Stroke rehab guidelines emphasize early support for physical, cognitive, and mental health

• Updated guidance suggests that stroke rehabilitation should begin as soon as a person is medically stable, ideally within 48 hours, although moderate- to high-intensity exercise should be avoided during the first 24 hours.
• Recovery plans should also address each person’s physical, cognitive, communication, and mental health needs, with care coordinated by a multidisciplinary team.
• Monitoring and treatment of mental health should also occur alongside rehab, as individuals work toward their highest possible level of independence.
• The guidelines also advise providing support for caregivers and helping individuals address challenges that may arise from changes in independence.

Stroke represents a major health concern in the United States, with nearly 800,000 people experiencing a stroke each year. It is also the country’s fourth-leading cause of death and a leading cause of serious, long-term disability.

Rehabilitation plays an important role in helping stroke survivors regain independence and optimize their recovery outcomes. Because a stroke can affect movement, communication, thinking, memory, and emotional health, recovery often requires more than physical therapy alone.

Now, new guidelines from the American Stroke Association emphasize that stroke rehabilitation should begin as soon as a patient is medically stable, ideally within 48 hours, and should address far more than physical recovery.

The 2026 Guideline for Adult Stroke Rehabilitation and Recovery, published in the American Heart Association’s peer-reviewed journal Stroke, calls for personalized rehabilitation plans that take into account physical, cognitive, communication, and mental health needs.

The guideline replaces recommendations issued in 2016 and reflects advances in stroke rehabilitation and recovery.

“This guideline expands or makes new recommendations in cognition, mental health, sleep, and post-stroke fatigue, recreation and leisure,” Lorie Richards, PhD, FAHA, who chaired the guideline writing group and is an associate professor at the University of Utah and a licensed occupational therapist, told Medical News Today.

“It updates recommendations in multiple other areas based on the evidence literature that was published between the last guideline and the current one,” she said.