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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(04): s00451806924
DOI: 10.1055/s-0045-1806924
Brazilian Academy of Neurology

A physiotherapy protocol* for stroke patients in acute hospital settings: expert consensus from the Brazilian early stroke rehabilitation task force

Iara Maso 
1   Hospital Geral Roberto Santos, Unidade de AVC, Salvador BA, Brazil.
2   Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa Comportamento Motor e Reabilitação Neurofuncional, Salvador BA, Brazil.
,
Gustavo José Luvizutto 
3   Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil.
,
Jéssica Mariana de Aquino Miranda 
3   Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil.
,
Carla Ferreira do Nascimento 
1   Hospital Geral Roberto Santos, Unidade de AVC, Salvador BA, Brazil.
2   Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa Comportamento Motor e Reabilitação Neurofuncional, Salvador BA, Brazil.
,
Luana Aparecida Miranda Bonome 
4   Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil.
,
Elen Beatriz Pinto 
2   Escola Bahiana de Medicina e Saúde Pública, Grupo de Pesquisa Comportamento Motor e Reabilitação Neurofuncional, Salvador BA, Brazil.
,
Fabiane Maria Klitzke 
5   Hospital Municipal São José, Programa de Residência Multiprofissional em Neurologia, Joinville SC, Brazil.
,
Ricardo Machado Souza 
6   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Unidade de AVC, Ribeirão Preto SP, Brazil.
,
Carla Heloisa Cabral Moro 
7   Hospital São José, Unidade de AVC, Joinville SC, Brazil.
,
Rodrigo Bazan 
4   Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil.
,
Pedro Antonio Pereira de Jesus 
1   Hospital Geral Roberto Santos, Unidade de AVC, Salvador BA, Brazil.
8   Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador BA, Brazil.
,
Eduardo de Melo Carvalho Rocha 
9   Santa Casa de São Paulo, Faculdade de Ciências Médicas, São Paulo SP, Brazil.
,
Cesar Minelli 
10   Hospital Carlos Fernando Malzoni, Matão SP, Brazil.
11   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Programa de Pós-Graduação do Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
,
Sheila Ouriques Martins 
12   Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
13   Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil.
14   Rede Brasil AVC, Porto Alegre RS, Brazil.
15   World Stroke Organization, Geneva, Switzerland.
,
Jussara Almeida de Oliveira Baggio 
16   Universidade Federal de Alagoas, Curso de Medicina, Arapiraca AL, Brazil.
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Abstract

The present protocol provides general recommendations based on the best evidence currently available for physiotherapists to use as a guide for the care of stroke patients during hospitalization. The Brazilian Early Stroke Rehabilitation Task Force, comprising physical therapy experts and researchers from different Brazilian states, was organized to develop this care protocol based on a bibliographical survey, including meta-analyses, systematic reviews, clinical trials, and other more recent and relevant scientific publications. Professionals working in stroke units were also included in the task force to ensure the practicality of the protocol in different contexts. This protocol provides guidance on assessment strategies, safety criteria for the mobilization of patients with stroke, recommendations for mobilization and proper positioning, as well as evidence-based practices for treatment during hospitalization, including preventive measures for shoulder pain and shoulder-hand syndrome. The protocol also provides information on the organization of the physiotherapy service at stroke units, guidelines for hospital discharge, and quality indicators for physiotherapy services. We have included detailed activities that can be performed during mobilization in the supplementary material, such as postural control training, sensory and perceptual stimulation, task-oriented training, and activities involving an enriched environment. The protocol was written in a user-friendly format to facilitate its application in different social and cultural contexts, utilizing resources readily available in most clinical settings.

Keywords

Stroke - Stroke Rehabilitation - Physical Therapy Modalities - Early Ambulation

Authors' Contributions

IM, GJL, JMAM, CFN, LAMB, EBP, FMK, RMS, PAPJ, JAOB: conceptualization, writing, review, editing, and validation of the original draft. CHCM, RB: conceptualization of the original draft and participation as reviewer. EMCR, CM, SOM: participation as reviewers. All authors reviewed and approved the final version of the manuscript.


Editor-in-Chief: Ayrton Roberto Massaro.


Associate Editor: Chien Hsin Fen.


*This protocol has been endorsed by the Brazilian Academy of Neurology and the Brazilian Association of Neurofunctional Physiotherapy.




Publication History

Received: 03 April 2024

Accepted: 03 February 2025

Article published online:
22 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Iara Maso, Gustavo José Luvizutto, Jéssica Mariana de Aquino Miranda, Carla Ferreira do Nascimento, Luana Aparecida Miranda Bonome, Elen Beatriz Pinto, Fabiane Maria Klitzke, Ricardo Machado Souza, Carla Heloisa Cabral Moro, Rodrigo Bazan, Pedro Antonio Pereira de Jesus, Eduardo de Melo Carvalho Rocha, Cesar Minelli, Sheila Ouriques Martins, Jussara Almeida de Oliveira Baggio. A physiotherapy protocol* for stroke patients in acute hospital settings: expert consensus from the Brazilian early stroke rehabilitation task force. Arq Neuropsiquiatr 2025; 83: s00451806924.
DOI: 10.1055/s-0045-1806924
 

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