Recovering from a Stroke

 

May is American Stroke Awareness Month

If you or a loved one has suffered a stroke, you are in the company of almost 800,000 other Americans who experience a stroke every year. More than 7 million Americans have had a stroke at some time, and many are still living with the effects.

The effects of stroke can differ widely, depending on which part of the brain is damaged and the severity of the stroke. While the effects of stroke can be quite serious, the research news is not all bad: 10 percent of stroke survivors recover completely and another 25 percent recover with relatively minor impairments, according to the National Stroke Association. While rehabilitation cannot “heal” stroke, it can help patients achieve the best possible outcome and improve independent living and quality of life.

When and How Does Recovery Begin?

Rehabilitation aims to help patients “relearn” skills that are lost or impaired when stroke occurs. Think of how you first learned a new skill, such as riding a bicycle. The ability to learn the skill came with practice. It’s the same with recovery from stroke. Rehabilitation professionals agree that the most important key to success is carefully directed, well-focused repetitive practice. Recovery also involves learning new ways of doing things. For example, patients may learn to bathe or dress themselves using one hand.

Rehabilitation therapy begins in the hospital within 24 to 48 hours after the stroke occurs. Because the stroke may cause weakness or paralysis, the first part of recovery involves independent movement. A therapist may help the patient move their limbs at first. This is called “passive” therapy. Patients may also be encouraged to perform exercises on their own if they can.

Regaining the ability to carry out the basic activities of daily living is the first step to returning to independent living. Ongoing therapy with a variety of therapists may be needed for months or even years.

Where Will Rehabilitation Occur?

Rehabilitation will usually begin as a form of inpatient care as soon as the patient’s medical condition becomes stable. Then, when the patient is ready for discharge, a hospital social worker will help develop a plan for continuing care and rehabilitation. Some of the options include:

• Discharge to a skilled nursing or other licensed care facility that specializes in rehabilitation therapy. A stay in such a subacute or transitional care setting typically lasts two or three weeks, while the patient receives rehabilitation therapy in preparation for returning home.
• Return home, with arrangements made for ongoing therapy on an outpatient basis. Outpatient rehab facilities typically provide access to physicians and the full range of therapists specializing in stroke rehabilitation. A typical program might include visits several days each week participating in therapy sessions and working on a personalized plan for rehabilitation reviewed and approved by the physician.
• Return home with home rehabilitation. This allows for great flexibility with scheduling and gives patients the advantage of practicing skills and developing compensatory strategies in their own living environment. A disadvantage is that at home, patients don’t have access to the specialized rehabilitation equipment available in an outpatient setting.

What is Involved in Stroke Rehabilitation?

Generally, stroke can cause five types of disabilities:

• paralysis or problems controlling movement
• sensory disturbances, including pain
• problems using or understanding language
• problems with thinking and memory
• emotional disturbances

The kind of rehabilitation a doctor will prescribe depends on the type and degree of disability a patient’s stroke has caused. Post-stroke rehabilitation involves teamwork, with various healthcare professionals working together to achieve a specific set of goals.

Neurologists usually lead acute-care stroke teams and direct patient care during hospitalization, and they sometimes remain in charge of long-term rehabilitation. However, physicians trained in other specialties often assume responsibility after the acute stage has passed, including physiatrists, physicians who specialize in physical medicine and rehabilitation.

The patient’s doctor may also recommend lifestyle changes and/or medication to help prevent a second stroke. These changes may include controlling high blood pressure or diabetes, and eliminating risk factors such as cigarette smoking, excessive weight, a high-cholesterol diet, and high alcohol consumption.

Other healthcare professionals who may help with recovery include:

• Rehabilitation nurses, who specialize in nursing care for people with disabilities
• Physical therapists, who help restore physical functioning by evaluating and treating problems with movement, balance and coordination
• Occupational therapists, who provide exercises and practice to help patients perform activities of daily living
• Speech pathologists, who help patients improve language skills and swallowing
• Social workers, who may help with financial decisions and a plan for returning home or a new living place
• Psychologists or other mental health professionals, who can help with emotional and behavioral changes that may occur after stroke, as well as depression, a common side effect
• Therapeutic recreation specialists, who can assist patients in resuming as fully as possible the hobbies and leisure time activities they enjoyed before the stroke

The Support of Professional In-Home Care

In-home companion care, less costly than skilled nursing, also helps keep stroke survivors safe at home and supports recovery. Trained, professional in-home caregivers:

• Transport patients to doctor appointments, outpatient rehabilitation appointments and other healthcare appointments
• Pick up prescriptions at the pharmacy and help patients use pill reminders
• Prepare meals that meet the nutritional and safety specifications of the patient’s healthcare provider
• Provide supervision and confidence as the patient regains strength and function
• Keep the home clean and safe, removing any hazards that could cause a fall
• Help coordinate other services, including visits from skilled nursing and rehabilitation professionals
• Provide companionship to help patients avoid isolation and depression
• Provide peace of mind and respite for other family members, whether nearby or out of town

The information in this article is not intended to replace the advice of your doctor. Consult with your neurologist or other healthcare provider if you have questions about stroke care and recovery.

Source: Assisting Hands Home Care Potomac in association with IlluminAge. Copyright © IlluminAge, 2015