Division professor leads effort to develop first-ever stroke rehab guidelines for AHA/ASA


By Breanne Grady MCM ’10

Every year, 800,000 Americans suffer a stroke, with more than 80 percent surviving, many of them living for decades with some degree of disability.

For the first time ever, the American Heart Association/American Stroke Association (AHA/ASA) has issued evidence-based strategies to help improve outcomes for adult stroke survivors.

This “how-to” manual recommends a comprehensive post-acute care strategy in the aftermath of a stroke.

“Previous guidelines have focused on the medical issues involved in the initial management of stroke, but many people survive a stroke with some level of disability,” said Dr. Carolee Winstein MS ’84, professor at the USC Division of Biokinesiology and Physical Therapy and lead author of the guidelines. “There is increasing evidence that rehabilitation can have a big impact on the survivors’ quality of life, so the time is right to review the evidence in this complex field and highlight effective and important aspects of rehabilitation.”

In the statement, the associations recommend that stroke patients seek treatment when possible in an in-patient rehabilitation facility (IRF) as opposed to a skilled nursing facility. While in an IRF, a patient typically participates in three hours of rehabilitation each day with an integrated team of health professionals, including physical therapists, occupational therapists, speech therapists, health aides, psychologists, nurses, nutritionists and social workers.

“There is considerable evidence that patients benefit from the team approach in a facility that understands the importance of rehabilitation during the early period after a stroke,” Winstein said.

Caregivers should also advocate that stroke patients not be discharged until they have participated in a formal falls-prevention program, which includes education on removing fall risks from the home, being aware of medication side effects and learning to safely operate assistive devices like wheelchairs and canes.

Both recommendations have been backed by several high-quality studies, and the AHA/ASA have ranked the level of scientific evidence supporting them as strong.
Other new guidelines include:

● Rehab should include intense mobility-task training for stroke patients with walking limitations
● Stroke survivors should be given individually tailored exercise programs to improve their cardiovascular fitness after rehabilitation.
● Patients should be provided intellectually stimulating environments, with access to computers, books, music, etc.
● Patients with impaired speech should be offered speech therapy.
● Eye exercises should be given to patients with impaired eye coordination and focus.
● Stroke survivors with balance issues should be provided a balance training program.

Winstein has been working at the USC Division of Biokinesiology and Physical Therapy since 1990. She has a dual appointment with the neurology department at the Keck School of Medicine of USC. Her research has focused on neurological rehabilitation. Winstein has written more than 100 research articles and book chapters. She is the director of the Motor Behavior and Neurorehabilitation Lab.

She served as the chair of an expert writing team that put together these guidelines, which was published May 4 in the journal Stroke, which has an impact factor of 5.7.

Click to download a free copy of the complete “AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery.”