Brazilian Practice Guidelines for Stroke Rehabilitation: Part II
Arquivos de Neuro-Psiquiatria
Minelli, C., Luvizutto, G. J., et al. (2022).
Arquivos de Neuro-Psiquiatria, 80(7), 741-758.
This clinical practice guideline provides recommendations for the provision of rehabilitation therapies for individuals recovering from stroke. Recommendations relevant to speech-language pathology practice are included within this article summary.
Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology
<div>"Speech and language therapy should be started early for all [post-stroke] patients with aphasia" (p. 743; Class I, Level A Evidence)</div>
<div>"The effectiveness of combined early and intensive aphasia therapy is uncertain" (p. 744; Class IIb, Level A Evidence).</div>
<div>"For [apraxia of speech] AOS, an articulatory–kinematic approach is recommended" (p. 744, Class IIa, Level A Evidence).</div>
<div>"Speech therapy is indicated for dysarthria rehabilitation" (p. 744; Class IIa, Level A Evidence).</div>
<div>"Early swallowing therapies are recommended for recovery from dysphagia" (p. 744; Class I, Level A Evidence).</div>
<div>"Dysphagia screening should be performed early after stroke to prevent aspiration pneumonia, malnutrition, and dehydration" (p. 744; Class I, Level B Evidence).</div>
<div>Stimulation treatments, including surface neuromuscular electrical stimulation, are under investigation due to limited evidence regarding their clinical effectiveness (Class IIb, Level A Evidence).</div>
<div>"Videofluoroscopy and fiberoptic endoscopic evaluations can be performed if aspiration is suspected without clinical symptoms or signs" (p. 744; Class IIa, Level B Evidence).</div>
<div>"Pharyngeal electrical stimulation is not recommended to improve dysphagia after stroke" (p. 744; Class III, Level A Evidence).</div>
<div>"Task training, with specific goals, can be used in [post-stroke] ataxia" (p. 745; Class IIb, Level C Evidence).</div>
<div>"Cognition assessment [post-stroke] with validated tests is recommended" (p. 748; Class I, Level B Evidence).</div>
<div>"The association of cognitive rehabilitation with physical rehabilitation may be beneficial" (p. 748; Class IIa, Level C Evidence).</div>
<div>"Cognitive rehabilitation strategies for memory may be used, but the benefits are uncertain" (p. 748; Class IIb, Level C Evidence).</div>
<div>"Neuromodulation and neurofeedback techniques [for remediation of cognitive deficits] are still under investigation, and should not be used routinely" (p. 748; Class III, Level C Evidence).</div>
<div>"Frequency-modulated systems are recommended for hearing loss after stroke" (p. 749; Class I, Level B Evidence).</div>
<div>The following recommendations were made for home rehabilitation (HR) programs for individuals status post stroke:</div>
<ul>
<li><span style="color: #333333;">"Early planned HR is recommended for [post-stroke recovery]" (p. 750; Class I, Level A Evidence). </span></li>
<li><span style="color: #333333;">"It is recommended that caregivers be educated to help patients' physical and emotional recovery at home" (p. 750; Class I, Level A Evidence). </span></li>
<li><span style="color: #333333;">"The combination of rehabilitation with mirror therapy and specific training can be used at home" (p. 750; Class IIa, Level B Evidence). </span></li>
<li><span style="color: #333333;">"[Post-stroke] patients should receive guidelines for recreational activities" (p. 750; Class IIa, Level B Evidence). </span></li>
<li><span style="color: #333333;">"Interventions in the workplace must be available to facilitate [post-stroke] return to work" (p. 750; Class IIa, Level B Evidence).</span></li>
</ul>
<div>The following recommendations were made regarding medication adherence for individuals status post stroke:</div>
<ul>
<li><span style="color: #333333;">"Interventions based on cognitive and behavioral orientation should be conducted to improve medication adherence" (p. 750; Class I, Level A Evidence). </span></li>
<li><span style="color: #333333;">"Self-management interventions to control risk factors may be beneficial to improve [post-stroke] medication adherence" (p. 750; Class IIa, Level A Evidence). </span></li>
<li><span style="color: #333333;">"Information about medications and their use is recommended to improve medication adherence after stroke" (p. 750; Class I, Level B Evidence). </span></li>
<li><span style="color: #333333;">"Telephone calls can be effective in improving medication adherence" (p. 750; Class IIa, Level A Evidence). </span></li>
<li><span style="color: #333333;">"The benefits of telecommunication are uncertain" (p. 750; Class IIb, Level A).</span></li>
</ul>
<div>The following recommendations were made regarding palliative care (PC) for individuals status post stroke:</div>
<ul>
<li><span style="color: #333333;">"[PC] is recommended for people with stroke in cases of reduced quality of life and reduced life expectancy" (p. 751; Class I, Level C Evidence). </span></li>
<li><span style="color: #333333;">"[PC] should be provided by neurologists, the ICU team, and the PC Service at the time of diagnosis" (p. 751; Class I, Level B Evidence). </span></li>
<li><span style="color: #333333;">"Formal assessment of PC should be recommended in end-of-life situations, in the presence of refractory pain, dyspnea, agitation, mood disorders, long-term feeding assistance, ventilation, palliative extubation, and assistance in resolving conflicts between family members and health teams" (p. 751; Class I, Level B Evidence).</span></li>
</ul>
<div>The following recommendations were made for rehabilitation of adults following stroke secondary to SARS-CoV-2 infection:</div>
<ul>
<li><span style="color: #333333;">"Rehabilitation strategies must comprise a multidisciplinary approach focusing on neurological impairments and disabilities after stroke that is related to SARS-CoV-2 infection" (p. 752; Class IIb, Level C Evidence). </span></li>
<li><span style="color: #333333;">"Access to specialized centers such as stroke units, outpatient care, early support on discharge, and community stroke rehabilitation might be considered for stroke related to SARS-CoV-2" (p. 752; Class IIb, Level C Evidence).</span></li>
</ul>
