The Stroke Foundation is updating its Clinical Guidelines for Stroke Management and is seeking feedback on draft recommendations in areas such as pre-hospital care, stroke telehealth services and rehabilitation.

The guidelines include new and revised recommendations in areas such as acute management, with a draft recommendation on head position stating that patients with acute stroke, while in bed and not receiving nasogastric feeding, may be managed in any position during the first 24 hours after hospital admission.

For telehealth the Foundation is seeking public consultation that in hospitals without onsite 24/7 stroke medical specialist availability, telestroke systems should be used to assist in patient assessment and decision making regarding acute thrombolytic therapy and possible transfer for endovascular therapy.

“This system should include the ability for stroke medical specialists to access remote brain imaging scans and preferably include the use of videoconferencing facilities or, if not possible, ensure the diagnosis and management discussions between local clinicians/family/patient occurs via a telephone consultation,” it states

Another draft recommendation states that for patients with ischaemic stroke due to atrial fibrillation and a genuine contraindication to long-term anticoagulation, percutaneous left atrial appendage occlusion may be a reasonable treatment to reduce recurrent stroke risk.

The revised guidelines also cover areas such as rehabilitation, with a draft recommendation that cognitive rehabilitation may be used in stroke survivors to improve memory function in the short term.

There are also new recommendations on the use of virtual reality and interactive games in rehabilitation) and the use of passive mobilisation in managing complications such as swelling of the extremities).

In February 2021 the guidelines for acute antiplatelet therapy were updated to advise that, ticagrelor in combination with aspirin could be considered soon after a minor ischaemic stroke or high-risk transient ischaemic attack, to prevent another stroke.

Other new and updated recommendations included more specific targets and thresholds for blood oxygen levels and a new target set for lowering LDL cholesterol to prevent further strokes and cardiovascular disease.

In the guidelines chapter on weakness, the Stroke Foundation has added new evidence for recovery of muscle strength with progressive resistance training, and a new recommendation for certain types of repetitive practice.

For shoulder pain, the guidelines were updated to advise that electrical stimulation may be used for pain management, and acupuncture may also be used to reduce pain.

The draft guidelines are available to view electronically on the MAGICapp platform. Submission on the revisions can be made until 30 July 2021, and they will be submitted to the NHMRC for approval.

For additional information see Living guidelines updates.