What is stroke rehabilitation?
After hospitalization for stroke, many patients still have problems with physical, speech, and mental functions. Rehabilitation for these problems can be provided in a variety of settings. Rehabilitation programs are critical in helping patients regain lost skills, relearn tasks, and work to be independent again. In many cases, there is great potential for the brain to recover. With diligent rehabilitation, these prospects can get even better. Even if major neurological deficits do not improve, the patients’ functioning can improve as they learn ways to compensate for their problems.
Some factors that play a role in success of stroke rehabilitation are:
- The extent of the brain injury. The less severe the injury, the better the chances for recovery.
- The stroke survivor's attitude. A survivor's positive attitude can help him or her cope with difficult times and focus on getting better.
- Family support. A stroke survivor's family can be the most important form of support during rehabilitation. Family members can reassure stroke survivors that they're wanted, needed, and still important to the family.
- Time until start of rehabilitation. Rehabilitation must begin as soon after the stroke as possible. Even simple tasks such as exercising paralyzed muscles and turning the person in bed should begin very soon after the stroke. Stroke rehabilitation is most successful when it is a team effort. The stroke survivor and his or her family must work together with the doctor, nurse, and other rehabilitation specialists.
What happens after the stroke patient leaves the hospital?
Stroke rehabilitation is provided in a number of settings. Doctors, therapists, and case managers will determine what setting would provide the most appropriate treatment based primarily on the stroke disability and prognosis for improvement. Sayings like “no pain – no gain” and “use it or lose it” do not apply to stroke patients. More exercise is not necessarily better.
A safe and effective rehabilitation program allows patients to recover at a pace that fits their needs and abilities. Patients usually move among various levels of care during their recovery. Deciding on the right setting for rehabilitation involves many elements:
- The severity and unique characteristics of the physical problems caused by the stroke
- The presence of other medical conditions like arthritis, kidney disease, or heart disease
- Availability and location of family and friends
- Insurance coverage for rehabilitation services
What are the choices for stroke rehabilitation?
Three or more hours of therapy are provided five days a week, and sometimes over the weekend. Doctors may visit the patient five or more days a week. Patients at this level of care must demonstrate the ability to tolerate and benefit from intensive exercise and training.
Subacute or skilled nursing rehabilitation
In this type of rehabilitation, one or two hours of rehabilitation treatment are provided five days a week. Patients in this setting are often recovering from difficult medical problems, and are able to tolerate a moderate pace of exercise. Doctors supervise the medical and rehabilitative care, and visit the patient as needed, usually three times a week.
This means that the patient lives at home and travels two or three times a week to a rehabilitation facility for a few hours of treatment. Usually, family members drive patients to their treatments. Therapists can do a lot more in the facility than they can do in the patient’s home.
Rehabilitation in the home
This kind of rehabilitation usually is for homebound patients with very mild problems and extensive family support. Members of the therapy team come to the home of the patient, usually for 2 or 3 hours of therapy per week. Simple therapy services are provided.
These rehabilitation services are provided in special hospital units that are designed to care for patients with major medical problems requiring intense treatment (patients that require ventilators for breathing, dialysis, drugs that support heart function). Doctors visit the patient frequently.
Nursing home restorative care
This kind of care is the least intensive level of rehabilitation care in an institutional setting. Patients participate in an exercise program a few hours a week, generally in a group setting.
How long does rehabilitation last?
Stroke rehabilitation takes time. Each advance in a patient’s skills and condition is a victory, and over time these small victories start to add up. For persons receiving rehabilitation services in an acute, subacute, skilled, LTAC or nursing home setting, the period of treatment often lasts from two to four weeks. After this, many patients can return home and engage therapy services over several months as they continue to recover.
Is the family involved?
Yes. The time that rehabilitation specialists spend with the patient in rehabilitation is just a “blink of the eye” in that patient’s lifetime. Family and friends' active involvement in the patient's rehabilitation process helps the patient achieve success. The patient’s loved ones can help specialists understand what the patient was like before the stroke and help plan for the best outcome after the patient goes home.