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Comprehensive assessment of a patient’s cognitive and functional status conducted within the first few days following a stroke is essential to guide the development of individualized care plans. These assessments should be conducted using a standardized approach with validated tools. Areas of evaluation should include a person’s ability to perform basic self-care activities (such as dressing, grooming, personal hygiene, feeding, functional mobility and communication) and instrumental activities of daily living (including meal preparation, home management, communication activities, financial management, shopping and community living skills).
Admission to an interprofessional program should be limited to patients who have more than one type of disability and who, require the services of two or more rehabilitation disciplines. Patients with a single disability can usually benefit from outpatient or community-based services, and generally do not require an interprofessional program. Hakkennes et al. (2013) surveyed 14 clinicians responsible for assessing the suitability of patients for inpatient rehabilitation. A questionnaire was administered to assess factors that were used to assess a patient’s suitability for rehabilitation. Potentially relevant items included 15 patient-related factors (e.g. age, pre-morbid mobility) and 2 organization factors (bed availability and funding source). Using data from 8,783 Veterans admitted to a Veterans Affairs Medical Center with a primary diagnosis of stroke, Stineman et al. (2013) reported that 11.2% of veterans were selected for comprehensive-level rehabilitation. Patients at the lowest grades of physical independence and the middle cognitive stages had significantly higher odds of admission to a comprehensive rehabilitation unit. Other independent factors associated with higher odds of admission for comprehensive rehabilitation included patients who were age <70 years, married, living at home pre-stroke and the presence of a comprehensive rehabilitation unit at admitting hospital. In the CERISE study (Putman et al. 2007), the presence of pre-morbid cognitive disability, depression and severe behavioral problems were identified as factors where the probability of being admitted for inpatient rehabilitation was lowered.