Guidelines for Adult Stroke Rehabilitation and Recovery: Difference between revisions

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Latest revision as of 17:46, 13 December 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S [2]

Guidelines for Adult Stroke Rehabilitation and Recovery^[1]

Organization of Poststroke Rehabilitation Care^[1]

Class I
"1." It is recommended that stroke patients who are candidates for postacute rehabilitation receive organized, coordinated, interprofessional care(Level of Evidence:A ) "
"2." It is recommended that stroke survivors who qualify for and have access to IRF care receive treatment in an IRF in preference to a SNF. (Level of Evidence:B ) "
"3." Organized community-based and coordinated interprofessional rehabilitation care is recommended in the outpatient or home-based settings. (Level of Evidence:C ) "

Class IIb
"1."ESD services may be reasonable for people with mild to moderate disability.(Level of Evidence:B ) "

Rehabilitation

Interventions in the Inpatient Hospital Setting

Class I
"1." It is recommended that early rehabilitation for hospitalized stroke patients be provided in environments with organized, interprofessional stroke care. (Level of Evidence:A ) "
"2." It is recommended that stroke survivors receive rehabilitation at an intensity commensurate with anticipated benefit and tolerance (Level of Evidence:B ) "

Class III
"1." High-dose, very early mobilization within 24 hours of stroke onset can reduce the odds of a favorable outcome at 3 months and is not recommended.. (Level of Evidence:A ) "

Prevention of Skin Breakdown and Contractures

Class I
"1." During hospitalization and inpatient rehabilitation, regular skin assessments are recommended with objective scales of risk such as the Braden scale (Level of Evidence:C ) "
"2." It is recommended to minimize or eliminate skin friction, to minimize skin pressure, to provide appropriate support surfaces, to avoid excessive moisture, and to maintain adequate nutrition and hydration to prevent skin breakdown. Regular turning, good skin hygiene, and use of specialized mattresses, wheelchair cushions, and seating are recommended until mobility returns. (Level of Evidence:C ) "
"3." Patients, staff, and caregivers should be educated about the prevention of skin breakdown. (Level of Evidence:C ) "

Class IIa
"1."Positioning of hemiplegic shoulder in maximum external rotation while the patient is either sitting or in bed for 30 minutes daily is probably indicated..(Level of Evidence:B ) "

Class IIb
"1." Resting hand/wrist splints, along with regular stretching and spasticity management in patients lacking active hand movement, may be considered..(Level of Evidence:C ) "
"2." Use of serial casting or static adjustable splints may be considered to reduce mild to moderate elbow and wrist contractures.(Level of Evidence:C ) "
"3." Surgical release of brachialis, brachioradialis, and biceps muscles may be considered for substantial elbow contractures and associated pain.(Level of Evidence:B ) "
"4." Resting ankle splints used at night and during assisted standing may be considered for prevention of ankle contracture in the hemiplegic limb..(Level of Evidence:B ) "

Prevention of DVT

Class I
"1." In ischemic stroke, prophylactic-dose subcutaneous heparin (UFH or LMWH) should be used for the duration of the acute and rehabilitation hospital stay or until the stroke survivor regains mobility. (Level of Evidence:A ) "

Class IIa
"1." In ischemic stroke, it is reasonable to use prophylactic-dose LMWH over prophylactic dose UFH for prevention of DVT.(Level of Evidence:A ) "

Class IIb
"1." In ischemic stroke, it may be reasonable to use intermittent pneumatic compression over no prophylaxis during the acute hospitalization.(Level of Evidence:B ) "
"2." In ICH, it may be reasonable to use prophylactic-dose subcutaneous heparin (UFH or LMWH) started between days 2 and 4 over no prophylaxis..(Level of Evidence:C ) "
"3." In ICH, it may be reasonable to use prophylactic dose LMWH over prophylactic-dose UFH.(Level of Evidence:C ) "
"4." In ICH, it may be reasonable to use intermittent pneumatic compression devices over no prophylaxis.(Level of Evidence:C ) "

Class III
"1." In ischemic stroke, it is not useful to use elastic compression stockings. (Level of Evidence:B ) "
"2." In ICH, it is not useful to use elastic compression stockings.(Level of Evidence:C ) "

Treatment of Bowel and Bladder Incontinence

Class I
"1." Assessment of bladder function in acutely hospitalized stroke patients is recommended. A history of urological issues before stroke should be obtained. (Level of Evidence:B ) "
"2." Assessment of urinary retention through bladder scanning or intermittent catheterizations after voiding while recording volumes is recommended for patients with urinary incontinence or retention. (Level of Evidence:B )
"Removal of the Foley catheter (if any) within 24 hours after admission for acute stroke is recommended.(Level of Evidence:B )

Class IIa
"1." Assessment of cognitive awareness of need to void or having voided is reasonable.(Level of Evidence:B ) "
"2." It is reasonable to use the following treatment interventions to improve bladder incontinence in stroke patients: a) Prompted voiding b) Pelvic floor muscle training (after discharge home.(Level of Evidence:B ) "

Class IIb
"1." It may be reasonable to assess prior bowel function in acutely hospitalized stroke patients and include the following.(Level of Evidence:C) " a) Stool consistency, frequency, and timing (before stroke) b) Bowel care practices before stroke

Assessment, Prevention, and Treatment of Hemiplegic Shoulder Pain

Class Ia
"1." Patient and family education (ie, range of motion, positioning) is recommended for shoulder pain and shoulder care after stroke, particularly before discharge or transitions in care.(Level of Evidence:C) "

Class IIa
"1." Botulinum toxin injection can be useful to reduce severe hypertonicity in hemiplegic shoulder muscles.(Level of Evidence:A ) "
"2." A trial of neuromodulating pain medications is reasonable for patients with hemiplegic shoulder pain who have clinical signs and symptoms of neuropathic pain manifested as sensory change in the shoulder region, allodynia, or hyperpathia.(Level of Evidence:A) "
"3." It is reasonable to consider positioning and use of supportive devices and slings for shoulder subluxation.(Level of Evidence:C ) "
"4." A clinical assessment can be useful, including: a) Musculoskeletal evaluation b) Evaluation of spasticity c) Identification of any subluxation d) Testing for regional sensory changes.(Level of Evidence:C ) "

Class IIb
"1." NMES may be considered (surface or intramuscular) for shoulder pain.(Level of Evidence:A ) "
"2." Ultrasound may be considered as a diagnostic tool for shoulder soft tissue injury.(Level of Evidence:B ) "
"3." Usefulness of acupuncture as an adjuvant treatment for hemiplegic shoulder pain is of uncertain value.(Level of Evidence:B ) "
"4." Usefulness of subacromial or glenohumeral corticosteroid injection for patients with inflammation in these locations is not well established.(Level of Evidence:B ) "
"5." Suprascapular nerve block may be considered as an adjunctive treatment for hemiplegic shoulder pain.(Level of Evidence:B ) "
"6." Surgical tenotomy of pectoralis major, lattisimus dorsi, teres major, or subscapularis may be considered for patients with severe hemiplegia and restrictions in shoulder range of motion.(Level of Evidence:C ) "

Class III
"1." The use of overhead pulley exercises is not recommended. (Level of Evidence:C ) "

Central Pain After Stroke

Class I
"1." The diagnosis of central poststroke pain should be based on established diagnostic criteria afterother causes of pain have been excluded. (Level of Evidence:C ) "
"2." The choice of pharmacological agent for the treatment of central poststroke pain should be individualized to the patient’s needs and response to therapy and any side effects. (Level of Evidence:C ) "

Class III
"1." TENS has not been established as an effective treatment. (Level of Evidence:B ) "
"2." Deep brain stimulation has not been established as an effective treatment. (Level of Evidence:B ) "

Class IIa
"1." Amitriptyline and lamotrigine are reasonable first-line pharmacological treatments.(Level of Evidence:B ) "
"2." Interprofessional pain management is probably useful in conjunction with pharmacotherapy.(Level of Evidence:C )"

Class IIb
"1." Motor cortex stimulation might be reasonable for the treatment of intractable central poststroke pain that is not responsive to other treatments in carefully selected patients.(Level of Evidence:B ) "
"2." Standardized measures may be useful to monitor response to treatment.(Level of Evidence:C ) "
"3." Pregabalin, gabapentin, carbamazepine, or phenytoin may be considered as second-line treatments..(Level of Evidence:B ) "

Prevention of Falls

Class I
"1." It is recommended that individuals with stroke discharged to the community participate in exercise programs with balance training to reduce falls. (Level of Evidence:B ) "
"2." It is recommended that individuals with stroke be provided a formal fall prevention program during hospitalization.(Level of Evidence:A ) "

Class IIa
"1." It is reasonable that individuals with stroke be evaluated for fall risk annually with an established instrument appropriate to the setting.(Level of Evidence:B ) "
"2." It is reasonable that individuals with stroke and their caregivers receive information targeted to home and environmental modifications designed to reduce falls.(Level of Evidence:B ) "

Class IIb
"1." Tai Chi training may be reasonable for fall prevention.(Level of Evidence:B ) "

Seizures

Class I
"1." Any patient who develops a seizure should be treated with standard management approaches, including a search for reversible causes of seizure in addition to potential use of antiepileptic drugs.(Level of Evidence:C ) "

Class III
"1." Routine seizure prophylaxis for patients with ischemic or hemorrhagic stroke is not recommended.. (Level of Evidence:C ) "

Poststroke Depression, Including Emotional and Behavioral State

Class I
"1." Administration of a structured depression inventory such as the Patient Health Questionnaire-2 is recommended to routinely screen for poststroke depression.(Level of Evidence:B ) "
"2."Patient education about stroke is recommended. Patients should be provided with information, advice, and the opportunity to talk about the impact of the illness on their lives.(Level of Evidence:B ) "
"3." Patients diagnosed with poststroke depression should be treated with antidepressants in the absence of contraindications and closely monitored to verify effectiveness.(Level of Evidence:B ) "

Class IIa
"1." A therapeutic trial of an SSRI or dextromethorphan/quinidine is reasonable for patients with emotional lability or pseudobulbar affect causing emotional distress.(Level of Evidence:A ) "
"2." Periodic reassessment of depression, anxiety, and other psychiatric symptoms may be useful in the care of stroke survivors..(Level of Evidence:B ) "
"3." Consultation by a qualified psychiatrist or psychologist for stroke survivors with mood disorders causing persistent distress or worsening disability can be useful.(Level of Evidence:C ) "

Class IIb
"1." The usefulness of routine use of prophylactic antidepressant medications is unclear.(Level of Evidence:A ) "
"2." Combining pharmacological and nonpharmacological treatments of poststroke depression may be considered.(Level of Evidence:A ) "
"3." The efficacy of individual psychotherapy alone in the treatment of poststroke depression is unclear.(Level of Evidence:B ) "
"4." Patient education, counseling, and social support may be considered as components of treatment for poststroke depression.(Level of Evidence:B ) "
"5." An exercise program of at least 4 weeks duration may be considered as a complementary treatment for poststrok depression.(Level of Evidence:B ) "
"6." Early effective treatment of depression may have a positive effect on the rehabilitation outcome.(Level of Evidence:B ) "

Class III
"1." No recommendation for the use of any particular class of antidepressants is made. SSRIs are commonly used and generally well tolerated in this patient population. (Level of Evidence:A ) "

Poststroke Osteoporosis

Class I
"1." It is recommended that individuals with stroke residing in long-term care facilities be evaluated for calcium and vitamin D supplementation.(Level of Evidence:A ) "
"2." It is recommended that US Preventive Services Task Force osteoporosis screening recommendations be followed in women with stroke. (Level of Evidence:B ) "

Class IIa
"1." Increased levels of physical activity are probably indicated to reduce the risk and severity of poststroke osteoporosis.(Level of Evidence:B ) "

Assessment of Disability and Rehabilitation Needs

Class I
"1." It is recommended that all individuals with stroke be provided a formal assessment of their ADLs and IADLs, communication abilities, and functional mobility before discharge from acute care hospitalization and the findings be incorporated into the care transition and the discharge planning process.(Level of Evidence:B ) "
"2." It is recommended that all individuals with stroke discharged to independent community living from postacute rehabilitation or SNFs receive ADL and IADL assessment directly related to their discharge living setting. (Level of Evidence:B ) "
"3." A functional assessment by a clinician with expertise in rehabilitation is recommended for patients with an acute stroke with residual functional deficits. (Level of Evidence:C ) "
"4." Determination of postacute rehabilitation needs should be based on assessments of residual neurological deficits; activity limitations; cognitive, communicative, and psychological status; swallowing ability; determination of previous functional ability and medical comorbidities; level of family/caregiver support; capacity of family/ caregiver to meet the care needs of the stroke survivor; likelihood of returning to community living; and ability to participate in rehabilitation. (Level of Evidence:C ) "

Class IIa
"1." It is reasonable that individuals with stroke discharged from acute and postacute hospitals/centers receive formal follow-up on their ADL and IADL status, communication abilities, and functional mobility within 30 days of discharge.(Level of Evidence:B ) "
"2." The routine administration of standardized measures can be useful to document the severity of stroke and resulting disability, starting in the acute phase and progressing over the course of recovery and rehabilitation.(Level of Evidence:C ) "

Class IIa
"1." A standardized measure of balance and gait speed (for those who can walk) may be considered for planning postacute rehabilitation care and for safety counseling with the patient and family.(Level of Evidence:B ) "

Assessment of Motor Impairment, Activity, and Mobility

Class IIb
"1." Motor impairment assessments (paresis/muscle strength, tone, individuated finger movements, coordination) with standardized tools may be useful.(Level of Evidence:C ) "
"2." Upper extremity activity/function assessment with a standardized tool may be useful.(Level of Evidence:C ) "
"3." Balance assessment with a standardized tool may be useful.(Level of Evidence:C ) "
"4." Mobility assessment with a standardized tool may be useful.(Level of Evidence:C ) "
"5." The use of standardized questionnaires to assess stroke survivor perception of motor impairments, activity limitations, and participation may be considered.(Level of Evidence:C ) "
"6." The use of technology (accelerometers, stepactivity monitors, pedometers) as an objective means of assessing real-world activity and participation may be considered.(Level of Evidence:C ) "
"7." Periodic assessments with the same standardized tools to document progress in rehabilitation may be useful.(Level of Evidence:C ) "

Assessment of Communication Impairment

Class I
"1." Communication assessment should consist of interview, conversation, observation, standardized tests, or nonstandardized items; assess speech, language, cognitive communication, pragmatics, reading, and writing; identify communicative strengths and weaknesses; and identify helpful compensatory strategies. (Level of Evidence:B ) "

Class IIa
"1." Telerehabilitation is reasonable when face-to face assessment is impossible or impractical.(Level of Evidence:A ) "

Class IIb
"1." Communication assessment may consider the individual’s unique priorities using the ICF framework, including quality of life.(Level of Evidence:C ) "

Assessment of Cognition and Memory

Class I
"1." Screening for cognitive deficits is recommended for all stroke patients before discharge home. (Level of Evidence:B ) "

Class IIa
"1." When screening reveals cognitive deficits, a more detailed neuropsychological evaluation to identify areas of cognitive strength and weakness may be beneficial.(Level of Evidence:C ) "

Sensory Impairments, Including Touch, Vision, and Hearing

Class IIa
"1." Evaluation of stroke patients for sensory impairments, including touch, vision, and hearing, is probably indicated.(Level of Evidence:B ) "

Dysphagia Screening, Management, and Nutritional Support

Class I
"1." Early dysphagia screening is recommended for acute stroke patients to identify dysphagia or aspiration, which can lead to pneumonia, malnutrition, dehydration, and other complications. (Level of Evidence:B ) "
"2." Assessment of swallowing before the patient begins eating, drinking, or receiving oral medications is recommended. (Level of Evidence:B ) "
"3." Oral hygiene protocols should be implemented to reduce the risk of aspiration pneumonia after stroke. (Level of Evidence:B ) "
"4." Enteral feedings (tube feedings) should be initiated within 7 days after stroke for patients who cannot safely swallow. (Level of Evidence:A ) "
"5." Nasogastric tube feeding should be used for short term (2–3 weeks) nutritional support for patients who cannot swallow safely. (Level of Evidence:B ) "
"6." Percutaneous gastrostomy tubes should be placed in patients with chronic inability to swallow safely. (Level of Evidence:B ) "

Class IIa
"1." Dysphagia screening is reasonable by a speech-language pathologist or other trained healthcare provider.(Level of Evidence:C ) "
"2." An instrumental evaluation is probably indicated for those patients suspected of aspiration to verify the presence/absence of aspiration and to determine the physiological reasons for the dysphagia to guide the treatment plan.(Level of Evidence:B ) "
"3." Nutritional supplements are reasonable to consider for patients who are malnourished or at risk of malnourishment.(Level of Evidence:B ) "
"4." Incorporating principles of neuroplasticity into dysphagia rehabilitation strategies/interventions is reasonable.(Level of Evidence:C ) "

Class IIb
"1." Selection of instrumental study (fiberoptic endoscopic evaluation of swallowing, videofluoroscopy, fiberoptic endoscopic evaluation of swallowing with sensory testing) may be based on availability or other considerations.(Level of Evidence:C ) "
"2." Behavioral interventions may be considered as a component of dysphagia treatment.(Level of Evidence:A ) "
"3." Acupuncture may be considered as a adjunctive treatment for dysphagia.(Level of Evidence:B ) "

Class III
"1." Drug therapy, NMES, pharyngeal electrical stimulation, physical stimulation, tDCS, and transcranial magnetic stimulation are of uncertain benefit and not currently recommended. (Level of Evidence:A ) "

Nondrug Therapies for Cognitive Impairment, Including Memory

Class I
"1."Enriched environments to increase engagement with cognitive activities are recommended. (Level of Evidence:A ) "

Class IIb
"1." Use of cognitive rehabilitation to improve attention, memory, visual neglect, and executive functioning is reasonable.(Level of Evidence:B ) "
"2." Use of cognitive training strategies that consider practice, compensation, and adaptive techniques for increasing independence is reasonable.(Level of Evidence:B ) "

Class IIb
"1." Virtual reality training may be considered for verbal, visual, and spatial learning, but its efficacy is not well established.(Level of Evidence:C ) "
"2." Exercise may be considered as adjunctive therapy to improve cognition and memory after stroke.(Level of Evidence:C ) "
"3." Compensatory strategies may be considered to improve memory functions, including the use of internalized strategies (eg, visual imagery, semantic organization, spaced practice) and external memory assistive technology (eg, notebooks, paging systems, computers, other prompting devices).(Level of Evidence:A ) "
"4." Some type of specific memory training is reasonable such as promoting global processing in visual-spatial memory and constructing a semantic framework for language-based memory.(Level of Evidence:B ) "
"5." Errorless learning techniques may be effective for individuals with severe memory impairments for learning specific skills or knowledge, although there is limited transfer to novel tasks or reduction in overall functional memory problems.(Level of Evidence:B ) "
"6." Music therapy may be reasonable for improving verbal memory.(Level of Evidence:B ) "

Class III
"1." Anodal tDCS over the left dorsolateral prefrontal cortex to improve language-based complex attention (working memory) remains experimental.(Level of Evidence:B ) "

Use of Drugs to Improve Cognitive Impairments, Including Attention

Class IIb
"1." The usefulness of donepezil in the treatment of poststroke cognitive deficits is not well established.(Level of Evidence:B ) "
"2." The usefulness of rivastigmine in the treatment of poststroke cognitive deficits is not well established.(Level of Evidence:B ) "
"3." The usefulness of antidepressants in the treatment of poststroke cognitive deficits is not well established.(Level of Evidence:B ) "
"4." The usefulness of dextroamphetamine, methylphenidate, modafinil, and atomoxetine in the treatment of poststroke cognitive deficits is unclear.(Level of Evidence:C ) "

Limb Apraxia

Class IIb
"1." Strategy training or gesture training for apraxia may be considered.(Level of Evidence:B ) "
"2." Task practice for apraxia with and without mental rehearsal may be considered.(Level of Evidence:C ) "

Hemispatial Neglect or Hemi-Inattention

Class IIa
"1." It is reasonable to provide repeated top-down and bottom-up interventions such as prism adaptation, visual scanning training, optokinetic stimulation, virtual reality, limb activation, mental imagery, and neck vibration combined with prism adaptation to improve neglect symptoms.(Level of Evidence:B ) "

Class IIb
"1." Right visual field testing may be considered.(Level of Evidence:B ) "
"2." Repetitive transcranial magnetic stimulation of various forms may be considered to ameliorate neglect symptoms.(Level of Evidence:B ) "

Cognitive Communication Disorders

Class IIa
"1." Interventions for cognitive-communication disorders are reasonable to consider if they are individually tailored and target: a) The overt communication deficit affecting prosody, comprehension, expression of discourse, and pragmatics. b) The cognitive deficits that accompany or underlie the communication deficit, including attention, memory, and executive functions.(Level of Evidence:B ) "

Aphasia

Class I
"1." Speech and language therapy is recommended for individuals with aphasia. (Level of Evidence:A ) "
"2." Speech and language therapy is recommended for individuals with aphasia. (Level of Evidence:B ) "

Class IIa
"1." Intensive treatment is probably indicated, but there is no definitive agreement on the optimum amount, timing, intensity, distribution, or duration of treatment.(Level of Evidence:B ) "

Class IIb
"1." Computerized treatment may be considered to supplement treatment provided by a speech language pathologist.(Level of Evidence:A ) "
"2." A variety of different treatment approaches for aphasia may be useful, but their relative effectiveness is not known.(Level of Evidence:B ) "
"3." Group treatment may be useful across the continuum of care, including the use of community-based aphasia groups.(Level of Evidence:B ) "
"4." Pharmacotherapy for aphasia may be considered on a case-by-case basis in conjunction with speech and language therapy, but no specific regimen is recommended for routine use at this time.(Level of Evidence:B ) "

Class III
"1." Brain stimulation techniques as adjuncts to behavioral speech and language therapy are considered experimental and therefore are not currently recommended for routine use. (Level of Evidence:B ) "

Motor Speech Disorders:Dysarthria and Apraxia of Speech

Class I
"1." Interventions for motor speech disorders should be individually tailored and can include behavioral techniques and strategies that target: a) Physiological support for speech, including respiration, phonation, articulation, and resonance.(Level of Evidence:A ) " b) Global aspects of speech production such as loudness, rate, and prosody.
"2." Augmentative and alternative communication devices and modalities should be used to supplement speech. (Level of Evidence:B ) "

Class IIa
"1." Telerehabilitation may be useful when face-to face treatment is impossible or impractical.(Level of Evidence:A ) "

Class IIb
"1." Environmental modifications, including listener education, may be considered to improve communication effectiveness.(Level of Evidence:C ) "
"2." Activities to facilitate social participation and promote psychosocial well-being may be considered.(Level of Evidence:C ) "

Spasticity

Class I
"1." Targeted injection of botulinum toxin into localized upper limb muscles is recommended to reduce spasticity, to improve passive or active range of motion, and to improve dressing, hygiene, and limb positioning. (Level of Evidence:A ) "
"2." Targeted injection of botulinum toxin into lower limb muscles is recommended to reduce spasticity that interferes with gait function. (Level of Evidence:A ) "

Class IIa
"1." Oral antispasticity agents can be useful for generalized spastic dystonia but may result in dose-limiting sedation or other side effects.(Level of Evidence:A ) "

Class IIb
"1." Physical modalities such as NMES or vibration applied to spastic muscles may be reasonable to improve spasticity temporarily as an adjunct to rehabilitation therapy.(Level of Evidence:A ) "
"2." Intrathecal baclofen therapy may be useful for severe spastic hypertonia that does not respond to other interventions.(Level of Evidence:A ) "
"3." Postural training and task-oriented therapy may be considered for rehabilitation of ataxia.(Level of Evidence:A ) "

Class III
"1." The use of splints and taping are not recommended for prevention of wrist and finger spasticity after stroke.. (Level of Evidence:B ) "

Balance and Ataxia

Class I
"1." Individuals with stroke who have poor balance, low balance confidence, and fear of falls or are at risk for falls should be provided with a balance training program. (Level of Evidence:A ) "
"2." Individuals with stroke should be prescribed and fit with an assistive device or orthosis if appropriate to improve balance. (Level of Evidence:A ) "
"3." Individuals with stroke should be evaluated for balance, balance confidence, and fall risk. (Level of Evidence:C ) "

Class IIb
"1." Postural training and task-oriented therapy may be considered for rehabilitation of ataxia.(Level of Evidence:C ) "

Mobility

Class I
"1." Intensive, repetitive, mobility- task training is recommended for all individuals with gait limitations after stroke. (Level of Evidence:A ) "
"2." An AFO after stroke is recommended in individuals with remediable gait impairments (eg, foot drop) to compensate for foot drop and to improve mobility and paretic ankle and knee kinematics, kinetics, and energy cost of walking. (Level of Evidence:A ) "

Class IIa
"1." Group therapy with circuit training is a reasonable approach to improve walking.(Level of Evidence:B ) "
"2." Incorporating cardiovascular exercise and strengthening interventions is reasonable to consider for recovery of gait capacity and gait related mobility tasks.(Level of Evidence:B ) "
"3." NMES is reasonable to consider as an alternative to an AFO for foot drop.(Level of Evidence:B ) "

Class IIb
"1." The effectiveness of TENS in conjunction with everyday activities for improving mobility, lower extremity strength, and gait speed is uncertain.(Level of Evidence:B ) "
"2." The effectiveness of rhythmic auditory cueing to improve walking speed and coordination is uncertain.(Level of Evidence:B ) "
"3." The usefulness of electromyography biofeedback during gait training in patients after stroke is uncertain.(Level of Evidence:B ) "
"4." Virtual reality may be beneficial for the improvement of gait.(Level of Evidence:B ) "
"5." The effectiveness of neurophysiological approaches (ie, neurodevelopmental therapy, proprioceptive neuromuscular facilitation) compared with other treatment approaches for motor retraining after an acute stroke has not been established.(Level of Evidence:B ) "
"6." The effectiveness of water-based exercise for motor recovery after an acute stroke is unclear.(Level of Evidence:B ) "
"7." The effectiveness of fluoxetine or other SSRIs to enhance motor recovery is not well established.(Level of Evidence:B ) "
"8." The effectiveness of levodopa to enhance motor recovery is not well established.(Level of Evidence:B ) "
"9." Practice walking with either a treadmill (with or without body-weight support) or overground walking exercise training combined with conventional rehabilitation may be reasonable for recovery of walking function.(Level of Evidence:B ) "
"10." Robot-assisted movement training to improve motor function and mobility after stroke in combination with conventional therapy may be considered.(Level of Evidence:A ) "
"11." Mechanically assisted walking (treadmill, electromechanical gait trainer, robotic device, servo-motor) with body weight support may be considered for patients who are nonambulatory or have low ambulatory ability early after stroke.(Level of Evidence:A ) "
"12." There is insufficient evidence to recommend acupuncture for facilitating motor recovery and walking mobility.(Level of Evidence:A ) "

Class III
"1." The use of dextroamphetamine or methylphenidate to facilitate motor recovery is not recommended . (Level of Evidence:B ) "

Upper Extremity Activity, Including ADLs, IADLs, Touch, and Proprioception

Class I
"1." Functional tasks should be practiced; that is, task-specific training, in which the tasks are graded to challenge individual capabilities, practiced repeatedly, and progressed in difficulty on a frequent basis. (Level of Evidence:A ) "
"2." All individuals with stroke should receive ADL training tailored to individual needs and eventual discharge setting. (Level of Evidence:A ) "
"3." All individuals with stroke should receive IADL training tailored to individual needs and eventual discharge setting. (Level of Evidence:B ) "

Class IIa
"1." CIMT or its modified version is reasonable to consider for eligible stroke survivors.(Level of Evidence:A ) "
"2." Robotic therapy is reasonable to consider to deliver more intensive practice for individuals with moderate to severe upper limb paresis.(Level of Evidence:A ) "
"3." NMES is reasonable to consider for individuals with minimal volitional movement within the first few months after stroke or for individuals with shoulder subluxation.(Level of Evidence:A ) "
"4." Mental practice is reasonable to consider as an adjunct to upper extremity rehabilitation services.(Level of Evidence:A ) "
"5." Strengthening exercises are reasonable to consider as an adjunct to functional task practice.(Level of Evidence:B ) "
"6." Virtual reality is reasonable to consider as a method for delivering upper extremity movement practice.(Level of Evidence:B ) "

Class IIb
"1." Somatosensory retraining to improve sensory discrimination may be considered for stroke survivors with somatosensory loss.(Level of Evidence:B ) "
"2." Bilateral training paradigms may be useful for upper limb therapy.(Level of Evidence:A ) "

Class III
"1." Acupuncture is not recommended for the improvement of ADLs and upper extremity activity. (Level of Evidence:A ) "

Adaptive Equipment, Durable Medical Devices, Orthotics, and Wheelchairs

Class I
"1." Ambulatory assistive devices (eg, cane, walker) should be used to help with gait and balance impairments, as well as mobility efficiency and safety, when needed. (Level of Evidence:B ) "
"2." AFOs should be used for ankle instability or dorsiflexor weakness. (Level of Evidence:B ) "
"3." Wheelchairs should be used for nonambulatory individuals or those with limited walking ability. (Level of Evidence:C ) "
"4." Adaptive and assistive devices should be used for safety and function if other methods of performing the task/activity are not available or cannot be learned or if the patient’s safety is a concern. (Level of Evidence:C ) "

Chronic Care Management: Home- and Community-Based Participation

Class I
"1." After successful screening, an individually tailored exercise program is indicated to enhance cardiorespiratory fitness and to reduce the risk of stroke recurrence. (Level of Evidence:A ) "
"2." After completion of formal stroke rehabilitation, participation in a program of exercise or physical activity at home or in the community is recommended (Level of Evidence:A ) "

Treatments/Interventions for Visual Impairments

Class I
"1." Multimodal audiovisual spatial exploration training appears to be more effective than visual spatial exploration training alone and is recommended to improve visual scanning. (Level of Evidence:B ) "
"2.The use of behavioral optometry approaches involving eye exercises and the use of lenses and colored filters to improve eye movement control, eye focusing, and eye coordination is not recommended.(Level of Evidence:A )

Class IIb
"1." There is insufficient evidence to support or refute any specific intervention as effective at reducing the impact of impaired perceptual functioning..(Level of Evidence:B ) "
"2." The use of virtual reality environments to improve visual-spatial/perceptual functioning may be considered.(Level of Evidence:B ) "
"3." The use of behavioral optometry approaches involving eye exercises and the use of lenses and colored filters to improve eye movement control, eye focusing, and eye coordination is not recommended.(Level of Evidence:B ) "
"4." Compensatory scanning training may be considered for improving functional ADLs.(Level of Evidence:B ) "
"5." Compensatory scanning training may be considered for improving scanning and reading outcomes.(Level of Evidence:B ) "
"6." Yoked prisms may be useful to help patients compensate for visual field cuts.(Level of Evidence:B ) "
"7." Compensatory scanning training may be considered for improving functional deficits after visual field loss but is not effective at reducing visual field deficits.(Level of Evidence:B ) "
"8."Computerized vision restoration training may be considered to expand visual fields, but evidence of its usefulness is lacking.(Level of Evidence:C)

Class III
"1." The use of behavioral optometry approaches involving eye exercises and the use of lenses and colored filters to improve eye movement control, eye focusing, and eye coordination is not recommended. (Level of Evidence:B ) "

Hearing Loss

Class IIa
"1." If a patient is suspected of a hearing impairment, it is reasonable to refer to an audiologist for audiometric testing.(Level of Evidence:C ) "
"2." It is reasonable to use some form of amplification (eg, hearing aids).(Level of Evidence:C ) "
"3." It is reasonable to use communication strategies such as looking at the patient when speaking.(Level of Evidence:C ) "
"4." It is reasonable to minimize the level of background noise in the patient’s environment.(Level of Evidence:C ) "

Ensuring Medical and Rehabilitation Continuity Through the Rehabilitation Process and Into the Community

Class IIa
"1." It is reasonable to consider individualized discharge planning in the transition from hospital to home.(Level of Evidence:B ) "
"2." It is reasonable to consider alternative methods of communication and support (eg, telephone visits, telehealth, or Web-based support), particularly for patients in rural settings.(Level of Evidence:B ) "

Social and Family Caregiver Support

Class IIb
"1." It may be useful for the family/caregiver to be an integral component of stroke rehabilitation.(Level of Evidence:A ) "
"2." It may be reasonable that family/caregiver support include some or all of the following on a regular basis: a) Education b) Training c) Counseling d) Development of a support structure e) Financial assistance(Level of Evidence:A ) "
"3." It may be useful to have the family/caregiver involved in decision making and treatment planning as early as possible and throughout the duration of the rehabilitation process.(Level of Evidence:B ) "

Referral to Community Resources

Class I
"1." It is recommended that acute care hospitals and rehabilitation facilities maintain up-to-date inventories of community resources. (Level of Evidence:C ) "
"2." Patient and family/caregiver preferences for resources should be considered. (Level of Evidence:C ) "
"3." It is recommended that information about local resources be provided to the patient and family. (Level of Evidence:C ) "
"4." It is recommended that contact with community resources be offered through formal or informal referral. (Level of Evidence:C ) "
"5." Follow-up is recommended to ensure that the patient and family receive the necessary services. (Level of Evidence:C ) "

Rehabilitation in the Community

Class I
"1." Patients with stroke receiving comprehensive ADL, IADL, and mobility assessments, including evaluation of the discharge living setting, should be considered candidates for communityor home-based rehabilitation when feasible. Exclusions include individuals with stroke who require daily nursing services, regular medical interventions, specialized equipment, or interprofessional expertise. (Level of Evidence:A ) "

Class IIa
"1." It is reasonable that caregivers, including family members, be involved in training and education related directly to home-based rehabilitation programs and be included as active partners in the planning and implementation or treatment activities under the supervision of professionals.(Level of Evidence:B ) "

Class IIb
"1." A formal plan for monitoring compliance and participation in treatment activities may be useful for individuals with stroke referred for home- or community-based rehabilitation services. A case manager or professional staff person should be assigned to oversee implementation of the plan.(Level of Evidence:B ) "

Sexual Function

Class IIb
"1." An offer to patients and their partners to discuss sexual issues may be useful before discharge home and again after transition to the community. Discussion topics may include safety concerns, changes in libido, physical limitations resulting from stroke, and emotional consequences of stroke.(Level of Evidence:B ) "

Recreational and Leisure Activity

Class IIa
"1." It is reasonable to promote engagement in leisure and recreational pursuits, particularly through the provision of information on the importance of maintaining an active and healthy lifestyle.(Level of Evidence:B ) "
"2." It is reasonable to foster the development of self-management skills for problem solving for overcoming barriers to engagement in active activities.(Level of Evidence:B ) "
"3." It is reasonable to start education and selfmanagement skill development about leisure/recreation activities during and in conjunction with in-patient rehabilitation.(Level of Evidence:B ) "

Return to Work

Class IIa
"1." Vocationally targeted therapy or vocational rehabilitation is reasonable for individuals with stroke considering a return to work.(Level of Evidence:C ) "

Class IIb
"1." An assessment of cognitive, perception, physical, and motor abilities may be considered for stroke survivors considering a return to work.(Level of Evidence:C ) "

Return to Driving

Class I
"1." Individuals who appear to be ready to return to driving, as demonstrated by successful performance on fitness-to-drive tests, should have an on-the-road test administered by an authorized person. (Level of Evidence:C ) "

Class IIa
"1." It is reasonable that individuals be assessed for cognitive, perception, physical, and motor abilities to ascertain readiness to return to driving according to safety and local laws.(Level of Evidence:B ) "
"2." It is reasonable that individuals who do not pass an on-the-road driving test be referred to a driver rehabilitation program for training.(Level of Evidence:B ) "

Class IIb
"1." A driving simulation assessment may be considered for predicting fitness to drive.(Level of Evidence:C ) "

References

↑ ^1.0 ^1.1 Winstein, Carolee J., et al. "Guidelines for Adult Stroke Rehabilitation and Recovery A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association." Stroke 47.6 (2016): e98-e169.

Template:WH Template:WS|}

[abc-1] 1.0 ^1.1 Winstein, Carolee J., et al. "Guidelines for Adult Stroke Rehabilitation and Recovery A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association." Stroke 47.6 (2016): e98-e169.

[1]

@@ Line 4: / Line 4: @@
 {{CMG}}{{AE}}{{AA}}
-==Guidelines for Adult Stroke Rehabilitation and Recovery==
+==Guidelines for Adult Stroke Rehabilitation and Recovery<ref name=abc>Winstein, Carolee J., et al. "Guidelines for Adult Stroke Rehabilitation and Recovery A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association." Stroke 47.6 (2016): e98-e169.</ref>==
-===Organization of Poststroke Rehabilitation Care (Levels of Care===
+===Organization of Poststroke Rehabilitation Care<ref name=abc>Winstein, Carolee J., et al. "Guidelines for Adult Stroke Rehabilitation and Recovery A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association." Stroke 47.6 (2016): e98-e169.</ref> ===
 {|class="wikitable" style="width:80%"
 |-
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is recommended that stroke patients who are candidates for postacute rehabilitation receive organized, coordinated, interprofessional care''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is recommended that stroke survivors who qualify for and have access to IRF care receive treatment in an IRF in preference to a SNF. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Organized community-based and coordinated interprofessional rehabilitation care is recommended in the outpatient or home-based settings. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |}
 {|class="wikitable" style="width:80%"
@@ Line 20: / Line 20: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>ESD services may be reasonable for people with mild to moderate disability.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |}Rehabilitation
 ===Interventions in the Inpatient Hospital Setting===
@@ Line 27: / Line 27: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is recommended that early rehabilitation for hospitalized stroke patients be provided in environments with organized, interprofessional stroke care. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is recommended that stroke survivors receive rehabilitation at an intensity commensurate with anticipated benefit and tolerance ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 36: / Line 36: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> High-dose, very early mobilization within 24 hours of stroke onset can reduce the odds of a favorable outcome at 3 months and is not recommended.''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 44: / Line 44: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> During hospitalization and inpatient rehabilitation, regular skin assessments are recommended with objective scales of risk such as the Braden scale ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is recommended to minimize or eliminate skin friction, to minimize skin pressure, to provide appropriate support surfaces, to avoid excessive moisture, and to maintain adequate nutrition and hydration to prevent skin breakdown. Regular turning, good skin hygiene, and use of specialized mattresses, wheelchair
+cushions, and seating are recommended until mobility returns. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Patients, staff, and caregivers should be educated about the prevention of skin breakdown. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |}
 {|class="wikitable" style="width:80%"
@@ Line 54: / Line 55: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>Positioning of hemiplegic shoulder in maximum external rotation while the patient is either sitting or in bed for 30 minutes daily is probably indicated..''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |}
 {|class="wikitable" style="width:80%"
@@ Line 60: / Line 61: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Resting hand/wrist splints, along with regular stretching and spasticity management in patients lacking active hand movement, may be considered..''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Use of serial casting or static adjustable splints may be considered to reduce mild to moderate elbow and wrist contractures.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Surgical release of brachialis, brachioradialis, and biceps muscles may be considered for substantial elbow contractures and associated pain.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Resting ankle splints used at night and during assisted standing may be considered for prevention of ankle contracture in the hemiplegic limb..''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |}
 ===Prevention of DVT===
@@ Line 73: / Line 74: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> In ischemic stroke, prophylactic-dose subcutaneous heparin (UFH or LMWH) should be used for the duration of the acute and rehabilitation hospital stay or until the stroke survivor regains mobility. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 80: / Line 81: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> In ischemic stroke, it is reasonable to use prophylactic-dose LMWH over prophylactic dose UFH for prevention of DVT.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 87: / Line 88: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> In ischemic stroke, it may be reasonable to use intermittent pneumatic compression over no prophylaxis during the acute hospitalization.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> In ICH, it may be reasonable to use prophylactic-dose subcutaneous heparin (UFH or LMWH) started between days 2 and 4 over no prophylaxis..''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> In ICH, it may be reasonable to use prophylactic dose LMWH over prophylactic-dose UFH.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> In ICH, it may be reasonable to use intermittent pneumatic compression devices over no prophylaxis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |}
 {|class="wikitable" style="width:80%"
@@ Line 99: / Line 100: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> In ischemic stroke, it is not useful to use elastic compression stockings. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> .([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> In ICH, it is not useful to use elastic compression stockings.([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 109: / Line 110: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Assessment of bladder function in acutely hospitalized stroke patients is recommended. A history of urological issues before stroke should be obtained. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Assessment of urinary retention through bladder scanning or intermittent catheterizations after voiding while recording volumes is recommended for patients
-|-
+with urinary incontinence or retention. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )''
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
+|<nowiki>"</nowiki>Removal of the Foley catheter (if any) within 24 hours after admission for acute stroke is recommended.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )''
 |}
 {|class="wikitable" style="width:80%"
@@ Line 120: / Line 121: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Assessment of cognitive awareness of need to void or having voided is reasonable.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is reasonable to use the following treatment interventions to improve bladder incontinence in stroke patients:
+a) Prompted voiding
+b) Pelvic floor muscle training (after discharge home.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 129: / Line 133: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It may be reasonable to assess prior bowel function in acutely hospitalized stroke patients and include the following.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]])'' <nowiki>"</nowiki>
+a) Stool consistency, frequency, and timing (before stroke)
+b) Bowel care practices before stroke
 |-
 |}
 ===Assessment, Prevention, and Treatment of Hemiplegic Shoulder Pain===
+{|class="wikitable" style="width:80%"
+|-
+|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class Ia]]
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Patient and family education (ie, range of motion, positioning) is recommended for shoulder pain and shoulder care after stroke, particularly before discharge or transitions in care.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]])'' <nowiki>"</nowiki>
+|-
+|}
 {|class="wikitable" style="width:80%"
 |-
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Botulinum toxin injection can be useful to reduce severe hypertonicity in hemiplegic shoulder muscles.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> A trial of neuromodulating pain medications is reasonable for patients with hemiplegic shoulder pain who have clinical signs and symptoms of neuropathic pain manifested as sensory change in the shoulder region, allodynia, or hyperpathia.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]])'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> It is reasonable to consider positioning and use of supportive devices and slings for shoulder subluxation.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> A clinical assessment can be useful, including:
+a) Musculoskeletal evaluation
+b) Evaluation of spasticity
+c) Identification of any subluxation
+d) Testing for regional sensory changes.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 150: / Line 171: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> NMES may be considered (surface or intramuscular) for shoulder pain.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Ultrasound may be considered as a diagnostic tool for shoulder soft tissue injury.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Usefulness of acupuncture as an adjuvant treatment for hemiplegic shoulder pain is of uncertain value.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Usefulness of subacromial or glenohumeral corticosteroid injection for patients with inflammation in these locations is not well established.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> Suprascapular nerve block may be considered as an adjunctive treatment for hemiplegic shoulder pain.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki> Surgical tenotomy of pectoralis major, lattisimus dorsi, teres major, or subscapularis may be considered for patients with severe hemiplegia and restrictions in shoulder range of motion.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 167: / Line 188: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> The use of overhead pulley exercises is not recommended''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
 ===Central Pain After Stroke===
 {|class="wikitable" style="width:80%"
@@ Line 175: / Line 197: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> The diagnosis of central poststroke pain should be based on established diagnostic criteria afterother causes of pain have been excluded. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> The choice of pharmacological agent for the treatment of central poststroke pain should be individualized to the patient’s needs and response to therapy and any side effects. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |}
 {|class="wikitable" style="width:80%"
@@ Line 183: / Line 205: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> TENS has not been established as an effective treatment''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Deep brain stimulation has not been established as an effective treatment''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 192: / Line 214: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''" Amitriptyline and lamotrigine are reasonable first-line pharmacological treatments.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.'''" Interprofessional pain management is probably useful in conjunction with pharmacotherapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )''"
 |-
 |}
@@ Line 201: / Line 223: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''"  Motor cortex stimulation might be reasonable for the treatment of intractable central poststroke pain that is not responsive to other treatments in carefully selected patients.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Standardized measures may be useful to monitor response to treatment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Pregabalin, gabapentin, carbamazepine, or phenytoin may be considered as second-line treatments..''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 213: / Line 235: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is recommended that individuals with stroke discharged to the community participate in exercise programs with balance training to reduce falls. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is recommended that individuals with stroke be provided a formal fall prevention program during hospitalization''.([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 222: / Line 244: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is reasonable that individuals with stroke be evaluated for fall risk annually with an established instrument appropriate to the setting.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is reasonable that individuals with stroke and their caregivers receive information targeted to home and environmental modifications designed to reduce falls.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 231: / Line 253: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Tai Chi training may be reasonable for fall prevention.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |}
 ===Seizures===
@@ Line 238: / Line 260: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Any patient who develops a seizure should be treated with standard management approaches, including a search for reversible causes of seizure in addition to potential use of antiepileptic drugs''.([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 245: / Line 267: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Routine seizure prophylaxis for patients with ischemic or hemorrhagic stroke is not recommended.''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 253: / Line 275: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Administration of a structured depression inventory such as the Patient Health Questionnaire-2 is recommended to routinely screen for poststroke depression.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>Patient education about stroke is recommended. Patients should be provided with information, advice, and the opportunity to talk about the impact of the illness on their lives''.([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Patients diagnosed with poststroke depression should be treated with antidepressants in the absence of contraindications and closely monitored to verify effectiveness.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
-{|class="wikitable" style="width:80%"
-|-
-|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
-|-
 {|class="wikitable" style="width:80%"
 |-
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> A therapeutic trial of an SSRI or dextromethorphan/quinidine is reasonable for patients with emotional lability or pseudobulbar affect causing emotional distress.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Periodic reassessment of depression, anxiety, and other psychiatric symptoms may be useful in the care of stroke survivors..''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Consultation by a qualified psychiatrist or psychologist for stroke survivors with mood disorders causing persistent distress or worsening disability can be useful.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
 {|class="wikitable" style="width:80%"
 |-
-|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
+|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> The usefulness of routine use of prophylactic antidepressant medications is unclear.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Combining pharmacological and nonpharmacological treatments of poststroke depression may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> The efficacy of individual psychotherapy alone in the treatment of poststroke depression is unclear.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Patient education, counseling, and social support may be considered as components of treatment for poststroke depression.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> An exercise program of at least 4 weeks duration may be considered as a complementary treatment for poststrok depression.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki> Early effective treatment of depression may have a positive effect on the rehabilitation outcome.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 296: / Line 314: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> No recommendation for the use of any particular class of antidepressants is made. SSRIs are commonly used and generally well tolerated in this patient population''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
 ===Poststroke Osteoporosis===
 {|class="wikitable" style="width:80%"
@@ Line 304: / Line 323: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is recommended that individuals with stroke residing in long-term care facilities be evaluated for calcium and vitamin D supplementation''.([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Defining TIA with a 24-hour maximum duration has the potential to delay the initiation of effective stroke therapies''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is recommended that US Preventive Services Task Force osteoporosis screening recommendations be followed in women with stroke. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 313: / Line 332: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Increased levels of physical activity are probably indicated to reduce the risk and severity of poststroke osteoporosis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 321: / Line 340: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is recommended that all individuals with stroke be provided a formal assessment of their ADLs and IADLs, communication abilities, and functional mobility before discharge from acute care hospitalization and the findings be incorporated into the care transition and the discharge planning process.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is recommended that all individuals with stroke discharged to independent community living from postacute rehabilitation or SNFs receive ADL and IADL assessment directly related to their discharge living setting. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> A functional assessment by a clinician with expertise in rehabilitation is recommended for patients with an acute stroke with residual functional deficits. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Determination of postacute rehabilitation needs should be based on assessments of residual neurological deficits; activity limitations; cognitive, communicative, and psychological status; swallowing ability; determination of previous functional ability and medical comorbidities; level of family/caregiver support; capacity of family/ caregiver to meet the care needs of the stroke survivor; likelihood of returning to community living; and ability to participate in rehabilitation. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 334: / Line 353: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is reasonable that individuals with stroke discharged from acute and postacute hospitals/centers receive formal follow-up on their ADL and IADL status, communication abilities, and functional mobility within 30 days of discharge.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> The routine administration of standardized measures can be useful to document the severity of stroke and resulting disability, starting in the acute phase and progressing over the course of recovery and rehabilitation.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 343: / Line 362: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> A standardized measure of balance and gait speed (for those who can walk) may be considered for planning postacute rehabilitation care and for safety counseling with the patient and family.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 349: / Line 368: @@
 {|class="wikitable" style="width:80%"
 |-
-|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
+|colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Motor impairment assessments (paresis/muscle strength, tone, individuated finger movements, coordination) with standardized tools may be useful.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Upper extremity activity/function assessment with a standardized tool may be useful.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Balance assessment with a standardized tool may be useful.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Mobility assessment with a standardized tool may be useful.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> The use of standardized questionnaires to assess stroke survivor perception of motor impairments, activity limitations, and participation may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki> The use of technology (accelerometers, stepactivity monitors, pedometers) as an objective means of assessing real-world activity and participation may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.'''<nowiki>"</nowiki> Periodic assessments with the same standardized tools to document progress in rehabilitation may be useful.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 371: / Line 390: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Communication assessment should consist of interview, conversation, observation, standardized tests, or nonstandardized items; assess speech, language, cognitive communication, pragmatics, reading, and writing; identify communicative strengths and weaknesses; and identify helpful compensatory strategies. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 378: / Line 397: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Telerehabilitation is reasonable when face-to face assessment is impossible or impractical.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 385: / Line 404: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Communication assessment may consider the individual’s unique priorities using the ICF framework, including quality of life.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 393: / Line 412: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Screening for cognitive deficits is recommended for all stroke patients before discharge home. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 400: / Line 419: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> When screening reveals cognitive deficits, a more detailed neuropsychological evaluation to identify areas of cognitive strength and weakness may be beneficial.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 408: / Line 427: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Evaluation of stroke patients for sensory impairments, including touch, vision, and hearing, is probably indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 416: / Line 435: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Early dysphagia screening is recommended for acute stroke patients to identify dysphagia or aspiration, which can lead to pneumonia, malnutrition, dehydration, and other complications. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Assessment of swallowing before the patient begins eating, drinking, or receiving oral medications is recommended. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Oral hygiene protocols should be implemented to reduce the risk of aspiration pneumonia after stroke. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Enteral feedings (tube feedings) should be initiated within 7 days after stroke for patients who cannot safely swallow. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> Nasogastric tube feeding should be used for short term (2–3 weeks) nutritional support for patients who cannot swallow safely. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki> Percutaneous gastrostomy tubes should be placed in patients with chronic inability to swallow safely. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 433: / Line 452: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Dysphagia screening is reasonable by a speech-language pathologist or other trained healthcare provider.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> An instrumental evaluation is probably indicated for those patients suspected of aspiration to verify the presence/absence of aspiration and to determine the physiological reasons for the dysphagia to guide the treatment plan.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Nutritional supplements are reasonable to consider for patients who are malnourished or at risk of malnourishment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Incorporating principles of neuroplasticity into dysphagia rehabilitation strategies/interventions is reasonable.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 446: / Line 465: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Selection of instrumental study (fiberoptic endoscopic evaluation of swallowing, videofluoroscopy, fiberoptic endoscopic evaluation of swallowing with sensory
+testing) may be based on availability or other considerations.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Behavioral interventions may be considered as a component of dysphagia treatment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Acupuncture may be considered as a adjunctive treatment for dysphagia.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 457: / Line 477: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Drug therapy, NMES, pharyngeal electrical stimulation, physical stimulation, tDCS, and transcranial magnetic stimulation are of uncertain benefit and not currently recommended.  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 465: / Line 485: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>Enriched environments to increase engagement with cognitive activities are recommended. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 472: / Line 492: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>  Use of cognitive rehabilitation to improve attention, memory, visual neglect, and executive functioning is reasonable.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Use of cognitive training strategies that consider practice, compensation, and adaptive techniques for increasing independence is reasonable.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 481: / Line 501: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''" Virtual reality training may be considered for verbal, visual, and spatial learning, but its efficacy is not well established.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+|-
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Exercise may be considered as adjunctive therapy to improve cognition and memory after stroke.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+|-
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Compensatory strategies may be considered to improve memory functions, including the use of internalized strategies (eg, visual imagery, semantic organization, spaced practice) and external memory assistive technology (eg, notebooks, paging systems, computers, other prompting devices).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+|-
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Some type of specific memory training is reasonable such as promoting global processing in visual-spatial memory and constructing a semantic framework for
+language-based memory.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> Errorless learning techniques may be effective for individuals with severe memory impairments for learning specific skills or knowledge, although there is limited transfer to novel tasks or reduction in overall functional memory problems.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki> Music therapy may be reasonable for improving verbal memory.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+|}
+{|class="wikitable" style="width:80%"
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Anodal tDCS over the left dorsolateral prefrontal cortex to improve language-based complex attention (working memory) remains experimental.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
 ===Use of Drugs to Improve Cognitive Impairments, Including Attention===
 {|class="wikitable" style="width:80%"
@@ Line 499: / Line 528: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> The usefulness of donepezil in the treatment of poststroke cognitive deficits is not well established.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> The usefulness of rivastigmine in the treatment of poststroke cognitive deficits is not well established.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> The usefulness of antidepressants in the treatment of poststroke cognitive deficits is not well established.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> The usefulness of dextroamphetamine, methylphenidate, modafinil, and atomoxetine in the treatment of poststroke cognitive deficits is unclear.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 513: / Line 542: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Strategy training or gesture training for apraxia may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Task practice for apraxia with and without mental rehearsal may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 523: / Line 552: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is reasonable to provide repeated top-down and bottom-up interventions such as prism adaptation, visual scanning training, optokinetic stimulation, virtual reality, limb activation, mental imagery, and neck vibration combined with prism adaptation to improve neglect symptoms.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 530: / Line 559: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Right visual field testing may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Repetitive transcranial magnetic stimulation of various forms may be considered to ameliorate neglect symptoms.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 540: / Line 569: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Interventions for cognitive-communication disorders are reasonable to consider if they are individually tailored and target:
+''a)'' The overt communication deficit affecting prosody, comprehension, expression of discourse, and pragmatics.
+''b)'' The cognitive deficits that accompany or underlie the communication deficit, including attention, memory, and executive functions''.([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 548: / Line 580: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Speech and language therapy is recommended for individuals with aphasia. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Speech and language therapy is recommended for individuals with aphasia. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 557: / Line 589: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Intensive treatment is probably indicated, but there is no definitive agreement on the optimum amount, timing, intensity, distribution, or duration of treatment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 564: / Line 596: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Computerized treatment may be considered to supplement treatment provided by a speech language pathologist.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> A variety of different treatment approaches for aphasia may be useful, but their relative effectiveness is not known.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Group treatment may be useful across the continuum of care, including the use of community-based aphasia groups.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Pharmacotherapy for aphasia may be considered on a case-by-case basis in conjunction with speech and language therapy, but no specific regimen is recommended for routine use at this time.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 577: / Line 609: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Brain stimulation techniques as adjuncts to behavioral speech and language therapy are considered experimental and therefore are not currently recommended for routine use''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 585: / Line 617: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Interventions for motor speech disorders should be individually tailored and can include behavioral techniques and strategies that target:
+''a)'' Physiological support for speech, including respiration, phonation, articulation, and resonance.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+b) Global aspects of speech production such as loudness, rate, and prosody.
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Augmentative and alternative communication devices and modalities should be used to supplement speech. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 594: / Line 629: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Telerehabilitation may be useful when face-to face treatment is impossible or impractical.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 601: / Line 636: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Environmental modifications, including listener education, may be considered to improve communication effectiveness.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Activities to facilitate social participation and promote psychosocial well-being may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 611: / Line 646: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Targeted injection of botulinum toxin into localized upper limb muscles is recommended to reduce spasticity, to improve passive or active range of motion, and to improve dressing, hygiene, and limb positioning. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Targeted injection of botulinum toxin into lower limb muscles is recommended to reduce spasticity that interferes with gait function. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 620: / Line 655: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Oral antispasticity agents can be useful for generalized spastic dystonia but may result in dose-limiting sedation or other side effects.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 627: / Line 662: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Physical modalities such as NMES or vibration applied to spastic muscles may be reasonable to improve spasticity temporarily as an adjunct to rehabilitation therapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Intrathecal baclofen therapy may be useful for severe spastic hypertonia that does not respond to other interventions.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Postural training and task-oriented therapy may be considered for rehabilitation of ataxia.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
-|-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 640: / Line 673: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>  The use of splints and taping are not recommended for prevention of wrist and finger spasticity after stroke.''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 648: / Line 681: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Individuals with stroke who have poor balance, low balance confidence, and fear of falls or are at risk for falls should be provided with a balance training program. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Individuals with stroke should be prescribed and fit with an assistive device or orthosis if appropriate to improve balance. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Individuals with stroke should be evaluated for balance, balance confidence, and fall risk. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 659: / Line 692: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Postural training and task-oriented therapy may be considered for rehabilitation of ataxia.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 667: / Line 700: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Intensive, repetitive, mobility- task training is recommended for all individuals with gait limitations after stroke. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> An AFO after stroke is recommended in individuals with remediable gait impairments (eg, foot drop) to compensate for foot drop and to improve mobility and paretic ankle and knee kinematics, kinetics, and energy cost of walking. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 676: / Line 709: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Group therapy with circuit training is a reasonable approach to improve walking.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Incorporating cardiovascular exercise and strengthening interventions is reasonable to consider for recovery of gait capacity and gait related mobility tasks.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> NMES is reasonable to consider as an alternative to an AFO for foot drop.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 687: / Line 720: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> The effectiveness of TENS in conjunction with everyday activities for improving mobility, lower extremity strength, and gait speed is uncertain.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> The effectiveness of rhythmic auditory cueing to improve walking speed and coordination is uncertain.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> The usefulness of electromyography biofeedback during gait training in patients after stroke is uncertain.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Virtual reality may be beneficial for the improvement of gait.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> The effectiveness of neurophysiological approaches (ie, neurodevelopmental therapy, proprioceptive neuromuscular facilitation) compared with other treatment approaches for motor retraining after an acute stroke has not been established.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki> The effectiveness of water-based exercise for motor recovery after an acute stroke is unclear.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.'''<nowiki>"</nowiki> The effectiveness of fluoxetine or other SSRIs to enhance motor recovery is not well established.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''8.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''8.'''<nowiki>"</nowiki> The effectiveness of levodopa to enhance motor recovery is not well established.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''9.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''9.'''<nowiki>"</nowiki> Practice walking with either a treadmill (with or without body-weight support) or overground walking exercise training combined with conventional rehabilitation may be reasonable for recovery of walking function.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''10.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''10.'''<nowiki>"</nowiki> Robot-assisted movement training to improve motor function and mobility after stroke in combination with conventional therapy may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''11.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''11.'''<nowiki>"</nowiki> Mechanically assisted walking (treadmill, electromechanical gait trainer, robotic device, servo-motor) with body weight support may be considered for patients who are nonambulatory or have low ambulatory ability early after stroke.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''12.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''12.'''<nowiki>"</nowiki> There is insufficient evidence to recommend acupuncture for facilitating motor recovery and walking mobility.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 716: / Line 749: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> The use of dextroamphetamine or methylphenidate to facilitate motor recovery is not recommended ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 724: / Line 757: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Functional tasks should be practiced; that is, task-specific training, in which the tasks are graded to challenge individual capabilities, practiced repeatedly, and progressed in difficulty on a frequent basis. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> All individuals with stroke should receive ADL training tailored to individual needs and eventual discharge setting. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> All individuals with stroke should receive IADL training tailored to individual needs and eventual discharge setting. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 735: / Line 768: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> CIMT or its modified version is reasonable to consider for eligible stroke survivors.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Robotic therapy is reasonable to consider to deliver more intensive practice for individuals with moderate to severe upper limb paresis.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> NMES is reasonable to consider for individuals with minimal volitional movement within the first few months after stroke or for individuals with shoulder subluxation.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Mental practice is reasonable to consider as an adjunct to upper extremity rehabilitation services.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> Strengthening exercises are reasonable to consider as an adjunct to functional task practice.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki> Virtual reality is reasonable to consider as a method for delivering upper extremity movement practice.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 752: / Line 785: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Somatosensory retraining to improve sensory discrimination may be considered for stroke survivors with somatosensory loss.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Bilateral training paradigms may be useful for upper limb therapy.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 761: / Line 794: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Acupuncture is not recommended for the improvement of ADLs and upper extremity activity''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 769: / Line 802: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Ambulatory assistive devices (eg, cane, walker) should be used to help with gait and balance impairments, as well as mobility efficiency and safety, when needed. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> AFOs should be used for ankle instability or dorsiflexor weakness. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> Wheelchairs should be used for nonambulatory individuals or those with limited walking ability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Adaptive and assistive devices should be used for safety and function if other methods of performing the task/activity are not available or cannot be learned or if the patient’s safety is a concern. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 783: / Line 816: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> After successful screening, an individually tailored exercise program is indicated to enhance cardiorespiratory fitness and to reduce the risk of stroke
+recurrence. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> After completion of formal stroke rehabilitation, participation in a program of exercise or physical activity at home or in the community is recommended ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 793: / Line 827: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Multimodal audiovisual spatial exploration training appears to be more effective than visual spatial exploration training alone and is recommended to improve visual scanning. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''The use of behavioral optometry approaches involving eye exercises and the use of lenses and colored filters to improve eye movement control, eye focusing, and eye coordination is not recommended.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )''
 |-
 |}
@@ Line 800: / Line 836: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> There is insufficient evidence to support or refute any specific intervention as effective at reducing the impact of impaired perceptual functioning..''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> The use of virtual reality environments to improve visual-spatial/perceptual functioning may be considered.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> The use of behavioral optometry approaches involving eye exercises and the use of lenses and colored filters to improve eye movement control, eye focusing, and eye coordination is not recommended.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> Compensatory scanning training may be considered for improving functional ADLs.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> Compensatory scanning training may be considered for improving scanning and reading outcomes.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.'''<nowiki>"</nowiki> Yoked prisms may be useful to help patients compensate for visual field cuts.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''7.'''<nowiki>"</nowiki> Compensatory scanning training may be considered for improving functional deficits after visual field loss but is not effective at reducing visual field deficits.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+|-
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''8.'''<nowiki>"</nowiki>Computerized vision restoration training may be considered to expand visual fields, but evidence of its usefulness is lacking.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]])''
 |-
 |}
@@ Line 819: / Line 857: @@
 |colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 |-
-| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> The use of behavioral optometry approaches involving eye exercises and the use of lenses and colored filters to improve eye movement control, eye focusing, and eye coordination is not recommended. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
 ===Hearing Loss===
 {|class="wikitable" style="width:80%"
@@ Line 827: / Line 866: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> If a patient is suspected of a hearing impairment, it is reasonable to refer to an audiologist for audiometric testing.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is reasonable to use some form of amplification (eg, hearing aids).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> It is reasonable to use communication strategies such as looking at the patient when speaking.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> It is reasonable to minimize the level of background noise in the patient’s environment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 841: / Line 880: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is reasonable to consider individualized discharge planning in the transition from hospital to home.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is reasonable to consider alternative methods of communication and support (eg, telephone visits, telehealth, or Web-based support), particularly for patients in rural settings.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 851: / Line 890: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It may be useful for the family/caregiver to be an integral component of stroke rehabilitation.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It may be reasonable that family/caregiver support include some or all of the following on a regular basis:
+a) Education
+b) Training
+c) Counseling
+d) Development of a support structure
+e) Financial assistance''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> It may be useful to have the family/caregiver involved in decision making and treatment planning as early as possible and throughout the duration of the rehabilitation process.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 863: / Line 911: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is recommended that acute care hospitals and rehabilitation facilities maintain up-to-date inventories of community resources. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> Patient and family/caregiver preferences for resources should be considered. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> It is recommended that information about local resources be provided to the patient and family. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''<nowiki>"</nowiki> It is recommended that contact with community resources be offered through formal or informal referral. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.'''<nowiki>"</nowiki> Follow-up is recommended to ensure that the patient and family receive the necessary services. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 879: / Line 927: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Patients with stroke receiving comprehensive ADL, IADL, and mobility assessments, including evaluation of the discharge living setting, should be considered candidates for communityor home-based rehabilitation when feasible. Exclusions include individuals with stroke who require daily nursing services, regular medical interventions, specialized equipment, or interprofessional expertise. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:A]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 886: / Line 934: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is reasonable that caregivers, including family members, be involved in training and education related directly to home-based rehabilitation programs and be included as active partners in the planning and implementation or treatment activities under the supervision of professionals.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 893: / Line 941: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> A formal plan for monitoring compliance and participation in treatment activities may be useful for individuals with stroke referred for home- or community-based rehabilitation services. A case manager or professional staff person should be assigned to oversee implementation of the plan.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 901: / Line 949: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> An offer to patients and their partners to discuss sexual issues may be useful before discharge home and again after transition to the community. Discussion topics may include safety concerns, changes in libido, physical limitations resulting from stroke, and emotional consequences of stroke.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 909: / Line 957: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is reasonable to promote engagement in leisure and recreational pursuits, particularly through the provision of information on the importance of maintaining an active and healthy lifestyle.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is reasonable to foster the development of self-management skills for problem solving for overcoming barriers to engagement in active activities.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''<nowiki>"</nowiki> It is reasonable to start education and selfmanagement skill development about leisure/recreation activities during and in conjunction with in-patient rehabilitation.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 921: / Line 969: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Vocationally targeted therapy or vocational rehabilitation is reasonable for individuals with stroke considering a return to work.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 928: / Line 976: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> An assessment of cognitive, perception, physical, and motor abilities may be considered for stroke survivors considering a return to work.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 936: / Line 984: @@
 |colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 |-
-| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> Individuals who appear to be ready to return to driving, as demonstrated by successful performance on fitness-to-drive tests, should have an on-the-road test administered by an authorized person. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 943: / Line 991: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> It is reasonable that individuals be assessed for cognitive, perception, physical, and motor abilities to ascertain readiness to return to driving according to safety and local laws.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''<nowiki>"</nowiki> It is reasonable that individuals who do not pass an on-the-road driving test be referred to a driver rehabilitation program for training.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 952: / Line 1,000: @@
 |colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
 |-
-| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki>.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
+| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''<nowiki>"</nowiki> A driving simulation assessment may be considered for predicting fitness to drive.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]] )'' <nowiki>"</nowiki>
 |-
 |}
@@ Line 960: / Line 1,008: @@
 {{WH}}
-{{WS}}
+{{WS}}|}

Guidelines for Adult Stroke Rehabilitation and Recovery: Difference between revisions

Latest revision as of 17:46, 13 December 2016

Guidelines for Adult Stroke Rehabilitation and Recovery[1]

Organization of Poststroke Rehabilitation Care[1]

Interventions in the Inpatient Hospital Setting

Prevention of Skin Breakdown and Contractures

Prevention of DVT

Treatment of Bowel and Bladder Incontinence

Assessment, Prevention, and Treatment of Hemiplegic Shoulder Pain

Central Pain After Stroke

Prevention of Falls

Seizures

Poststroke Depression, Including Emotional and Behavioral State

Poststroke Osteoporosis

Assessment of Disability and Rehabilitation Needs

Assessment of Motor Impairment, Activity, and Mobility

Assessment of Communication Impairment

Assessment of Cognition and Memory

Sensory Impairments, Including Touch, Vision, and Hearing

Dysphagia Screening, Management, and Nutritional Support

Nondrug Therapies for Cognitive Impairment, Including Memory

Use of Drugs to Improve Cognitive Impairments, Including Attention

Limb Apraxia

Hemispatial Neglect or Hemi-Inattention

Cognitive Communication Disorders

Aphasia

Motor Speech Disorders:Dysarthria and Apraxia of Speech

Spasticity

Balance and Ataxia

Mobility

Upper Extremity Activity, Including ADLs, IADLs, Touch, and Proprioception

Adaptive Equipment, Durable Medical Devices, Orthotics, and Wheelchairs

Chronic Care Management: Home- and Community-Based Participation

Treatments/Interventions for Visual Impairments

Hearing Loss

Ensuring Medical and Rehabilitation Continuity Through the Rehabilitation Process and Into the Community

Social and Family Caregiver Support

Referral to Community Resources

Rehabilitation in the Community

Sexual Function

Recreational and Leisure Activity

Return to Work

Return to Driving

References

Navigation menu

Guidelines for Adult Stroke Rehabilitation and Recovery^[1]

Organization of Poststroke Rehabilitation Care^[1]