Wednesday, September 07, 2011 Guidelines Call for Early Physical Therapy in Patients With Stroke Primary stroke centers (PSCs) should develop early patient assessment and initiation of any needed physical therapy, occupational therapy, and speech therapy, say revised recommendations released by the Brain Attack Coalition on the essential elements necessary to properly care for patients with acute stroke in PSCs. The recommendations are based on extensive literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references, meta-analyses, and other care guidelines also were reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Other key clinical recommendations address forming acute stroke teams; having telemetry systems for monitoring blood pressure, pulse, and oxygenation, in addition to establishing protocol for who and when to call in the case of clinical deterioration; and making neurosurgical services available within 2 hours of the time they are deemed clinically necessary. Imaging is a major focus of the new document. BAC makes specific suggestions for cardiac imaging and scans of the brain's vascular system. "This is a way of just moving the bar up a little bit, and saying this, in 2011, is really what the requirements are, what the standard of care is or should be, in terms of diagnosing, managing, and treating acute stroke," lead author Mark J. Alberts, MD, told Medscape Medical News. A summary of the recommendations is available at this link.