Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part One: Rehabilitation and Recovery Following Stroke; 6th Edition Update 2019

Abstract

The sixth update of the Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Reintegration following Stroke. Part one: Rehabilitation and Recovery Following Stroke is a comprehensive set of evidence-based guidelines addressing issues surrounding impairments, activity limitations, and participation restrictions following stroke. Rehabilitation is a critical component of recovery, essential for helping patients to regain lost skills, relearn tasks, and regain independence. Following a stroke, many people typically require rehabilitation for persisting deficits related to hemiparesis, upper-limb dysfunction, pain, impaired balance, swallowing, and vision, neglect, and limitations with mobility, activities of daily living, and communication. This module addresses interventions related to these issues as well as the structure in which they are provided, since rehabilitation can be provided on an inpatient, outpatient, or community basis. These guidelines also recognize that rehabilitation needs of people with stroke may change over time and therefore intermittent reassessment is important. Recommendations are appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. Unlike the previous set of recommendations, in which pediatric stroke was included, this set of recommendations includes primarily adult rehabilitation, recognizing many of these therapies may be applicable in children. Recommendations related to community reintegration, which were previously included within this rehabilitation module, can now be found in the companion module, Rehabilitation, Recovery, and Community Participation following Stroke. Part Two: Transitions and Community Participation Following Stroke.

Canadian Stroke Best Practice Guidance During the COVID-19 Pandemic

“…Stroke rehabilitation is essential for people to achieve an optimal physical, cognitive, emotional, communicative, and social functional level following stroke, as well as to prevent or slow future functional decline and secondary health conditions. 19 Rehabilitation teams need to continue to follow evidencebased care for stroke patients. 19 Rehabilitation teams should be well educated on the use of PPE with strict adherence to infection control procedures for direct contact therapies, shared equipment, and spaces to ensure safe access is maintained.…”

“…19 Rehabilitation teams need to continue to follow evidencebased care for stroke patients. 19 Rehabilitation teams should be well educated on the use of PPE with strict adherence to infection control procedures for direct contact therapies, shared equipment, and spaces to ensure safe access is maintained. 17 Essential components of stroke rehabilitation care should be adapted to follow public health recommendations on physical distancing with consideration of such things as virtual team conferences.…”

“…If telerehabilitation is planned for outpatient therapy, then education, skills training, and setup of the selected telerehabilitation platform for patients and family and caregivers residing with them should be provided prior to discharge. Patients should also be provided with clear discharge recommendations 19 and instructions for continued rehabilitation at home. Consideration ought to be given for earlier follow-up for patients whose lengths of stays are shortened by COVID-19 policies to allow earlier identification of potential complications or functional decline.…”

“…The worldwide pandemic of coronavirus disease 19 (COVID- 19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Co2) has emerged as one of the biggest public health crises in a century. Health systems in Canada face immense challenges, both to cope with the number of affected patients and the constraints imposed by containment measures such as physical distancing, quarantine, and personal protection.…”

Access to Focal Spasticity Care: A Cross Canada Survey of Physiatrists

“…4 Additionally, the 2019 Canadian Stroke Best Practices Recommendations (CSBPR) notes that barriers to funded services for spasticity care can lead to an incomplete recovery. 5 Treatment of spasticity is dependent on presentation, severity, and the goals of the patient and healthcare team. 6 The CSBPR states that botulinum toxin A (BoNT-A) is recommended first-line therapy for focal spasticitya treatment approved by Health Canada.…”