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while interventions may be incorporated into the clinical and physical rehabilitation of stroke survivors, their use may be variable because of time and cost constraints, staffing and training limitations, and varying stakeholder preferences.⁶⁵

increased demands for acute stroke care have created great competition for irfs. to become eligible for medicare reimbursement, irfs have responded by offering shorter lengths of stay, providing social and recreational activities, and promoting technology to help with the rehabilitation process. advances in stroke rehabilitation include systematic physical and occupational therapies designed to enhance functional outcomes, the delivery of interventions in shorter periods of time (eg, less than 14 d), and more intensive therapies that enable patients to achieve higher levels of functional recovery.⁵⁷ the expansion of irfs is frequently associated with the development of subacute stroke units, which are organized under the stroke service and funded by accountable care organizations.

surgical and endovascular stroke treatment options are increasingly available. preliminary data suggest that decompressive hemicraniectomy may be effective in selected cases of malignant edema. preliminary data also suggest that staged treatment of infarctions by injecting recombinant tissue plasminogen activator (rt-pa) into the clot and then again after 2 to 4 hours may be effective, especially in cases of occlusion of major blood vessels.⁵⁷⁴ both techniques are still investigational. another investigational treatment option is the use of endovascular mechanical thrombectomy, in which a catheter is used to remove clot from areas of active cerebral infarction. this approach does not require the time and resources of surgical decompression, but the procedure is more complicated and the population that might benefit from this treatment option is limited.

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