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Rehabilitation
What Is Involved in Rehabilitation?Rehabilitation actually starts in the hospital as soon as possible after a stroke. Once patients are stable, rehabilitation may begin within 24 to 48 hours after a stroke occurs. During this acute phase, clinical rehabilitation priorities of the Stroke Unit Rehabilitation Team (SURT) include:
Plans for disposition after the acute hospital stage: Some of the first steps of rehabilitation involve promoting independent movement because many patients are paralyzed or seriously weakened. For example, you'll be asked to change positions frequently while lying in bed and to engage in passive or active range-of-motion exercises to strengthen stroke-impaired limbs. (Passive, range-of-motion exercises are those that involve a therapist helping a patient move limbs repeatedly. Active exercises are those that can be performed by a patient with no physical assistance from the therapist.) Generally, you will progress from sitting up and transferring between the bed and a chair to standing, bearing your own weight and walking—with or without assistance. Rehabilitation continues to evolve as new techniques become available. Depending on the severity of a stroke, rehabilitation options may include:
The goal in rehabilitation is to improve function so you can become as independent as possible. This should be accomplished in a way that preserves dignity and motivates you to relearn old skills that the stroke may have taken away, such as eating, dressing and walking. Rehabilitation also teaches new ways of performing tasks to compensate for any residual disabilities. For example, some patients need to learn how to bathe and dress using only one hand, or how to communicate effectively when their ability to use language has been compromised. There is a strong consensus among rehabilitation experts that the most important element in any rehabilitation program is carefully directed, well-focused, repetitive practice. Even though rehabilitation cannot reverse the damage caused to the brain
by stroke, it can substantially help you achieve the best possible long-term
outcome. Your Rehabilitation TeamPost-stroke rehabilitation involves physicians who specialize in rehabilitative medicine (physiatrists) and an interdisciplinary team of therapists, as well as rehabilitation nurses, case managers, social workers and neuropsychologists. PhysiciansRehabilitation physicians include both physiatrists and neurologists. Physiatrists assume a leading role in rehabilitation, both in acute and post-acute settings. Neurologists usually lead stroke teams in an acute care setting and provide medical treatment. Together, these physicians are responsible for developing a rehabilitation plan as well as managing and coordinating the efforts of your interdisciplinary team. Case ManagersCase managers help you access resources in the hospital and after discharge. They help those who don't qualify for in you services and coordinate resources for those who are not well enough for extensive rehabilitation, as well as for those who are too well to qualify for inpatient services. Rehabilitation NursesNurses specializing in rehabilitation help you relearn how to carry out the basic activities of daily living. They also educate you about routine health care, such as how to follow a medication schedule, how to care for the skin, how to manage transfers between a bed and a wheelchair and special needs for people with diabetes. Rehabilitation nurses also work with you to reduce risk factors that may lead to another stroke and provide training for caregivers. Physical TherapistsPhysical therapists (PTs) specialize in treating disabilities related to motor and sensory problems. They are trained in all aspects of anatomy and physiology related to normal function, with an emphasis on movement. They assess your strength, endurance, range of motion, gait (walking) abnormalities and sensory deficits to design individualized rehabilitation programs aimed at regaining control over motor functions. In general, physical therapy emphasizes practicing isolated movements, repeatedly changing from one kind of movement to another and rehearsing complex movements that require a great deal of coordination and balance, such as walking up or down stairs or moving safely between obstacles. A recent trend in physical therapy emphasizes the effectiveness of engaging in goal-directed activities, such as playing games, to promote coordination. Occupational TherapistsLike physical therapists, occupational therapists (OTs) are concerned with improving motor abilities. They help you relearn motor skills needed to perform self-directed activities—occupations—such as eating with utensils, cooking, housecleaning and driving. They often teach you to divide a complex activity into its component parts, show how to practice each part and then perform the whole sequence of actions. This strategy can improve coordination and can be particularly helpful if you have apraxia. OTs can also teach you how to develop compensatory strategies and how to change elements of your environment that limit goal-directed activities. For example, people with the use of only one hand can substitute Velcro closures for buttons on clothing. OTs also can help you learn how to use assistive devices such as canes, walkers or wheelchairs. Finally, they can teach you how to make changes in your home to increase safety, remove barriers and facilitate physical functioning, such as installing grab bars in bathrooms. Speech-Language TherapistsSpeech-language therapists (STs) help you with aphasia relearn how to use language or develop alternative means of communication. They also help people improve their ability to swallow. Communication-related therapies - Many special techniques have been developed to assist people with aphasia. Some forms of short-term therapy can improve understanding rapidly. Intensive exercises such as repeating words, following directions, and reading and writing exercises form the cornerstone of language rehabilitation. Conversational coaching and rehearsal, as well as the development of prompts or cues to help people remember specific words, can also be beneficial. STs can also help you develop strategies to compensate for language disabilities, such as using symbol boards, sign language and even the use of certain computer-based technologies. Swallowing therapies - STs use noninvasive imaging techniques to study swallowing patterns of stroke you to identify the exact source of problems. Difficulties with swallowing have many possible causes. Once the cause is identified, STs can work with you to devise strategies to overcome or minimize the deficit. Sometimes, simply changing body position and improving posture when eating help improve results. The texture of food can also be modified to make swallowing easier; for example, thin liquids, which often cause choking, can be thickened. Also, eating habits can be changed, such as taking smaller bites and chewing more slowly can help alleviate dysphagia. Vocational services - Vocational therapists or counselors are not part of the interdisciplinary team in the hospital, but may be accessed through the state-sponsored Division of Vocational Rehabilitation. Because many stroke patients are between the ages of 45 to 60, returning to work can be a primary concern. Vocational therapists perform many of the same functions as career counselors. They can help you with residual disabilities identify vocational strengths and develop resumes to highlight them. They also can help identify potential employers, assist in specific job searches and provide referrals to stroke vocational rehabilitation agencies. Most importantly, vocational therapists help educate you about their rights and protections as defined by the Americans with Disabilities Act of 1990, which requires employers to makes “reasonable accommodations” for disabled employees. Vocational therapists frequently act as mediators between employers and employees to negotiate the provision of reasonable accommodations in the workplace. Types of Rehabilitation ProgramsWhile the first stage of rehabilitation usually occurs within an acute-care hospital, you and your caregiver can coordinate with hospital case managers to obtain rehabilitation services either at home or at another medical facility. Inpatient Rehabilitation UnitsInpatient facilities may be freestanding (not associated with the hospital) or part of larger hospital complexes. Patients stay in the facility, usually for two to three weeks, and engage in a coordinated, intensive program of rehabilitation. Such programs often involve at least three hours of active therapy a day, five or six days a week. Inpatient facilities offer a comprehensive range of medical services, including full-time physician supervision and access to the full range of therapists specializing in post-stroke rehabilitation. Outpatient Programs/Day Treatment ProgramsOutpatient facilities are often part of a larger hospital complex and provide access to physicians and the full range of therapists specializing in stroke rehabilitation. Patients typically spend several hours, often three days each week, at the facility taking part in coordinated therapy sessions and return home at night. Day treatment programs offer structured, intense treatment tailored to your physical abilities. This usually provides a good transition from inpatient to the home environment. Nursing FacilitiesRehabilitation services available at nursing facilities are more variable than are those at inpatient and outpatient units. Skilled nursing facilities usually place a greater emphasis on rehabilitation, whereas traditional nursing homes emphasize residential care and provide fewer hours of therapy. Home-Based Rehabilitation ProgramsHome rehabilitation allows for great flexibility so that you can tailor your program of rehabilitation and follow individual schedules. You may participate in an intensive level of therapy several hours per week or follow a less demanding regimen. These arrangements are often best suited for people who lack transportation or require less-intensive therapy. Patients dependent on Medicare coverage for their rehabilitation must
meet Medicare's “homebound” requirements to qualify
for such services; at this time, lack of transportation is not a valid
reason for home therapy. The major disadvantage of home-based rehabilitation
programs is the lack of specialized equipment and intensity of service.
However, undergoing treatment at home gives people the advantage of practicing
skills and developing compensatory strategies in the context of their
own living environment. |
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Colorado Neurological
Institute Stroke Center
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