Blog is written in two parts.

  • The Development of the new guidelines and What’s New
  • Key messages of the new guidelines for Physio and OT

Key messages of the new guidelines for Physio and OT

This is a summary of some of the important recommendations that physiotherapists and OTs should be aware of:

Early mobilisation recommendations

  • STRONG recommendation AGAINST – For stroke patients, starting intensive out of bed activities within 24 hours of stroke onset is not recommended
  • STRONG recommendation – All stroke patients should commence mobilisation (out of bed activity) within 48 hrs of stroke onset unless otherwise contraindicated (e.g. receiving end of life care).
  • WEAK recommendation – For patients with mild and moderate stroke frequent, short sessions of out of bed activity should be provided but the optimal timing within the 48-hour post-stroke time period is unclear

Intensity of therapy recommendations

  • STRONG recommendation – rehabilitation should be structured to provide as much scheduled therapy (occupational therapy and physiotherapy) as possible.
  • STRONG recommendation – group circuit class therapy should be used to increase scheduled therapy time
  • WEAK recommendation – a minimum of three hours a day of scheduled therapy (occupational therapy and physiotherapy) is recommended, ensuring at least two hours of active task practice occurs during this time

Task specific practice

The evidence for task specific practice is very clear with STRONG recommendations for task specific training of all lower limb activities as follows:

  • For stroke survivors who have difficulty sitting, practising reaching beyond arm’s length while sitting with supervision/assistance should be undertaken.
  • For stroke survivors who have difficulty in standing up from a chair, practice of standing up should be undertaken
  • For stroke survivors who have difficulty standing, task-specific practice of standing balance should be provided
  • Stroke survivors with difficulty walking should be given the opportunity to undertake tailored repetitive practice of walking (or components of walking) as much as possible

If you are wondering where to save time the following are recommendations against certain interventions:

  • WEAK recommendation AGAINST Brain stimulation (transcranial direct stimulation or repetitive transcranial magnetic stimulation), it should not be used in routine practice for improving arm function and should only be used as part of a research framework
  • STRONG recommendation AGAINST Hand and wrist orthoses (splints) should not be used as part of routine practice as they have no effect on function, pain or range of movement (strong recommendation)
  • STRONG recommendation AGAINST For stroke survivors at risk of developing contracture, routine use of splints or prolonged positioning of upper or lower limb muscles in a lengthened position (stretch) is not recommended
  • WEAK recommendation AGAINST For stroke survivors at risk of shoulder subluxation, shoulder strapping is not recommended to prevent or reduce subluxation (weak recommendation)