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How Rehabilitation Can Help After Stroke

Imagine the daily news reporting that everyone in Milwaukee, Kenosha and Green Bay would suffer a debilitating, and sometimes fatal, medical condition over the next year. That would be pretty alarming, wouldn’t it?

The population of those three cities is about 800,000 — that’s the same figure as the number of men and women of all ages who will suffer a stroke this year.

What Is a Stroke?

A stroke can be caused by a blood clot in a blood vessel that supplies blood to the brain. This is called an ischemic stroke. A stroke can also result from a ruptured blood vessel, which causes bleeding in the brain. This is called a hemorrhagic stroke.

When either of these situations occur, brain cells start dying. The trauma to the brain can lead to disability or death.

Victims who survive a stroke are typically left with a range of disabilities. The extent of impairment depends on the part of the brain that was affected by the stroke, the severity the stroke and the amount of time that passes from the start of the stroke to the beginning of professional treatment.

Strokes can cause one or a combination of disabilities, including:

  • Paralysis, weakness in coordination, lack of balance, impaired speech and difficulty swallowing.
  • Sensory changes, which can include the loss of the sense of touch, pain, joint position, temperature and vision.
  • Difficulties understanding or using language. This occurs in about a quarter of stroke victims.
  • Trouble thinking clearly and remembering things.
  • Emotional problems such as feeling heightened fear, frustration, anxiety, anger or sadness.

What Can Be Done to Help a Stroke Patient?

About two-thirds of stroke victims survive and need rehabilitation to return to a normal life.

Recovering from a stroke takes a lot of work. It starts with rehabilitation therapy in the hospital. This begins once the patient’s overall condition is stable — usually within 24 to 48 hours.

During this time, the patient’s abilities and rehabilitation needs are assessed by a physical therapist, occupational therapist and speech therapist. If the patient is recognized to have ongoing needs for therapy, the patient may be a candidate for an inpatient rehabilitation program. 

To qualify for this type of program, the patient needs to have acceptance to the program by a physiatrist, a physician specially trained in rehabilitation. Typically, acceptance to the program is based on a patient’s rehabilitation needs, their ability to achieve significant improvement in a reasonable length of time and to show promise in returning directly to a community setting.

Inpatient Rehabilitation Program

The inpatient rehabilitation program is meant to provide hospital-level care to stroke patients who need intensive, 24-hour-per-day, multidisciplinary rehabilitation care. Patients receive a minimum of three hours of therapy per day (physical, occupational and speech therapies) for at least five days per week. The goals of rehabilitation are to improve physical functioning and increase a patient’s level of independence, to facilitate community discharge. 

Patients in the inpatient rehabilitation program will work with a specialized team of medical professionals who help the patient during their recovery. The team can include:

  • Physiatrist — a doctor who has specialized training in rehabilitation, whose primary responsibility is to manage the medical care of the patient.
  • Rehabilitation nurses — care for patients receiving rehabilitation in the hospital, offering 24/7 care for patients. They help patients learn about their medical conditions, provide and instruct on medications, offer emotional support and help patients relearn basic daily-living activities.
  • Physical therapists — work with patients to help them regain strength, coordination, and balance in order to help them regain their ability to mobilize with independence.
  • Occupational therapists — work with patients to help them improve their upper extremity function and their ability to perform basic activities of daily living, such as toileting, bathing and dressing.
  • Speech therapists — help patients improve language and communication skills. They also work with patients to improve swallowing impairments.
  • Recreational therapists — help patients pursue leisure and avocational activities after a stroke.
  • Psychologists or psychiatrists — doctors who help patients to cope and adjust to the emotional changes after stroke.
  • Social worker or case manager — social workers or nurses who help patients navigate the complex health care system, and help patients access medical resources and community assistance.
  • Registered dietitians — make dietary recommendations to optimize patients’ nutrition and provide dietary education to help the patients learn how to eat for optimum health.

Patients typically engage in therapeutic exercises including strengthening, stretching and range of motion exercises. They also work on balance, coordination and fine motor skills. 

Depending on patient abilities, patients work on functional mobility tasks such as moving in bed, sitting upright, standing, transferring and walking. Patients typically receive help from therapists until they’re able to do the movements on their own.

Before returning home, it’s also essential the patient regain the ability to perform the basic activities of daily living.

Rehab nurses and therapists help the stroke patient relearn how to do tasks such as eating and drinking. Throughout the rehab process, patients are encouraged to use limbs and muscles that have been impaired by the stroke. They are also instructed on how to adapt to new ways of doing things, such as dressing with only one hand.

Studies have shown that patients who participate in inpatient rehabilitation programs have higher rates of return to community, greater functional recovery, fewer rates of rehospitalization and improved survival compared to those who participate in subacute rehabilitation, which is less intensive. 

What Family and Friends Should Know

It’s important for families and friends of stroke survivors to know that the brain damage caused by the stroke cannot be reversed. However, with time and effort, rehabilitation can help people return to independence and an improved quality of life.

Some stroke survivors will spend months working with therapists to relearn or refine once-lost abilities. A study reported by the National Institutes of Health found functional improvements could be seen in survivors up to a year after their stroke.

Patience and repetitive practice is a key to regular progress during recovery.

What Are the Warning Signs of Stroke?

If you notice these warning signs of a stroke in a person, regardless of age, call 911 immediately. You can boost the victim’s chances for survival and recovery when you act FAST.

B – Balance. Watch for a sudden loss of balance.

E – Eyes. Is there a sudden loss of vision in one or both eyes? Or double vision?

F – Face drooping. Ask the person to smile. Does one side of their face droop?

A – Arm weakness. Ask the person to raise both of their arms. Does one arm drift downward?

S – Speech difficulty. Ask the person to repeat a simple phrase. Is their speech slurred or mumbled?

T – Terrible HeadacheDo they have a sudden onset of a terrible headache or the "worst of headache of their life?"

If the person shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Note the time when you started seeing symptoms and tell the medical personnel.

Ask the emergency personnel to take the affected person to a certified stroke center if there’s one in your area. That facility will be the most up-to-date on the best ways to help the victim.

Be Prepared

Before you or someone you know becomes one of the 800,000 stroke victims this year, learn the stroke FAST steps above. Also become familiar with the location of the nearest hospital emergency department. Since time is of the essence in case of a stroke, knowing how to get the victim professional medical care quickly can save his or her life.

Be Aware of Your Stroke Risk

Do you know your risks for stroke and how you might prevent one? Some risks you can’t control. Others, such as lifestyle and certain medical risks, you can control. In fact, 80 percent of strokes in adults are preventable.

Your eating habits, smoking and drinking can affect your risk. High blood pressure, atrial fibrillation and high cholesterol are also among the things that can boost your risk for stroke.

Ask your health care professional about your risks and how you can reduce them.

Meet the Author

Michele K. Stueve, MD practices as a specialist in physical medicine and rehabilitation at Aurora Lakeland Medical Center in Elkhorn, WI

Read more posts from this author

The information presented in this site is intended for general information and educational purposes. It is not intended to replace the advice of your own physician. Contact your physician if you believe you have a health problem.

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