VA/DoD Clinical Practice Guideline for the Management of Stroke Rehabilitation

Management of Stroke Rehabilitation Work Group. (2019).

Washington, D.C.: Department of Defense; Department of Veterans Affairs, 1-170.

This is a guideline providing recommendations on the assessment, treatment, and follow-up of stroke in the Department of Veteran Affairs (VA) and Department of Defense (DoD). The target audience for this guideline are VA and DoD healthcare practitioners, including, but not limited to, speech language pathologists, involved in the care of Service Members or Veterans receiving stroke rehabilitation services. This guideline updates the 2010 Stroke Rehabilitation Clinical Practice Guideline (CPG) and provides categories to account for ways older recommendations could have been updated or removed. The following sample of categories were created to consider whether the evidence for the recommendation was systematically reviewed, the degree of modification, and the degree to which the recommendation is clinically relevant and within the scope of the current guideline:<ul><li><strong>Reviewed, Amended:</strong> Recommendation was in the previous 2010 CPG and a minor amendment was made following a review of the evidence.</li><li><strong>Reviewed, New-replaced:</strong> Recommendation was in the previous CPG and was changed based on the review of the evidence.</li><li><strong>Reviewed, New-added:</strong> Recommendation was added following a review of the evidence.</li><li><strong>Not-reviewed, Amended:</strong> Recommendation was in the previous CPG and a minor amendment was made, but evidence was not reviewed.</li></ul>

Department of Veterans Affairs; Department of Defense

"There is insufficient evidence to recommend for or against any specific assessments or interventions regarding return to work" for veterans status-post stroke (Neither for nor against; Reviewed, Amended; p. 72).

"There is insufficient evidence to recommend for or against pharyngeal electrical stimulation for treatment of dysphagia" in veterans status-post stroke (Neither for nor against; Reviewed, New-replaced; p. 52).

"There is insufficient evidence to recommend for or against the use of any specific cognitive rehabilitation methodology or pharmacotherapy to improve cognitive outcomes" in veterans status-post stroke (Neither for nor against; Reviewed, New-replaced; p. 55).

"There is insufficient evidence to recommend for or against tongue to palate resistance training for treatment of dysphagia" for veterans status-post stroke (Neither for nor against; Reviewed, New-replaced; p. 50).

"We suggest offering Shaker or chin tuck against resistance exercises in addition to conventional dysphagia therapy" for veterans with stroke-associated dysphagia (Weak for; Reviewed, New-replaced; p. 48).

"There is insufficient evidence to recommend for or against the use of intensive language therapy for [veterans with stroke-associated] aphasia" (Neither for nor against; Reviewed, New-added; p. 56).

"There is insufficient evidence to recommend for or against neuromuscular electrical stimulation for treatment of dysphagia" in veterans status-post stroke (Neither for nor against; Reviewed, New-replaced; p. 50).

"We recommend a team-based approach in an organized inpatient unit that encompasses comprehensive rehabilitation in order to improve likelihood of discharge [of veterans] to home after acute stroke" (Strong for; Reviewed, Amended; p. 27). "These teams included physicians, nurses, and therapists with expertise in stroke. The exact makeup of the team varied somewhat among studies, and the optimal composition of such a team is not yet known" (p. 27).

"We suggest offering expiratory muscle strength training for treatment of [stroke-associated] dysphagia in [veterans] without a tracheostomy" (Weak for; Reviewed, New-replaced; p. 49).

"We recommend that rehabilitation therapy should start as soon as medical stability is reached" for veterans status-post stroke (Strong for; Not reviewed, Amended; p. 28).