In hospital or nursing facility rehabilitation programs, the patient may spend several hours a day in activities such as physical therapy, occupational therapy, speech therapy, recreational therapy, group activities, and patient and family education.
It is important to maintain skills that help recovery. Part of the time is spent relearning skills (such as walking and speaking) that the person had before the stroke. Part of it is spent learning new ways to do things that can no longer be done the old way (for example, using one hand for tasks that usually need both hands).
Setting Rehabilitation Goals
The goals of rehabilitation depend on the effects of the stroke, what the patient was able to do before the stroke, and the patient’s wishes. Working together, goals are set by the patient, family, and rehabilitation program staff. Sometimes, a person may need to repeat steps in striving to reach goals.
If goals are too high, the patient will not be able to reach them. If they are too low, the patient may not get all the services that would help. If they do not match the patient’s interests, the patient may not want to work at them. Therefore, it is important for goals to be realistic. To help achieve realistic goals, the patient and family should tell program staff about things that the patient wants to be able to do.
- Rehabilitation Goals
- Being able to walk, at least with a walker or cane, is a realistic goal for most stroke survivors.
- Being able to take care of oneself with some special equipment is a realistic goal for most.
- Being able to drive a car is a realistic goal for some. Having a job can be a realistic goal for some people who were working before the stroke. For some, the old job may not be possible but another job or a volunteer activity may be.
Reaching treatment goals does not mean the end of recovery. It just means that the stroke survivor and family are ready to continue recovery on their own.
- Rehabilitation Specialists
Because every stroke is different, treatment will be different for each person. Rehabilitation is provided by several types of specially trained professionals. A person may work with any or all of these:
All patients in stroke rehabilitation have a physician in charge of their care. Several kinds of doctors with rehabilitation experience may have this role. These include family physicians and internists (primary care doctors), geriatricians (specialists in working with older patients), neurologists (specialists in the brain and nervous system), and physiatrists (specialists in physical medicine and rehabilitation).
- Rehabilitation nurse
Rehabilitation nurses specialize in nursing care for people with disabilities. They provide direct care, educate patients and families, and help the doctor to coordinate care.
- Physical therapist
Physical therapists evaluate and treat problems with moving, balance, and coordination. They provide training and exercises to improve walking, getting in and out of a bed or chair, and moving around without losing balance. They teach family members how to help with exercises for the patient and how to help the patient move or walk, if needed.
- Occupational therapist
Occupational therapists provide exercises and practice to help patients do things they could do before the stroke such as eating, bathing, dressing, writing, or cooking. The old way of doing an activity sometimes is no longer possible, so the therapist teaches a new technique.
- Speech-language pathologist
Speech-language pathologists help patients get back language skills and learn other ways to communicate. Teaching families how to improve communication is very important. Speech-language pathologists also work with patients who have swallowing problems (dysphagia).
- Social worker
Social workers help patients and families make decisions about rehabilitation and plan the return to the home or a new living place. They help the family answer questions about insurance and other financial issues and can arrange for a variety of support services. They may also provide or arrange for patient and family counseling to help cope with any emotional problems.
Psychologists are concerned with the mental and emotional health of patients. They use interviews and tests to identify and understand problems. They may also treat thinking or memory problems or may provide advice to other professionals about patients with these problems.
- Therapeutic recreation specialist
These therapists help patients return to activities that they enjoyed before the stroke such as playing cards, gardening, bowling, or community activities. Recreational therapy helps the rehabilitation process and encourages the patient to practice skills.
- Other professionals
Other professionals may also help with the patient’s treatment. An orthotist may make special braces to support weak ankles and feet. A urologist may help with bladder problems. Other physician specialists may help with medical or emotional problems. Dietitians make sure that the patient has a healthy diet during rehabilitation. They also educate the family about proper diet after the patient leaves the program. Vocational counselors may help patients go back to work or school.
Rehabilitation professionals, the patient, and the family are vitally important partners in rehabilitation. They must all work together for rehabilitation to succeed.
In many programs, a special rehabilitation team with a team leader is organized for each patient. The patient, family, and rehabilitation professionals are all members. The team has regular meetings to discuss the progress of treatment. Using a team approach often helps everyone work together to meet goals.
The doctor and other hospital staff will provide information and advice about rehabilitation programs, but the patient and family make the final choice. Hospital staff know the patient’s disabilities and medical condition.
They should also be familiar with the rehabilitation programs in the community and should be able to answer questions about them. The patient and family may have a preference about whether the patient lives at home or at a rehabilitation facility. They may have reasons for preferring one program over another. Their concerns are important and should be discussed with hospital staff.
Things To Consider When Choosing a Rehabilitation Program
- Does the program provide the services the patient needs?
- Does it match the patient’s abilities or is it too demanding or not demanding enough?
- What kind of standing does it have in the community for the quality of the program?
- Is it certified and does its staff have good credentials?
- Is it located where family members can easily visit?
- Does it actively involve the patient and family members in rehabilitation decisions?
- Does it encourage family members to participate in some rehabilitation sessions and practice with the patient?
- How well are its costs covered by insurance or Medicare?
- If it is an outpatient or home program, is there someone living at home who can provide care?
- If it is an outpatient program, is transportation available?
A person may start rehabilitation in one program and later transfer to another. For example, some patients who get tired quickly may start out in a less intense rehabilitation program. After they build up their strength, they are able to transfer to a more intense program.
When Rehabilitation Is Not Recommended
Some families and patients may be disappointed if the doctor does not recommend rehabilitation. However, a person may be unconscious or too disabled to benefit. For example, a person who is unable to learn may be better helped by maintenance care at home or in a nursing facility. A person who is, at first, too weak for rehabilitation may benefit from a gradual recovery period at home or in a nursing facility. This person can consider rehabilitation at a later time. It is important to remember that:
Hospital staff are responsible for helping plan the best way to care for the patient after discharge from acute care. They can also provide or arrange for needed social services and family education.
This is not the only chance to participate in rehabilitation. People who are too disabled at first may recover enough to enter rehabilitation later.Tags: Healthcare, Rehabilitation medicine, Geriatrics, Stroke recovery, Nursing home, Nursing, Healthcare in the United States, Geriatric rehabilitation