2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association
Stroke
Prabhakaran, S., Gonzalez, N. R., et al. (2026).
Stroke, Advance online publication. https://doi.org/10.1161/str.0000000000000513.
<div>This clinical practice guideline provides recommendations for the early management of individuals with acute ischemic stroke across the lifespan. This article summary only contains recommendations relevant to the field of speech-language pathology. </div>
American Heart Association; American Stroke Association
American Association of Neurological Surgeons/Congress of Neurological Surgeons; Neurocritical Care Society; Society for Academic Emergency Medicine; Society of NeuroInterventional Surgery; Society of Vascular and Interventional Neurology
<div>In patients with acute ischemic stroke of all ages, it is recommended that formal, interdisciplinary assessment and rehabilitative treatment at an appropriate level for the individual patient is provided to improve functional recovery (Class 1, Level A Evidence).</div>
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<li>This care should be provided within an organized inpatient stroke care unit supported by a specialty trained, interdisciplinary care team (Class I, Level B-R Evidence). </li>
<li>Inpatient units may include acute stroke units, rehabilitation stroke units, comprehensive stroke units, and mixed rehabilitation units (Class I, Level B-R Evidence). </li>
<li>These units should incorporate standardized stroke care order sets and protocols to avoid adverse events (Class I, Level B-R Evidence). </li>
<li>Characteristics of organized, specialized inpatient care units should include:</li>
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<li>early rehabilitation assessment and mobilization by the stroke team;</li>
<li>weekly meetings of multidisciplinary teams with nurse and care partner involvement;</li>
<li>early goal setting and rehabilitation by physical therapists, occupational therapists, and speech-language pathologists;</li>
<li>integration of specialized nursing care and care partner involvement in the rehabilitation process;</li>
<li>collaborative planning with the interdisciplinary clinical team;</li>
<li>early assessment of discharge needs;</li>
<li>integration of the patient and care partners in discharge planning, with an emphasis on educational support; and</li>
<li>coordination of any recommended follow-up care/ongoing rehabilitation (Class I, Level B-R Evidence). </li>
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<div>The following recommendations were provided regarding dysphagia screening, assessment, and treatment in hospitalized patients of any age with acute ischemic stroke: </div>
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<li>Performing a bedside swallow screen prior to oral intake of liquids and foods is recommended (Class I, Level C-EO Evidence).</li>
<li>It is reasonable for the dysphagia screening to be conducted by a speech-language pathologist or other trained healthcare professional (Class 2a, Level C-LD Evidence).</li>
<li>It is reasonable to perform endoscopic evaluation of swallow function in patients who either fail the bedside swallow screening or are unable to participate in screening due to neurological deficits in order to determine dysphagia severity and aspiration risk (Class 2a, Level B-NR Evidence).</li>
<li>An oral hygiene protocol may be reasonable to reduce pneumonia risk (Class 2b, Level B-NR Evidence). </li>
<li>In individuals with dysphagia, pharyngeal electrical stimulation (PES) can be beneficial to decrease aspiration risk and improve dysphagia (Class 2a, Level B-NR Evidence). </li>
<li>In tracheostomy and/or mechanical ventilation-dependent individuals with severe stroke and dysphagia, treatment via PES after ventilator weaning can be beneficial to improve dysphagia, reduce aspiration risk, and promote decannulation (Class 2a, Level B-NR Evidence). </li>
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