• Posted September 2, 2026

Stroke Survivors Should Start Rehab Within 48 Hours, New Guidelines Say

Sara Kutzle worked as a makeup artist in San Francisco before suffering a stroke at age 39.

Her stroke cost her a week in intensive care, a month in the hospital and then months upon months relearning everyday skills like walking and writing — not to mention learning how to function again as a right-handed artist.

“At first, I was focused on getting my body to recover, but I quickly realized healing involved so much more than that,” Kutzle recalled in a news release. ”My confidence, my mental health, my relationships and my sense of independence were all affected.”

To help stroke survivors start healing, rehab should begin as soon as possible, under new guidelines from the American Stroke Association.

Rehabilitation should begin in the hospital as soon as the patient is stable, ideally within 48 hours of their stroke, according to guidelines published Aug. 27 in the journal Stroke.

The guidelines also emphasize personalizing stroke rehab based on a person’s symptoms and mental health.

“Stroke rehabilitation is complicated. A stroke can affect many of the skills people rely on for daily living, and even the most routine activities involve multiple physical, cognitive and communication abilities working together,” lead writer Lorie Gage Richards, an associate professor at the University of Utah, said in a news release.

“Developing rehabilitation guidelines is equally complex because every stroke is unique. Each person faces a different set of challenges. Recovery doesn’t look the same for everyone, and care should be personalized to fit each person’s needs,” Richards said.

Kutzle, who helped write the new rehab guidelines, agrees.

“Recovery wasn't just about learning how to do things again," she said. "It was about accepting the new version of myself and continuing to move forward.” 

A stroke can happen to anyone at any age. Every year, nearly 800,000 Americans suffer a stroke, researchers said in background notes. Stroke is now the fourth-leading cause of death in the United States. 

The guidelines also recommend mental health screening for depression, anxiety and other struggles that can hamper recovery.

”Joining a support group, journaling and learning to process what had happened to me helped me heal in ways physical therapy alone couldn't,” Kutzle said. “I had to stop comparing my recovery to everyone else's and focus on my own progress. Understanding that mental health is part of recovery changed everything for me.”

Patients also need help returning to their everyday lives, including picking up their jobs, parenting young children, addressing sleep and pain issues and even adapting to changes in sexual function, researchers said.

“Rehabilitation was difficult, but one of the hardest parts was accepting that my life might look different than I planned,” Kutzle said. ”My friends were thriving in their careers and building families, while I was learning how to navigate a completely different reality. Recovery meant discovering who I could become, not trying to return to who I was before.”

Further, stroke rehabilitation needs to take into account the caregivers of survivors, including them in rehab planning, education and support, the guidelines say.

They emphasize that a coordinated multidisciplinary care team is crucial for effective post-stroke rehabilitation, potentially including neurologists, rehabilitation nurses, occupational therapists, physical therapists, speech-language pathologists, social workers and psychologists.

Recovery might last months to years, with no clearly defined endpoint, the guidelines say. In addition, one person’s recovery will not look like another’s.

“Recovery after a stroke is about more than getting stronger physically and regaining abilities," Richards said. "It’s an ongoing process that includes coping with emotional changes after a major health event, adjusting to new challenges and moving forward with a renewed sense of purpose and resilience.”

More information

The U.S. Centers for Disease Control and Prevention has more on stroke treatment and recovery. 

SOURCE: American Stroke Association, news release, Aug. 27, 2026