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To the Editor: Dr Alberts and colleagues¹ reported that primary stroke centers should include "acute stroke teams, stroke units, written care protocols, and an integrated emergency response system." Regrettably, the authors only briefly mentioned the need for rehabilitation to "hasten recovery following stroke." They reported that only 2% to 3% of patients with stroke receive tissue-type plasminogen activator (tPA) nationwide, but they failed to mention that 31% of patients with stroke require assistance in activities of daily living, 20% require assistance in mobility, and 16% are institutionalized.²

The authors described rehabilitation as occurring "after the acute hospitalization and often in facilities remote from the acute care hospital." However, a consensus panel for poststroke rehabilitation practice guidelines³ recommended to "begin rehabilitation-oriented care immediately, and increase the patient's activity as soon as medically feasible during the acute phase," to "take steps to prevent complications throughout all stages of treatment," and to "screen . . . [Full Text of this Article]

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