(Australian) Clinical Guidelines for Stroke Management 2017 - Chapter 5 of 8: Rehabilitation

Main Editor Stroke Foundation
Language en
Last Update Jul 13, 2018
Published Date Jul 13, 2018
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Disclaimer

These Clinical Guidelines are a general guide to appropriate practice, to be followed subject to the clinician’s judgment and the patient’s preference in each individual case. The Clinical Guidelines are designed to provide information to assist decision-making and are based on the best evidence available at the time of development. The Clinical Guidelines can be viewed at www.informme.org.au - Citation: Stroke Foundation. Clinical Guidelines for Stroke Management 2017. Melbourne Australia. © No part of this publication can be reproduced by any process without permission from the Stroke Foundation. August 2017.

Sponsors The Stroke Foundation gratefully acknowledges the financial assistance provided by the Australian Government Department of Health. The development of the final recommendations has not been influenced by the views or interests of the funding body.
Abstract

This is the fifth in a series of eight guideline chapters that provide evidence-based recommendations for recovery from stroke and TIA.

PICOS
PICO 5.0
P: Adults with stroke
I: Early supported discharge services overall
C: Conventional care
O:

PICO 6.0
P: Adults with stroke
I: Home-based rehabilitation
C: Community-based rehabilitation
O:

PICO 7.0
P: Adults with stroke
I: Patient centred goal setting
C: Usual care
O:

PICO 8.0
P: Adults with stroke
I: Very early mobilisation (<24 hrs)
C: Usual care
O:

PICO 1.0
P: Adults with stroke
I: Electrical stimulation
C: Control
O:

PICO 2.0
P: All stroke patients with reduced sensation
I: Sensory-specific training
C: Conventional treatment
O:

PICO 3.0
P: Interventions for visual field defects in patients with stroke
I: Restitutive interventions
C: Control, placebo or no intervention
O:

PICO 1.0
P: Adults with stroke
I: Increased scheduled therapy time
C: Usual care
O:

PICO 2.0
P: Adults with stroke
I: Cardiorespiratory training
C: Control
O:

PICO 3.0
P: Adults with stroke with difficulty with sitting balance
I: Sitting balance training (reaching beyond arms length)
C: Control
O:

PICO 4.0
P: Adults with stroke
I: Interventions for improving sit to stand
C: Control
O:

PICO 5.0
P: Adults with stroke
I: Repetitive task practice
C: Control
O:

PICO 6.0
P: Adults with stroke
I: Task specific overground walking training
C: Usual care
O:

PICO 7.0
P: Adults with stroke
I: Constraint-induced movement therapy for upper extremities
C: Control
O:

PICO 11.0
P: Older adults with stroke in nursing homes
I: Occupational therapy
C: Control
O:

PICO 2.0
P: Adults with stroke with aphasia
I: Speech and language therapy
C: Control
O:

PICO 3.0
P: Stroke patients with dysarthria and aphasia , , Early well resources communication therapy SL , Attention Control AT,
I: Early, well-resourced communication therapy , , Early well resources communication therapy SL , Attention Control AT,
C: Attention control , , Early well resources communication therapy SL , Attention Control AT,
O: , , Early well resources communication therapy SL , Attention Control AT,

PICO 4.0
P: Stroke patients with apraxia of speech
I: Articulatory–kinematic treatment
C: Usual care
O:

PICO 5.0
P: Adults with stroke and cognitive communication difficulties
I: Interventions to improve cognitive communication
C: Usual care
O:

PICO 2.0
P: Adults with stroke
I: Cognitive training
C: Control
O:

PICO 3.0
P: Adults with stroke
I: Cognitive rehabilitation
C: Control
O:

PICO 4.0
P: Adults with stroke
I: Head mounted display virtual reality
C: Desktop based virtual reality
O:

PICO 5.0
P: Adults with impaired perception after stroke
I: Perceptual interventions
C: Control
O:

PICO 6.0
P: Adults with stroke
I: Strategy training
C: Control
O:

PICO 7.0
P: Adults with stroke with neglect
I: Rivastigmine + rehabilitation
C: Rehabilitation
O:

PICO 5.0
P: Adults with stroke
I: Early supported discharge service with ESD team co-ordination and delivery
C: Conventional care
O:

PICO 6.0
P: Community-dwelling adults with stroke
I: Home-based rehabilitation
C: Centre-based rehabilitation
O:

PICO 8.0
P: Adults with stroke
I: Physical rehabilitation (<3 days)
C: Usual care
O:

PICO 1.0
P: Adults with stroke
I: Task-oriented training
C: Control
O:

PICO 2.0
P: All stroke patients with reduced sensation
I: Sensory-specific training plus motor function training
C: Conventional treatment
O:

PICO 3.0
P: Interventions for visual field defects in patients with stroke
I: Compensative interventions
C: Control, placebo or no intervention
O:

PICO 1.0
P: Adults with stroke
I: Additional active practice
C: Usual care
O:

PICO 3.0
P: Adults with stroke
I: Repetitive task training
C: Control
O:

PICO 4.0
P: Adults with stroke
I: Repetitive task practice
C: Control
O:

PICO 5.0
P: Adults with stroke
I: Whole body vibration
C: Control
O:

PICO 6.0
P: Adults with stroke
I: Community-based ambulation
C: Control
O:

PICO 7.0
P: Adults with stroke
I: Bilateral training
C: Usual care or other intervention
O:

PICO 11.0
P: Adults with stroke
I: Occupational therapy
C: Control
O:

PICO 2.0
P: Adults with stroke with aphasia
I: High intensity speech and language therapy
C: Low intensity language and speech therapy
O:

PICO 3.0
P: Stroke patients with dysarthria
I: Communication therapy with non-speech oro-motor exercises
C: Communication therapy
O:

PICO 4.0
P: Stroke patients with apraxia of speech
I: Rhythm/rate control methods
C: Usual care
O:

PICO 2.0
P: Adults with stroke
I: Strategy training
C: Attention control
O:

PICO 3.0
P: Adults with chronic stroke
I: Exercise training and leisure/recreation activities
C: Usual care
O:

PICO 4.0
P: Adults with stroke
I: Selegiline
C: Placebo
O:

PICO 6.0
P: Adults with stroke
I: Gesture training
C: Control
O:

PICO 7.0
P: Adults with stroke with neglect
I: Mirror therapy
C: Control
O:

PICO 5.0
P: Adults with stroke
I: Early supported discharge service - ESD team co-ordination only
C: Conventional care
O:

PICO 1.0
P: Adults with stroke
I: Mechanical assisted training (arm)
C: Control
O:

PICO 3.0
P: Interventions for visual field defects in patients with stroke
I: Substitutive interventions
C: Control, placebo or no intervention
O:

PICO 1.0
P: Adults with stroke
I: Circuit therapy
C: 5-day week therapy (usual care)
O:

PICO 5.0
P: Adults with stroke
I: Virtual reality
C: Control
O:

PICO 6.0
P: Adults with stroke
I: Circuit class therapy
C: Usual care
O:

PICO 7.0
P: Adults with stroke
I: Bilateral training
C: Unilateral training
O:

PICO 11.0
P: Adults with stroke
I: Cognitive rehabilitation
C: Control
O:

PICO 2.0
P: Adults with stroke with aphasia
I: Repetitive Transcranial Magnetic Stimulation
C: Sham
O:

PICO 2.0
P: Adults with stroke
I: Intensive vascular risk factor intervention
C: Usual care
O:

PICO 3.0
P: Adults with stroke
I: Intensive vascular risk factor intervention
C: Usual care
O:

PICO 4.0
P: Adults with stroke
I: Citicoline
C: Control
O:

PICO 6.0
P: Adults with stroke
I: Error-less learning
C: Control
O:

PICO 7.0
P: Adults with stroke with neglect
I: repetitive transcranial magnetic stimulation (rTMS)
C: Control
O:

PICO 5.0
P: Adults with stroke
I: Early supported discharge service - No ESD team co-ordination or delivery
C: Conventional care
O:

PICO 1.0
P: Adults with stroke
I: Strength training
C: Control
O:

PICO 3.0
P: Interventions for visual field defects in patients with stroke
I: Compensative interventions
C: Restitutive interventions
O:

PICO 5.0
P: Adults with stroke
I: Biofeedback
C: Control
O:

PICO 6.0
P: Adults with stroke
I: Treadmill (with or without body weight support)
C: Usual care (walking training without mechanical assistance)
O:

PICO 7.0
P: Adults with stroke
I: Biofeedback
C: Usual care
O:

PICO 11.0
P: Adults with stroke
I: Transcranial direct-current stimulation
C: Placebo or passive control
O:

PICO 2.0
P: Adults with stroke with aphasia
I: tDCS plus speech and language therapy (SLT)
C: Sham tDCS plus SLT for improving aphasia
O:

PICO 2.0
P: Adults with stroke
I: Selegiline
C: Placebo
O:

PICO 3.0
P: Adults with stroke
I: Head mounted display virtual reality
C: Desktop based virtual reality
O:

PICO 7.0
P: Adults with stroke with neglect
I: Cognitive rehabilitation
C: Control
O:

PICO 3.0
P: Adults with recent stroke and visual field defect
I: Restorative computer based training of border areas of the visual field
C: Compensatory computer based visual scanning training
O:

PICO 5.0
P: Adults with stroke
I: Exercise training
C: Control
O:

PICO 7.0
P: Adults with stroke
I: Electrical stimulation
C: Usual care without stimulation
O:

PICO 11.0
P: Adults with stroke
I: Repetitive transcranial magnetic stimulation
C: Control
O:

PICO 2.0
P: Adults with stroke with aphasia
I: Piracetam
C: Placebo
O:

PICO 2.0
P: Adults with stroke
I: Citicoline
C: Control
O:

PICO 3.0
P: Adults with stroke
I: Transcranial direct current stimulation
C: Sham
O:

PICO 7.0
P: Adults with stroke with neglect
I: transcranial direct current stimulation (tDCS)
C: Control
O:

PICO 3.0
P: Adults with stroke with hemianopia
I: Serial anodal tDCS
C: Sham
O:

PICO 5.0
P: Adults with Stroke
I: Balance training on dynamic surface
C: Control (Balance training on stable ground)
O:

PICO 7.0
P: Adults with stroke
I: Manual (hands on) therapy
C: Usual care
O:

PICO 11.0
P: Adults with stroke
I: Acupuncture
C: Control
O:

PICO 2.0
P: Adults with stroke
I: Rivastigmine
C: Control
O:

PICO 7.0
P: Adults with stroke with neglect
I: Continuous theta-burst stimulation (cTBS)
C: Sham
O:

PICO 5.0
P: Adults with Stroke
I: Yoga or Tai Chi
C: Control
O:

PICO 6.0
P: Electromechanical-assisted training for walking after stroke
I: Electromechanical assisted gait training in combination with physiotherapy
C: Physiotherapy (or usual care)
O:

PICO 7.0
P: Adults with stroke
I: Electromechanical and robot-assisted arm training
C: All other interventions
O:

PICO 11.0
P: Adults with stroke
I: Water-based exercise
C: Control
O:

PICO 6.0
P: Adults with stroke
I: Cueing of cadence
C: Control (walking training alone)
O:

PICO 7.0
P: Adults with hemiparesis after stroke
I: Mental practice in addition to other treatment
C: Other treatment
O:

PICO 11.0
P: Adults with stroke
I: Amphetamine
C: Placebo
O:

PICO 6.0
P: Adults with stroke
I: Joint position feedback
C: Placebo or usual therapy
O:

PICO 7.0
P: Adults with stroke
I: Mirror therapy for improving motor function after stroke
C: All other interventions
O:

PICO 11.0
P: Adults with stroke
I: Virtual reality
C: Conventional therapy
O:

PICO 6.1
P: Adults with stroke
I: Electrical stimulation
C: Control (walking training alone)
O:

PICO 7.1
P: Adults with stroke
I: Orthosis
C: Usual care
O:

PICO 11.1
P: Adults with stroke
I: Motivational interviewing
C: Control
O:

PICO 6.1
P: Adults with stroke
I: Virtual reality
C: Usual care
O:

PICO 7.1
P: Adults with stroke
I: Practice with trunk restraint
C: Practice without trunk restraint
O:

PICO 11.1
P: Adults with stroke
I: Mental practice
C: Control
O:

PICO 6.1
P: Adults with stroke
I: Mental practice
C: Control
O:

PICO 7.1
P: Adults with stroke
I: Task specific practice
C: Control
O:

PICO 11.1
P: Adults with stroke
I: Selective serotonin reuptake inhibitor
C: Control
O:

PICO 6.1
P: Adults with stroke
I: Orthosis
C: No orthosis
O:

PICO 7.1
P: Adults with stroke
I: Virtual reality for stroke rehabilitation
C: Conventional therapy
O:

PICO 11.1
P: Adults with stroke
I: Repetitive task training
C: Control
O:

PICO 6.1
P: Adults with stroke
I: Water-based exercises
C: No water-based exercises
O:

PICO 7.1
P: Adults with stroke
I: Transcranial direct current stimulation
C: Placebo or passive control
O:

PICO 6.1
P: Adults with stroke
I: Whole body vibration
C: Control
O:

PICO 7.1
P: Adults with stroke
I: Repetitive transcranial magnetic stimulation
C: Usual care
O:

PICO 6.1
P: Adults with stroke
I: Repetitive task practice
C: Usual care/attention control/no treatment
O: