Stroke and Cardiac Rehabilitation

Table of Contents

Preface, Disclaimers – please review

Table of Contents

Quotes

Stroke rehabilitation

Introduction

Key components of a rehabilitation program

Goals for rehabilitation services

Initial assessment and stabilization

Inpatient rehabilitation 

Criteria for inpatient rehabilitation

Initiation of rehabilitation services

Rehabilitation referral criteria – decision tree

Speech therapy

Continued stay review

Home-based rehabilitation vs. day hospital rehabilitation stroke programs

Durable Medical Equipment needs

Coverage issues

Rehabilitation unit discharge criteria

Course of recovery and therapy following a stroke

Potential common complications secondary to neurologic deficits

Outcome evaluations

Depression

Post-stroke rehabilitation screening checklist

Medications affecting progress in stroke rehabilitation

Stroke rehabilitation algorithms

Standard instruments for patient assessment following a stroke

Constraint induced movement therapy 

Stroke Prevention - Primary and Secondary

Potential common complications secondary to neurologic deficits

Notes

  Cardiac rehabilitation

Cardiac rehabilitation program guidelines

Home Program

Case Management

Initial evaluation

Exercise testing

Exercise prescription

Risk definitions

Phases of cardiac rehabilitation

Exit criteria

Canadian Cardiovascular Society Classification of angina by effort

Cardiac Rehabilitation – Medicare policy

Notes

Coronary Artery Disease and Stroke – Preventive Health Care

·         Introduction

·         Risk factors, major and minor

·         The Metabolic Syndrome

·         Homocysteine

·         Protective factors and risk reduction strategies

·         Risk reduction strategies summary table

·         Management of hypercholesterolemia

·         Nutritional management of hypercholesterolemia

·         Hypolipemic drug therapy

·         Hypolipemic drug therapy, estrogen replacement therapy

·         Laboratory monitoring of therapy

·         Notes

References and Resources – Preventive Health Care for CAD & Stroke

References

Acronyms

Patient version of the guideline - A coronary artery disease prevention program for you and your family

Soy protein content of soy foods

Nutritional components of fish, shell fish

Web Sites

  Resources

·         Glossary of National Associations for Health Care related to stroke and CAD

·         OBRA Regulations

·         Case Mix Prospective Payment System (PPS) for Hospitals and SNFs

·         Rehabilitation Acronyms and Abbreviations

·         Types of facilities defined

  References

-  Preventive physical fitness

-  Stroke rehabilitation

-  Carotid/Vertebral Artery Endarterectomy, Percutaneous Angioplasty, Stenting

-  Cardiac rehabilitation  

JCAHO Standardized Stroke Measure Set

  Rehabilitation, Cardiovascular and Stroke web sites  

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Guidelines are an expected part of medical practice in today’s society. However, guidelines cannot be blindly accepted or considered inviolate. If that were to be the case, they would cease to be guidelines and would become “standards” or even “mandates”. Guidelines and their application must be directed primarily toward the well-being of the patient. The term “cost-effectiveness” should refer to efficiency with regard to time, safety, and utilization of resources for patient care, and should NOT be used as a means to maximize profit or for any other purpose that does not have the patient as the primary concern.

Statement on the use of proprietary guidelines by managed care organizations.

American College of Surgeons Bull Am Coll Surg 33-4, March 1998

Guidelines can in no way encompass every diagnosis or treatment of all disease states, nor can they include the variations that occur in the complexity of the human response to disease processes, which includes co-morbid conditions. Where clear discrepancies of opinion exist, the licensed physician as the caretaker of the patient must be responsible for guiding the individual patient’s course leading to diagnosis and treatment.

Statement on the use of proprietary guidelines by managed care organizations.

American College of Surgeons Bull Am Coll Surg 33-4, March 1998

Guidelines should be formulated such that they cannot automatically be used as a basis for disciplinary action or litigation if the physician or surgeon determines that strict adherence to their provisions is not in the patient’s best interest. The guidelines should be flexible to permit variations for patient condition and circumstances and should provide options for these variations, including severity of illness and co-morbid conditions. The guidelines should be formulated to consider the totality of an episode of care. For example, discharge criteria must take into account the supportive resources that are available to the patient, such as convalescent care, home care, hospice care, family availability, and so on.

Statement on the use of proprietary guidelines by managed care organizations.

American College of Surgeons Bull Am Coll Surg 33-4, March 1998

Referral to the foregoing reference in its entirety is recommended reading.

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