Australian and New Zealand Living Clinical Guidelines for Stroke Management - Chapter 5 of 8: Rehabilitation

Published by Stroke Foundation on Jul 28, 2023

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 Guideline is 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. Melbourne Australia. © No part of this publication can be reproduced by any process without permission from the Stroke Foundation. June 2022.

Sponsors

The Stroke Foundation gratefully acknowledges the previous financial assistance by the Australian Government, Medical Research Future Fund. The development of recommendations has not been influenced by the views or interests of the funding body.

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Abstract

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

Language

en-au

PICOS

PICO 1.1

Population
Adults with stroke
Intervention
Electrical stimulation
Comparator
Control
Outcomes

PICO 1.1

Population
Adults with stroke with difficulty with sitting balance
Intervention
Sitting balance training (reaching beyond arms length)
Comparator
Control
Outcomes

PICO 1.1

Population
Older adults with stroke in nursing homes
Intervention
Occupational therapy
Comparator
Control
Outcomes

PICO 1.2

Population
Adults with stroke
Intervention
Progressive resistance training
Comparator
Control
Outcomes

PICO 1.2

Population
Adults with stroke
Intervention
Repetitive task training
Comparator
Control
Outcomes

PICO 1.2

Population
Adults with stroke
Intervention
Occupational therapy
Comparator
Control
Outcomes

PICO 1.3

Population
Adults with stroke with weakness
Intervention
Repetitive practice
Comparator
Control
Outcomes

PICO 1.3

Population
Adults with stroke
Intervention
Cognitive rehabilitation
Comparator
Control
Outcomes

PICO 1.4

Population
Adults with stroke
Intervention
Robot-assisted training
Comparator
Conventional therapy
Outcomes

PICO 1.4

Population
Adults with stroke
Intervention
Transcranial direct-current stimulation (tDCS)
Comparator
Placebo or passive control
Outcomes

PICO 1.5

Population
Adults with stroke
Intervention
Repetitive transcranial magnetic stimulation (rTMS)
Comparator
Control
Outcomes

PICO 1.6

Population
Adults with stroke
Intervention
Acupuncture
Comparator
Control
Outcomes

PICO 1.7

Population
Adults with stroke
Intervention
Water-based exercise
Comparator
Control
Outcomes

PICO 1.8

Population
Adults with stroke
Intervention
Amphetamine
Comparator
Placebo
Outcomes

PICO 1.9

Population
Adults with stroke
Intervention
Virtual reality
Comparator
Conventional therapy
Outcomes

PICO 1.10

Population
Adults with stroke
Intervention
Mental practice
Comparator
Control
Outcomes

PICO 1.11

Population
Adults with stroke
Intervention
Selective serotonin reuptake inhibitor
Comparator
Control
Outcomes

PICO 1.12

Population
Adults with stroke
Intervention
Repetitive task training
Comparator
Control
Outcomes

PICO 1.13

Population
Adults with stroke
Intervention
Motivational interviewing
Comparator
Control
Outcomes

PICO 1.14

Population
Adults with stroke
Intervention
physical fitness training
Comparator
control
Outcomes

PICO 1.15

Population
Adults with stroke
Intervention
mind-body exercise (tai chi, qigong, and yoga)
Comparator
usual care
Outcomes

PICO 1.16

Population
Adults with stroke
Intervention
Trunk training
Comparator
Dose-matched control
Outcomes

PICO 1.17

Population
Adults with stroke
Intervention
Intermittent pneumatic compression combined with rehabilitation training
Comparator
Rehabilitation training alone
Outcomes

PICO 1.18

Population
Adults with stroke with hemiplegic shoulder pain
Intervention
Kinesio taping
Comparator
Standard Care
Outcomes

PICO 1.19

Population
Adults with stroke with motor impairment
Intervention
Transcutaneous electrical nerve stimulation (TENS)
Comparator
Placebo control
Outcomes

PICO 1.20

Population
Adults with stroke
Intervention
Associated Mirror Therapy
Comparator
Standard Bimanual Training
Outcomes

PICO 1.21

Population
Adults with stroke
Intervention
Telehealth interventions
Comparator
None or standard care
Outcomes

PICO 1.22

Population
Adults with stroke
Intervention
Robot-assisted training
Comparator
Standard treatment
Outcomes

PICO 2.1

Population
All stroke patients with reduced sensation
Intervention
Sensory-specific training
Comparator
Conventional treatment
Outcomes

PICO 2.1

Population
Adults with stroke
Intervention
Interventions for improving sit to stand
Comparator
Control
Outcomes

PICO 2.1

Population
Adults with stroke with aphasia
Intervention
Speech and language therapy
Comparator
Control
Outcomes

PICO 2.1

Population
Adults with impaired perception after stroke
Intervention
Perceptual interventions
Comparator
Control
Outcomes

PICO 2.2

Population
All stroke patients with reduced sensation
Intervention
Sensory-specific training plus motor function training
Comparator
Conventional treatment
Outcomes

PICO 2.2

Population
Adults with stroke
Intervention
Repetitive task practice
Comparator
Control
Outcomes

PICO 2.2

Population
Adults with stroke with aphasia
Intervention
Repetitive Transcranial Magnetic Stimulation
Comparator
Sham
Outcomes

PICO 2.3

Population
Adults with stroke with aphasia
Intervention
tDCS plus speech and language therapy (SLT)
Comparator
Sham tDCS plus SLT for improving aphasia
Outcomes

PICO 2.4

Population
Adults with stroke with aphasia
Intervention
Piracetam
Comparator
Placebo
Outcomes

PICO 2.5

Population
Adults with stroke with aphasia
Intervention
High intensity speech and language therapy
Comparator
Low intensity language and speech therapy
Outcomes

PICO 2.6

Population
Adults with stroke with aphasia
Intervention
Early aphasia therapy (<1 month post-onset)
Comparator
Usual care
Outcomes

PICO 2.7

Population
Adults with stroke with aphasia
Intervention
Aphasia therapy commenced 1-6 months post-onset
Comparator
Usual care
Outcomes

PICO 2.8

Population
Adults with stroke with aphasia
Intervention
Aphasia therapy commenced >6 months post-onset
Comparator
Usual care
Outcomes

PICO 2.9

Population
Adults with stroke with aphasia
Intervention
Communication partner training (CPT) with health care professional
Comparator
Usual care or no treatment
Outcomes

PICO 2.10

Population
Adults with stroke with aphasia
Intervention
Communication partner training (CPT) with family/carer
Comparator
Usual care or no treatment
Outcomes

PICO 2.11

Population
Adults with stroke with aphasia
Intervention
Music learning
Comparator
Standard care
Outcomes

PICO 2.12

Population
Adults with stroke with aphasia
Intervention
Acupuncture therapies
Comparator
Speech training
Outcomes

PICO 2.13

Population
Adults with stroke with aphasia
Intervention
Melodic intonation therapy (MIT)
Comparator
No therapy or other therapy
Outcomes

PICO 2.14

Population
Adults with stroke with aphasia
Intervention
Telerehabilitation
Comparator
Face-to-face speech and language treatment
Outcomes

PICO 3.1

Population
Adults with stroke
Intervention
Cardiorespiratory training
Comparator
Control
Outcomes

PICO 3.1

Population
Adults with stroke
Intervention
Repetitive task practice
Comparator
Control
Outcomes

PICO 3.1

Population
Stroke patients with apraxia of speech
Intervention
Articulatory–kinematic treatment
Comparator
Usual care
Outcomes

PICO 3.1

Population
Adults with stroke
Intervention
Cognitive rehabilitation
Comparator
Control
Outcomes

PICO 3.2

Population
Adults with stroke
Intervention
Mixed training (combined cardiorespiratory/resistance training)
Comparator
Control
Outcomes

PICO 3.2

Population
Adults with stroke
Intervention
Whole body vibration
Comparator
Control
Outcomes

PICO 3.2

Population
Stroke patients with apraxia of speech
Intervention
Rhythm/rate control methods
Comparator
Usual care
Outcomes

PICO 3.2

Population
Adults with chronic stroke
Intervention
Exercise training
Comparator
Usual care
Outcomes

PICO 3.3

Population
Adults with stroke
Intervention
Virtual reality
Comparator
Control
Outcomes

PICO 3.3

Population
Stroke patients with apraxia of speech
Intervention
Non-invasive brain stimulation
Comparator
Control
Outcomes

PICO 3.3

Population
Adults with stroke
Intervention
Intensive vascular risk factor intervention
Comparator
Usual care
Outcomes

PICO 3.4

Population
Adults with stroke
Intervention
Exercise training
Comparator
Control
Outcomes

PICO 3.4

Population
Patients with stroke with apraxia of speech.
Intervention
Action Observation Therapy based on Mirror Neuron System theory
Comparator
Standard Care, including articulatory-kinetic and rate-rhythm approaches
Outcomes

PICO 3.4

Population
Adults with stroke
Intervention
Virtual reality or Computer-assisted training
Comparator
Control
Outcomes

PICO 3.5

Population
Adults with Stroke
Intervention
Balance training on dynamic surface
Comparator
Control (Balance training on stable ground)
Outcomes

PICO 3.5

Population
Adults with stroke
Intervention
Non-invasive brain stimulation
Comparator
Sham or control
Outcomes

PICO 3.6

Population
Adults with Stroke
Intervention
Yoga or Tai Chi
Comparator
Control
Outcomes

PICO 3.6

Population
Adults with stroke
Intervention
Music therapy
Comparator
Control
Outcomes

PICO 3.7

Population
Adults with stroke
Intervention
Biofeedback
Comparator
Control
Outcomes

PICO 3.7

Population
Adults with stroke
Intervention
GABA A α5 antagonist
Comparator
Control
Outcomes

PICO 3.8

Population
Adults with stroke
Intervention
Mechanical-assisted therapy / robotics
Comparator
Control
Outcomes

PICO 3.9

Population
Adults with stroke
Intervention
Hydrotherapy
Comparator
Usual care
Outcomes

PICO 3.10

Population
Adults with stroke
Intervention
Transcranial magnetic stimulation
Comparator
Sham
Outcomes

PICO 3.11

Population
Adults with stroke
Intervention
Ankle-foot orthoses
Comparator
No ankle-foot orthoses
Outcomes

PICO 4.1

Population
Interventions for visual field defects in patients with stroke
Intervention
Restitutive interventions
Comparator
Control, placebo or no intervention
Outcomes

PICO 4.1

Population
Adults with stroke
Intervention
Task specific overground walking training
Comparator
Usual care
Outcomes

PICO 4.1

Population
Stroke patients with dysarthria and aphasia , , Early well resources communication therapy SL , Attention Control AT,
Intervention
Early, well-resourced communication therapy , , Early well resources communication therapy SL , Attention Control AT,
Comparator
Attention control , , Early well resources communication therapy SL , Attention Control AT,
Outcomes
, , Early well resources communication therapy SL , Attention Control AT,

PICO 4.1

Population
Adults with stroke
Intervention
Selegiline
Comparator
Placebo
Outcomes

PICO 4.2

Population
Interventions for visual field defects in patients with stroke
Intervention
Substitutive interventions
Comparator
Control, placebo or no intervention
Outcomes

PICO 4.2

Population
Adults with stroke
Intervention
Community-based ambulation
Comparator
Control
Outcomes

PICO 4.2

Population
Stroke patients with dysarthria
Intervention
Dysarthria interventions
Comparator
Another intervention, attention control, placebo or no intervention
Outcomes

PICO 4.2

Population
Adults with stroke
Intervention
Citicoline
Comparator
Control
Outcomes

PICO 4.3

Population
Interventions for visual field defects in patients with stroke
Intervention
Compensative interventions
Comparator
Restitutive interventions
Outcomes

PICO 4.3

Population
Adults with stroke
Intervention
Circuit class therapy
Comparator
Usual care
Outcomes

PICO 4.3

Population
People with stroke with memory problems
Intervention
Memory training as part of cognitive rehabilitation
Comparator
no memory training
Outcomes

PICO 4.4

Population
Adults with recent stroke and visual field defect
Intervention
Restorative computer based training of border areas of the visual field
Comparator
Compensatory computer based visual scanning training
Outcomes

PICO 4.4

Population
Adults with stroke
Intervention
Treadmill (with or without body weight support)
Comparator
Usual care (walking training without mechanical assistance)
Outcomes

PICO 4.4

Population
Adults with memory impairment following a stroke
Intervention
Brain stimulation
Comparator
Control
Outcomes

PICO 4.5

Population
Adults with stroke with hemianopia
Intervention
Serial anodal tDCS
Comparator
Sham
Outcomes

PICO 4.5

Population
Electromechanical-assisted training for walking after stroke
Intervention
Electromechanical assisted gait training in combination with physiotherapy
Comparator
Physiotherapy (or usual care)
Outcomes

PICO 4.5

Population
Adults with memory impairment following a stroke
Intervention
Exercise
Comparator
Control
Outcomes

PICO 4.6

Population
Interventions for visual field defects in patients with stroke
Intervention
Compensative interventions
Comparator
Control, placebo or no intervention
Outcomes

PICO 4.6

Population
Adults with stroke
Intervention
Electrical stimulation
Comparator
Control (walking training alone)
Outcomes

PICO 4.6

Population
Adults with memory impairment following a stroke
Intervention
Music therapy
Comparator
Control
Outcomes

PICO 4.7

Population
Adults with stroke
Intervention
Virtual reality
Comparator
Usual care
Outcomes

PICO 4.7

Population
Adults with memory impairment following a stroke
Intervention
Yoga
Comparator
Control
Outcomes

PICO 4.8

Population
Adults with stroke
Intervention
Mental practice
Comparator
Control
Outcomes

PICO 4.8

Population
Adults with stroke
Intervention
Virtual reality (VR) or computer-assisted training
Comparator
Control
Outcomes

PICO 4.9

Population
Adults with stroke
Intervention
Orthosis
Comparator
No orthosis
Outcomes

PICO 4.10

Population
Adults with stroke
Intervention
Water-based exercises
Comparator
No water-based exercises
Outcomes

PICO 4.11

Population
Adults with stroke
Intervention
Whole body vibration
Comparator
Control
Outcomes

PICO 4.12

Population
Adults with stroke
Intervention
Repetitive task practice
Comparator
Usual care/attention control/no treatment
Outcomes

PICO 4.13

Population
Adults with stroke
Intervention
Cueing of cadence
Comparator
Control (walking training alone)
Outcomes

PICO 4.14

Population
Adults with stroke
Intervention
Joint position feedback
Comparator
Placebo or usual therapy
Outcomes

PICO 4.15

Population
Adults with stroke
Intervention
Mirror therapy
Comparator
Usual care
Outcomes

PICO 4.16

Population
Adults with stroke
Intervention
Dual task training
Comparator
Usual care
Outcomes

PICO 4.17

Population
Adults with stroke
Intervention
Repetitive transcranial magnetic stimulation (rTMS)
Comparator
Control
Outcomes

PICO 4.18

Population
Adults with stroke
Intervention
Transcranial direct current stimulation (tDCS)
Comparator
Control
Outcomes

PICO 4.19

Population
Adults with stroke
Intervention
Backward walking
Comparator
Forward walking or conventional treatment
Outcomes

PICO 4.20

Population
Adults with stroke
Intervention
Cycling with electrical stimulation
Comparator
Control
Outcomes

PICO 4.21

Population
Adults with stroke
Intervention
Trunk training
Comparator
Control
Outcomes

PICO 5.1

Population
Adults with stroke
Intervention
Very early mobilisation (<24 hrs)
Comparator
Usual care
Outcomes

PICO 5.1

Population
Adults with stroke
Intervention
Constraint-induced movement therapy for upper extremities
Comparator
Control
Outcomes

PICO 5.1

Population
Adults with stroke and cognitive communication difficulties
Intervention
Interventions to improve cognitive communication
Comparator
Usual care
Outcomes

PICO 5.1

Population
Adults with stroke
Intervention
Cognitive training
Comparator
Control
Outcomes

PICO 5.2

Population
Adults with stroke
Intervention
Physical rehabilitation (<3 days)
Comparator
Usual care
Outcomes

PICO 5.2

Population
Adults with stroke
Intervention
Bilateral training
Comparator
Usual care or other intervention
Outcomes

PICO 5.2

Population
Adults with stroke
Intervention
Strategy training
Comparator
Attention control
Outcomes

PICO 5.3

Population
Adults with stroke
Intervention
early communication therapy
Comparator
usual care (later communication therapy)
Outcomes

PICO 5.3

Population
Adults with stroke
Intervention
Biofeedback
Comparator
Usual care
Outcomes

PICO 5.3

Population
Adults with stroke
Intervention
Intensive vascular risk factor intervention
Comparator
Usual care
Outcomes

PICO 5.4

Population
Adults with stroke
Intervention
Electrical stimulation
Comparator
Usual care without stimulation
Outcomes

PICO 5.4

Population
Adults with stroke
Intervention
Selegiline
Comparator
Placebo
Outcomes

PICO 5.5

Population
Adults with stroke
Intervention
Manual (hands on) therapy
Comparator
Usual care
Outcomes

PICO 5.5

Population
Adults with stroke
Intervention
Citicoline
Comparator
Control
Outcomes

PICO 5.6

Population
Adults with stroke
Intervention
Electromechanical and robot-assisted arm training
Comparator
All other interventions
Outcomes

PICO 5.6

Population
Adults with stroke
Intervention
Rivastigmine
Comparator
Control
Outcomes

PICO 5.7

Population
Adults with stroke
Intervention
Mental practice in addition to other treatment
Comparator
Other treatment
Outcomes

PICO 5.7

Population
Adults with stroke
Intervention
Non-invasive brain stimulation therapies
Comparator
Sham control
Outcomes

PICO 5.8

Population
Adults with stroke
Intervention
Mirror therapy for improving motor function after stroke
Comparator
All other interventions
Outcomes

PICO 5.8

Population
Adults with stroke
Intervention
Virtual Reality (VR) or computer-assisted training
Comparator
Standard care
Outcomes

PICO 5.9

Population
Adults with stroke
Intervention
Orthosis
Comparator
Usual care
Outcomes

PICO 5.10

Population
Adults with stroke
Intervention
Practice with trunk restraint
Comparator
Practice without trunk restraint
Outcomes

PICO 5.11

Population
Adults with stroke
Intervention
Task specific practice
Comparator
Control
Outcomes

PICO 5.12

Population
Adults with stroke
Intervention
Virtual reality for stroke rehabilitation
Comparator
Conventional therapy
Outcomes

PICO 5.13

Population
Adults with stroke
Intervention
Transcranial direct current stimulation
Comparator
Placebo or passive control
Outcomes

PICO 5.14

Population
Adults with stroke
Intervention
Repetitive transcranial magnetic stimulation
Comparator
Usual care
Outcomes

PICO 6.1

Population
Adults with stroke
Intervention
Increased scheduled therapy time
Comparator
Usual care
Outcomes

PICO 6.1

Population
Adults with stroke
Intervention
Strategy training
Comparator
Control
Outcomes

PICO 6.2

Population
Adults with stroke
Intervention
Circuit therapy
Comparator
5-day week therapy (usual care)
Outcomes

PICO 6.2

Population
Adults with stroke
Intervention
Error-less learning
Comparator
Control
Outcomes

PICO 6.3

Population
Adults with stroke
Intervention
Additional active practice
Comparator
Usual care
Outcomes

PICO 6.3

Population
Adults with stroke
Intervention
Gesture training
Comparator
Control
Outcomes

PICO 6.4

Population
Adults with acute stroke (0-7 days)
Intervention
Greater amount of therapy
Comparator
Usual / lower amount of therapy
Outcomes

PICO 6.5

Population
Adults with subacute stroke (7-90 days)
Intervention
Greater amount of therapy
Comparator
Usual / lower amount of therapy
Outcomes

PICO 6.6

Population
Adults with chronic stroke
Intervention
Greater amount of therapy
Comparator
Usual / lower amount of therapy
Outcomes

PICO 6.7

Population
Adults with acute stroke with communication difficulties
Intervention
Greater amount of communication therapy
Comparator
Usual / lower amount of therapy
Outcomes

PICO 6.8

Population
Adults with subacute stroke with communication difficulties
Intervention
Greater amount of communication therapy
Comparator
Usual / lower amount of therapy
Outcomes

PICO 7.1

Population
Adults with stroke
Intervention
Early supported discharge services
Comparator
Conventional care
Outcomes

PICO 7.1

Population
Adults with stroke with neglect
Intervention
Rivastigmine + rehabilitation
Comparator
Rehabilitation
Outcomes

PICO 7.2

Population
Adults with stroke with neglect
Intervention
Mirror therapy
Comparator
Control
Outcomes

PICO 7.3

Population
Adults with stroke with neglect
Intervention
repetitive transcranial magnetic stimulation (rTMS)
Comparator
Control
Outcomes

PICO 7.4

Population
Adults with stroke with neglect
Intervention
transcranial direct current stimulation (tDCS)
Comparator
Control
Outcomes

PICO 7.5

Population
Adults with stroke with neglect
Intervention
Continuous theta-burst stimulation (cTBS)
Comparator
Sham
Outcomes

PICO 7.6

Population
Adults with stroke with spatial neglect.
Intervention
Technology assisted rehabilitation interventions.
Comparator
Standard cognitive Rehabilitation and/or occupational rehabilitation.
Outcomes

PICO 7.7

Population
Adults with stroke with neglect
Intervention
Individualised therapy.
Comparator
Standard therapy
Outcomes

PICO 7.8

Population
Adults with stroke with spatial neglect
Intervention
Prism adaption
Comparator
Standard care
Outcomes

PICO 7.9

Population
Adults with stroke with spatial neglect
Intervention
Visual Interventions
Comparator
Standard Care
Outcomes

PICO 8.1

Population
Community-dwelling adults with stroke
Intervention
Home-based rehabilitation provided by therapist in person
Comparator
Community-based rehabilitation by therapist in person
Outcomes

PICO 8.2

Population
Community-dwelling adults with stroke
Intervention
Home-based rehabilitation
Comparator
Centre-based rehabilitation
Outcomes

PICO 9.1

Population
Adults with stroke
Intervention
Patient centred goal setting
Comparator
Usual care
Outcomes

PICO 15.1

Population
Adults with stroke
Intervention
Telerehabilitation
Comparator
in-person rehabilitation
Outcomes

PICO 15.2

Population
Adults with stroke
Intervention
Telerehabilitation for post hospital discharge support
Comparator
Usual care or no rehab
Outcomes