Rehabilitation for Stroke
What is rehabilitation?
Rehabilitation is the process of helping an individual achieve the highest level of independence and quality of life possible - physically, emotionally, socially, and spiritually. Rehabilitation does not reverse or undo the damage caused by a stroke, but rather helps restore the individual to optimal health, functioning, and well-being. Rehabilitate (from the Latin "habilitas") means "to make able again."
St. Johns Hospital’s
Inpatient Rehabilitation unit provides a comprehensive stroke rehabilitation
program. The rehabilitation unit is accredited as a Comprehensive Integrated
Inpatient Rehabilitation Program by CARF (Commission Accreditation for
Rehabilitation Facilities).
According to the American Heart Association, about 700,000 people a year
suffer a stroke or brain attack. Individuals who suffer a stroke cope with
numerous problems. Some of these problems may include difficulty with
communication, loss of function or weakness on either the left or right side of
the body, difficulty with swallowing, bathing, dressing, walking and/or bladder
and bowel function.
Rehabilitation should start as early as possible after a stroke. St. John’s
Inpatient Rehabilitation unit has an interdisciplinary team that works with the
patient on regaining as much function as possible. Team members include
rehabilitation physician, rehabilitation nursing, physical therapist,
occupational therapist, speech therapist, recreational therapist, psychologist
and a case manager.
Inpatient Rehabilitation patients must:
Be 13 years or older;
In stable medical condition;
Requiring close medical supervision;
Have the potential to gain in functional skill;
Have the ability to tolerate three hours of therapy per day;
Have the ability to comprehend the goals of the program and to cooperate
with the program.
Inpatient services include:
Physical therapy helps improve the strength and mobility required for
the stroke patient to increase their level of independence. The therapist will
emphasize exercises to increase strength, endurance and coordination. The stroke
patient works on functional skill training for safe, daily living activities
like walking or wheelchair activities.
Occupational therapy emphasizes activities of daily living or ADL.
Goals are set to increase their level of independence for eating, personal
hygiene, dressing and homemaking. Some activities not only help increase
dexterity, coordination, muscle strength, and range of motion, but also
attention span and problem-solving ability.
Speech therapy helps with swallowing problems, speech problems or
other communication disorders if required. After examining the stroke patient
needs, the therapist will plan an individual treatment program incorporating
hearing, verbal communication, reading, writing, swallowing and mental function.
The therapist will help the family understand communication problems and
communicate with the stroke patient.
The team meets weekly to review patient’s progress. Patient discharge from
the program is based on either meeting the goals, or being unable to make
progress with the treatment goals.
St. John’s offers other services after discharge that continues with the
rehabilitation process. There are Outpatient Therapy Services, Home Health Care
Services and a Community Re-entry program, Ozark Neuro Rehabilitation Center,
sponsored by St. John’s and Cox Health Systems .Outpatient services
may include:
Day treatment
Pool therapy
Driving evaluation
Adapted fitness program
Physical therapy
Occupational therapy
Speech therapy
Home health care services, such as:
- Skilled nursing
- Home health aides
- Social services: To help the stroke patient and family deal with the
emotional stresses and financial impact, Social Services is available.
Counseling is available to assist in returning to work or school. Counseling
can also help with income planning and benefits, including insurance coverage,
Social Security and other government assistance. The social worker assists in
discharge planning, including future living arrangements and contact with the
community resources that can provide supportive services at home. If unable to
return home, alternative living arrangements will be explored.
- Physical therapy
- Occupational therapy
- Speech therapy
- Hospice
Neuropsychology
Support groups and follow-up with Stroke Ambassadors, a special group of
volunteers through the Seniors Program at St. John’s who are trained ombudsmen.
These volunteers visit all stroke patients at St. John’s, bringing get well
balloons and stroke magazines from the National Stroke Association and the
American Stroke Association. A few days after discharge to home, the Stroke
Ambassadors also call the stroke patients to make sure that the transition back
to home is going smoothly, to answer any questions that they might have. If
medical concerns are brought up, the Stroke Ambassadors notifies the Stroke
Coordinator who will follow up with the patient or they are encouraged to call
their primary care physician.
Stroke screenings
Community preventive education.
The stroke rehabilitation team:
The stroke rehabilitation team revolves around the patient and family. The team helps set short- and long-term treatment goals for recovery and is made up of many skilled professionals, including the following:
- physicians such as a neurologist (a physician who treats conditions of the nervous system such as stroke) and physiatrist (a physician who specializes in physical medicine and rehabilitation)
- internists and specialists
- critical care nurses
- rehabilitation nurses
- physical therapists
- occupational therapists
- speech and language pathologists
- dietitians
- social workers and chaplains
- psychologists, neuropsychologists, and psychiatrists
- case managers.
The stroke rehabilitation program:
The outlook for stroke patients today is more hopeful than ever due to advances in both stroke treatment and rehabilitation. Stroke rehabilitation works best when the patient, family, and rehabilitation staff works together as a team. Family members must learn about impairments and disabilities caused by the stroke and how to help the patient achieve optimal function again.
Rehabilitation medicine is designed to meet each person's specific needs; thus, each program is different. Some general treatment components for stroke rehabilitation programs include the following:
- treating the basic disease and preventing complications
- treating the disability and improving function
- providing adaptive tools and altering the environment
- teaching the patient and family and helping them adapt to lifestyle changes
The success of stroke rehabilitation depends on many variables, including the following:
- the cause, location, and severity of stroke
- the type and degree of any impairments and disabilities from the stroke
- the overall health of the patient
- family and community support
Areas covered in stroke rehabilitation programs may include the following:
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Patient need:
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Example:
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| Self-care skills, including activities of daily living (ADLs) |
Feeding, grooming, bathing, dressing, toileting, and sexual functioning |
| Mobility skills |
Walking, transfers, and self-propelling a wheelchair |
| Communication skills |
Speech, writing, and alternative methods of communication |
| Cognitive skills |
Memory, concentration, judgment, problem solving, and organizational skills |
| Socialization skills |
Interacting with others at home and within the community |
| Vocational training |
Work-related skills |
| Pain management |
Medicines and alternative methods of managing pain |
| Psychological testing |
Identifying problems and solutions with thinking, behavioral, and emotional issues |
| Family support |
Assistance with adapting to life styles changes, financial concerns, and discharge planning |
| Education |
Patient and family education and training about stroke, medical care, and adaptive techniques |
Choosing a rehabilitation facility:
Rehabilitation services are provided in many different settings, including the following:
- acute care and rehabilitation hospitals
- subacute facilities
- long-term care facilities
- outpatient rehabilitation facilities
- home health agencies
When investigating rehabilitation facilities and services, some general questions to ask include the following:
- Does my insurance company have a preferred rehabilitation provider that I must use to qualify for payment of services?
- What is the cost and will my insurance company cover all or part of the cost?
- How far away is the facility and what is the family visiting policy?
- What are the admission criteria?
- What are the qualifications of the facility? Is the facility accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF)?
- Has the facility handled treatment for this type of condition before?
- Is therapy scheduled every day? How many hours a day?
- What rehabilitation team members are available for treatment?
- What type of patient and family education and support is available?
- Is there a physician onsite 24 hours a day?
- How are emergencies handled?
- What type of discharge planning and assistance available?
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