A Guide to Stroke Rehabilitation:
Take Charge of Your Recovery

Introduction

Recognizing the warning signs of a stroke and implementing effective stroke rehabilitation has the potential to save many lives. Stroke is the most frequent cause of long-term disability in the U.S. and the fourth leading cause of death, according to the American Stroke Association. In fact, it’s estimated that strokes affect about 795,000 Americans, killing 137,000 people—one every four minutes—every year.

Because a stroke can significantly impair motor skills, language, cognition, and physical function, working with a professional rehabilitation team is necessary. The good news is that studies show that earlier and more repetitious rehab can greatly benefit stroke patients by optimizing recovery.

Though they are very common, strokes can be particularly tricky to spot and understand. Learning about the signs can help you catch an episode sooner, enhancing your chances of recovery. Once on the path to rehabilitation, you’ll likely have many concerns, including what types of rehab are available, what to expect from the process, and how best to choose a rehab facility. This guide takes a step-by-step look at each stage of the process, so that you can step toward recovery with the support of your rehab team.

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Chapter 1: What Is a Stroke?

What Is a Stroke?

Strokes are both relatively commonplace, and extremely serious--in fact, chances are one of your family members or friends has experienced one. Sadly, they are a primary cause of long-term disability in adults and the fourth leading cause of death in the U.S. While strokes may be all too common, they are also frequently misunderstood.

Let’s examine the science behind this disease to gain a better understanding of how rehabilitation can help.

A stroke occurs when a vessel that supplies blood to the brain ruptures or becomes blocked, starving brain cells of oxygen and resulting in brain damage. When an area of the brain experiences a sudden reduction or loss of blood flow, the affected brain cells are deprived of oxygen, and within seconds begin to die. 

Though most strokes have this basic element in common, there are five different types of strokes, so it’s important to make that distinction. According to the American Stroke Association, the five main types of strokes include the following:

  • Ischemic Stroke (Clots) Accounting for about 87 percent of all strokes, ischemic strokes are caused by an obstruction in a blood vessel supplying blood to the brain. 
  • Hemorrhagic Stroke (Bleeds) Frequently caused by uncontrolled high blood pressure, this type occurs when weakened blood vessels rupture. You may recognize the two types of hemorrhagic strokes by their common names: aneurysms and arteriovenous malformations (AVMs). 
  • TIA (Transient Ischemic Attack) A TIA is a temporary blockage of blood flow to the brain. One of the most tricky types to diagnose, these are often referred to as “mini-strokes.” However, there is nothing mini about them--they are often early warning signs that a major stroke is to come. 
  • Cryptogenic Stroke  When the cause of a stroke cannot be determined, it’s labeled a “cryptogenic stroke.” Though in most cases, a stroke is caused by a blood clot that blocks the flow of blood to the brain, sometimes tests cannot specify. 
  • Brain Stem Stroke  Because the brainstem controls all basic activities of the central nervous system (consciousness, blood pressure, and breathing) and all motor control for the body, these strokes can impair any or all of these functions. More severe brain stem strokes can cause locked-in syndrome, a condition in which survivors are generally unable to speak or move below the neck.

The First Step: Recognizing the Risks Factors for Stroke

To understand the risk factors for stroke, the first thing to realize is that there are two broad categories of risks: controllable and uncontrollable. While it’s true that having uncontrollable risk factors does not mean that a stroke is inevitable, it’s still wise to evaluate those risks so you can monitor your health carefully.

Uncontrollable risk factors include increasing age, family history of stroke, previous stroke, gender (more females die of stroke than males), and ethnicity (African and Hispanic Americans at higher than average risk). 

The good news is that even if you can’t prevent strokes, knowing which risk factors you can control puts you in a position to make lifestyle adjustments that could dramatically reduce your chances of the disease. 

Let’s review which controllable risk factors you can take into account to lower your overall risk:

The most common ones are:

  • High blood pressure – Damages blood vessels and is the leading cause of stroke
  • Smoking – Causes gradual damage to the cardiovascular system
  • Diabetes – Can cause damage to blood vessels in the brain, particularly when it is poorly controlled
  • High cholesterol – High LDL (bad) cholesterol and low HDL (good) cholesterol have been shown to increase stroke risk
  • Inactivity – Raises risk of high blood pressure, high cholesterol, diabetes, and heart disease, all of which increase stroke risk
  • Poor diet – Too much saturated fat, trans fats, cholesterol and sodium in your diet increase risk of high cholesterol and high blood pressure
  • Overweight or obesity – Increases risk of high blood pressure, high cholesterol, diabetes, and heart disease
  • Arteriosclerosis – Plaque buildup in arteries narrows them, increasing risk of blockages that lead to stroke
  • Existing heart diseases – People with atrial fibrillation, coronary heart disease, congestive heart failure, and dilated cardiomyopathy (enlarged heart) are at greater risk for stroke.
  • Excessive alcohol use – Raises blood pressure and increases risk of arteriosclerosis

In short, controlling your risks means learning to live a healthier lifestyle. Eating a healthy, well- balanced diet and getting plenty of regular exercise can help to alleviate high blood pressure, diabetes, arteriosclerosis, weight problems, and heart disease. It’s best to ask your doctor for a referral to a nutritionist or health coach to obtain professional help.

Knowing the Warning Signs Is Critical

Many times it may not be immediately clear that a person is having a stroke. What is clear is that knowing all the warning signs can help save your life. Time is critical when it comes to responding to a stroke.

Here are eight warning signs of stroke that everyone should know:

  • Facial numbness or drooping – This may be indicated by a lopsided smile or drooping of the eyelid and/or cheek on one side of the face.
  • Weakness or numbness in an arm or leg – A person may have trouble controlling one side of the body, with one arm that drifts downward when asked to raise their arms, a weak grip with one hand, or one leg that shuffles along while walking.
  • Confusion – A person who is having a stroke may suddenly seem confused, having trouble understanding other people or what is going on around them.stroke-rehab-dizzy
  • Difficulty with speech – Speech may be slurred or a person may have difficulty with word retrieval – unable to find the appropriate words to express thoughts or recall the names of everyday items or familiar people.
  • Sudden vision changes – A person in the midst of a stroke may have blurred vision, double vision, or significant gaps in their field of vision, unable to see a person or object slightly off to the side of them, for instance.
  • Trouble walking – A stroke can cause a person to feel very dizzy or suddenly have difficulty with balance and coordination, issues that are often most obvious while a person is standing or walking.
  • Severe and sudden headache pain – Intense, sudden onset headache pain is among the more common warning signs of stroke.
  • Nausea and vomiting – Sudden feelings of all-over weakness, nausea and vomiting with no obvious cause can be a symptom of stroke.

There’s a handy acronym that can help you remember stroke symptoms in a stressful situation. Keep in mind the acronym FAST to recognize it quickly--and act swiftly.  

  • Check the Face for drooping muscles
  • Raise both Arms to check for paralysis
  • Try to Speak and watch out for any slurring or word confusion
  • Finally, check the Time and call 911 immediately

What Are the Most Common Side Effects?

Just like everybody is unique, every stroke patient will experience different effects after a stroke. Patients can expect side effects to fall into three primary groups: physical, cognitive, and emotional. 

Physical Side Effects

The most common physical side effects of a stroke include: 

  • Dysphagia –  Many patients experience difficulty swallowing, or dysphagia, after a stroke. It usually diminishes over time. 
  • Fatigue – Most patients will feel frequently tired, or tire easily, after a stroke.  
  • Muscle impairment – Muscle weakness is common after a stroke. This side effect may be displayed as hemiparesis (weakness on one side of the body), incontinence (the inability to control the bladder and/or bowel movements), foot drop (dragging your toes when walking, in one or both feet), or paralysis (the inability to move muscles or muscle groups). 
  • Pain – Pain is pervasive in stroke patients. It may present as joint pain or other pains caused by miscommunication between the brain and the nervous system. 
  • Seizures and epilepsy – The brain damage caused by a stroke can trigger seizures and/or epilepsy as a side effect. Around 5 percent of stroke patients will have a seizure in the weeks after a stroke. Of those, some may develop chronic seizures and be diagnosed with epilepsy
  • Spasticity – Spasticity refers to painful or uncontrollable muscle movements and spasms that can result from a stroke. 
  • Vision impairment – Up to two-thirds of stroke patients will experience problems with their vision as a side effect. Issues include partial blindness, tunnel vision, double vision, and blind spots.  

Cognitive Side Effects 

According to the National Stroke Association, many individuals who have suffered a stroke also experience some form of cognitive impairment. While patients may experience some or all of these, the typical ones include:  

  • Aphasia – Problems with language use are very common after a stroke. Examples of aphasia include difficulty speaking, word confusion, trouble understanding others’ speech, and issues with reading and/or writing. 
  • Memory loss – Damage to brain cells during a stroke can frequently cause memory loss. Patients may struggle to remember words, names, faces, routes, recent events, or new information. 
  • Sensory issues – Post-stroke patients may confuse sensations like hot and cold, or experience tingling like pins and needles. 
  • Vascular dementia – Patients suffering from vascular dementia after a stroke may have difficulty making decisions, planning, and reasoning. 

Something as simple as following directions may be difficult, as brain injury can slow or impair the ability to process information, and communication may be a struggle. Reading and writing can become monumental tasks as well. For many people, these frustrating difficulties will ease with healing and therapy, but for some, they will persist.

Emotional and Psychological Side Effects

It’s not always easy to see the emotional and psychological effects stroke patients must reckon with daily. That’s why it’s crucial for patients and their loved ones to educate themselves on these challenges, which in some cases can be just as troublesome (if not more so) than the physical symptoms. 

It’s not unusual for many patients who have gone through a stroke to experience issues like: 

  • Post-stroke depression – Strokes can cause a major depressive episode. Signs of post-stroke depression include feelings of sadness, hopelessness or helplessness, alterations to appetite and sleep, and irritability. Depression affects more than one out of three stroke sufferers. As with any life-changing event, it is perfectly normal to feel depression after a stroke. It’s crucial to understand that, for many stroke survivors, the feelings of sadness and loss can actually be caused by physical and chemical changes in the brain related to brain injury. That’s why severe post-stroke depression requires medical attention. When patients experience feelings of hopelessness, worthlessness, apathy, sluggishness and—in many cases—thoughts of death or suicide, they must be treated professionally in order to reclaim their lives. Left untreated, extreme depression can last up to three years after a stroke, significantly impacting every facet of life. stroke-rehab-sad
  • Anxiety – In the aftermath of a stroke, feeling anxious or afraid is also a typical response to the traumatic event as well as the evidence of a stroke-related brain injury. When fearfulness and anxiety can become constant and overwhelming, treatment can prevent this condition from becoming a debilitating one that interferes with stroke recovery.
  • Pseudobulbar affect (PBA) – Up to 50 percent of stroke victims report experiencing PBA at some point. Described as “emotional incontinence,” PBA can manifest as uncontrollable bursts of emotion, including hysterical laughter or tears, which may take place in inappropriate social contexts. Family members may observe emotions that are uncharacteristic of the individual or notice that emotions cycle quickly (i.e. crying one minute then laughing the next) for no obvious reason. Brain injuries inflicted by stroke cause this condition, which usually improves or resolves over time as the brain heals. Medication is available for PBA if it is severe enough to inhibit progress with stroke rehab.

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Chapter 2: Recovering From A Stroke

Recovering From A Stroke

The long-term goal of rehabilitation is to help improve the stroke survivor's physical and cognitive functions, to relearn the skills they have lost, and to ultimately improve their overall quality of life so that they can become as independent as possible.

Recovering from a stroke is a process, but there is encouraging news. Studies show that earlier and more repetitive rehab can greatly enhance recovery. With that in mind, stroke rehabilitation generally starts in the hospital, as soon as the patient is stable. It often begins as early as two days after a stroke has occurred and continues in the hospital until the patient is able to be released.

The Rehab Option you choose should depend on the situation and severity of the stroke. 

The range of options available includes:

  • Staying in the hospital while participating in inpatient therapy
  • Transitioning to a long-term care facility that provides rehab therapy and skilled nursing care
  • Entering a subacute care unit
  • Choosing a rehabilitation facility that offers individualized inpatient or outpatient therapy
  • Opting for in-home physical therapy
  • Selecting a combination of home therapy and outpatient therapy

Types of Stroke Rehab

The repetition in stroke rehab is part of what makes it successful. Practicing learned skills consistently can help patients adapt and recover some brain function. Generally, stroke rehab aims to address the physical, cognitive, and emotional impact strokes can have. Let’s learn more about how the main types of rehab fall under these broad categories:stroke-rehab-walker

Physical Therapy

Physical rehab focuses on strengthening motor skills. Exercises are designed to help improve muscle strength and coordination, utilizing specific therapies in order to strengthen the stroke-affected parts of the body.

For example, many stroke survivors will go through mobility training to learn to use walking aids (canes, braces, or walkers) and to help increase ankle strength, which will better help support the body. Forced therapy, or constraint-induced therapy, involves restricting the use of an unaffected limb to help stroke survivors practice moving the affected limb. Range-of-motion therapy exercises help lessen muscle tension and help patients regain range of motion.

Technology is becoming increasingly incorporated into many types of stroke rehabilitation. For example, controlled amounts of electricity can be used to stimulate weakened muscles. The electricity causes those muscles to contract, helping with muscle memory. Other therapies use robotic devices to help assist impaired limbs in performing repetitive motions.

Cognitive Therapy

Cognitive therapies are used for communication disorders caused by stroke damage in the brain. This therapy helps patients regain lost abilities in comprehension, speaking, listening, and writing. Evaluations are used to test cognitive skills and emotional adjustment. Counseling with a mental health professional is typically provided.

Psychiatric Therapy 

It is not uncommon for patients to need psychiatric help after a stroke for depression. Although depression can come as a result of having a stroke and the life changes that may occur, depression as a direct effect of the stroke is also not uncommon. Strokes cause brain changes that can actually cause depression, depending on where the injury from the stroke occurs.

Psychotherapy ("talk therapy") can help relieve patients' depression after a stroke and improve recovery. Psychotherapy is also beneficial to family members who are dealing with the ramifications of the stroke. Further, when patients are responding favorably to their treatment for depression, they are also much more likely to be compliant with rehabilitative therapies that will help them restore physical and cognitive abilities.

Most antidepressants are extremely safe for those who are recovering from a stroke. But make sure to note any medications patients may be taking, since there may be unwanted interactions with other medications. Additionally, some supplements may be contraindicated with these medications, or because of the stroke itself. Unwanted interactions and side effects from the medications will need to be monitored by a physician.

Tips for Making the Most of Stroke Recovery

Since every stroke patient is different, there simply are no easy answers as to how fast or how far recovery will progress. Still, you should know that there are things you can do to help ensure that recovery potential is realized to the very fullest. With that in mind, here are three tips for stroke recovery.

  1. Get started quickly - Early, intensive rehabilitative therapy has been shown to improve levels of recovery, so rehabilitation should begin as soon as it’s medically safe and feasible. In fact, physical and occupational therapy are often initiated before hospital discharge. Additionally, research has shown that therapy provided by a well-coordinated, multidisciplinary team of rehabilitative specialists and in a therapeutic environment can make a substantial difference in recovery, which is why an intensive inpatient program may be your best place to start your rehabilitation journey. 
  2. Work on your deficits - Stroke survivors who spend time in occupational therapy are taught how to compensate for functional deficits, or physical impairments, that result from stroke. While learning to work around those deficits is very important, if optimal recovery is your goal, so too is working to improve them. That's why occupational therapy professionals also stress the importance of exercising, moving and using limbs on your affected side that may be weakened or even paralyzed by stroke. 
  3. Don't buy into the "recovery plateau" myth - It was once commonly believed that there was a distinct window of recovery for stroke patients. This assumption was based on the idea that improvement came to a halt once the physical healing of tissues in the brain had occurred, which led to the assumption that the level of recovery a patient had achieved within six months was the best that patient could hope for. However, that idea of the "recovery plateau" has long been discredited by advancing knowledge of neuroplasticity—which is the brain's ability to forge new pathways and connections. It is now known that continuing therapy, especially speech and occupational therapy, can continue to yield functional improvements over many months, and even years, in stroke survivors. 

What’s a Typical Stroke Recovery Timeline?

The stroke recovery timeline is unpredictable. Some patients may recover completely within weeks of a stroke; others may take months or even years to recover fully; and still others may experience moderate to severe side effects on a permanent basis.

While it is difficult to estimate how long a patient will take to recover from a stroke, we can examine a number of factors that affect how long recovery will take: 

Stroke Type

There are several different types of strokes, and they will have varying impacts on the patient’s stroke recovery timeline. Stroke types include: 

  • Transient ischemic attack (TIA) – Sometimes called a “warning stroke,” TIAs are not full-blown strokes and are therefore less likely to cause long-term severe side effects. During a TIA, the patient experiences “stroke-like” symptoms for hours. 
  • Ischemic Stroke – Ischemic strokes are the most common type - up to 87% of strokes are ischemic. In this type of stroke, a blood vessel to the brain is obstructed by a clot. 
  • Hemorrhagic Stroke – This type of stroke involves a bleed in the brain, usually when a weakened blood vessel ruptures. Blood collecting in the brain tissue causes it to weaken and die. 

Stroke Location

The type of side effects experienced by a patient will vary depending on whether the stroke happens in the left or right hemisphere of the brain or the brain stem. stroke-rehab-brain-sides

  • Left brain stroke – If the stroke affects the left side of the brain, the patient will be more likely to experience paralysis on the right side of the body, aphasia, memory issues, and hesitant, slow movements, and behavior. 
  • Right brain stroke – Patients with a stroke on the right side of the brain are more likely to experience left-body paralysis or weakness, vision problems, memory loss, and quicker movements and behavior. 
  • Brain stem stroke – Usually, brain stem stroke patients experience severe dizziness and loss of balance, double vision, slurred speech, and loss of consciousness. Severe brain stem strokes can cause locked-in syndrome, in which the patient can only move their eyes. In mild and moderate cases, double vision and vertigo can resolve themselves after several weeks. The function of the brain area affected by the stroke will also have an impact on symptoms and recovery rates. For example, a stroke toward the back of the brain will likely have an impact on vision.

Stroke Severity

Of course, the most significant factor for a stroke recovery timeline is how serious the stroke was. The stroke may only have caused blood flow loss to a small area of the brain, in which case recovery will be faster and easier. If the stroke affected a larger area, recovery will obviously take longer. 

If the patient received prompt treatment immediately after the stroke, the damage will often be less severe than in a patient whose stroke passed unnoticed for hours. According to the National Stroke Association, 10% of stroke patients will recover completely; 25% will suffer mild on-going symptoms; 40% will be moderately impaired, and 10% will require long-term care. 

Stroke Recovery Process

Every stroke is unique; therefore, the recovery process will be different for every patient. This stroke recovery timeline is intended only as a rough guide for what to expect.

Stage 1: Initial Recovery 

The process of stroke recovery begins as soon as the stroke victim has been treated for any critical symptoms, while the patient is in hospital. Doctors will take preventative measures to prevent any further strokes. Rehab will often begin at this stage, and patients are encouraged to sit up, move around, and, if possible, stand and walk around.  

Stage 2: First 2 Weeks

Patients who have experienced a minor stroke will usually be discharged from the hospital within a week. Survivors of major strokes may take longer to leave intensive care. Once discharged, patients with severe side effects will likely be transferred to a long-term acute care facility; those with less serious issues will either be referred to an inpatient or outpatient rehab center. The majority of patients will experience a 50 percent recovery within the first two weeks. 

Stage 3: Month 3

All patients are recommended to undergo intensive rehabilitative therapy during the first two to three months of recovery. The Stroke Association explains: “For the first three months after a stroke, the brain is much like a new brain. It’s ready to learn, ready to make new connections. This ability for our brains to adjust is known as neuroplasticity, and it plays a vital role in recovery. It takes about three months after the stroke for neuroplasticity to return to a more normal state. After that, a survivor can still work on regaining function and practice for improvement, but those improvements may come at a slower pace.”  

stroke-rehab-railing

Stage 4: Beyond Month 3 

Once patients have completed a course of intensive rehab, they will be advised to continue rehabilitation at home. The rehab team will provide guidance on appropriate exercises and lifestyle choices, designed to improve quality of life, minimize remaining post-stroke symptoms, and reduce the risk of another stroke. While the majority of recovery takes place in the first weeks and months after a stroke, the Mayo Clinic confirms that “performance can improve even 12 to 18 months [afterwards].”

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Chapter 3: What Is Stroke Rehabilitation?

What Is Stroke Rehabilitation?

Post-stroke rehabilitation helps those who have suffered strokes to relearn the skills they lost due to the brain damage caused by the stroke. For instance, these skills may include coordinating leg movements to allow an individual to walk again or performing steps in a complex activity. Therapists teach stroke survivors new ways to perform tasks to compensate for the loss of movement.

Following a stroke, an individual may only be capable of dressing or bathing using just one arm or hand. He or she may also need to learn how to communicate effectively if his ability to speak is compromised. Reacquiring the ability to perform these daily activities is the first stage stroke survivors need in order to regain their independence. Rehabilitation experts agree that a well-focused, carefully directed, repetitive practice is a fundamental element of any rehabilitation program.

The kinds of disabilities and the degree of impairment a stroke causes depends on the area of the brain that is damaged and how much damage was done. Comparing one person’s disability to another is difficult because every stroke may damage different parts of the brain and cause the following:

  • Sensory disturbances
  • Paralysis
  • Difficulty controlling movement
  • Problems understanding and using language
  • Emotional disturbance

Life After a Stroke: Rehab, Recovery, and New Beginnings

The good news is that with effective stroke rehab therapy, as well as a great deal of determination, hard work and patience, you can take your life back from stroke, and overcome many of the challenges it brings to move on to a fulfilling future.

Stroke rehabilitation is a comprehensive program to help you recover from the effects of the event and lower your risk of having another one. The typical program will begin by assessing the damage stroke has done, as well as your existing risk factors for a subsequent stroke in order to formulate a personalized plan to address your needs.

That assessment is typically done by a team of medical professionals and therapists that may include a general physician, neurologist, Neuropsychologist, physical therapist, speech-language pathologist, occupational therapist, dietitian, and rehabilitation nurse, among others. Generally, a case manager is also involved in coordinating your care.

Inpatient or Outpatient Rehab?

Inpatient stroke rehab involves checking into a specialized rehabilitation facility for intensive therapy and care. Outpatient rehabilitation therapy may consist of appointments at a rehabilitation clinic daily or several times per week or having therapists and other rehab professionals provide services in your home.

Which option is best for you is a decision best made with your doctor who will be familiar with your personal circumstances. However, many patients—especially those who experience significant impairments after stroke—find that the round-the-clock professional attention and intensive rehabilitation programs of dedicated inpatient rehab centers benefit them greatly during those first weeks after stroke, helping them recover more quickly and stay motivated.

What Stroke Therapies Are Available for Patients?

Stroke therapies are prescribed to address how individuals experience symptoms, so there is no one-size-fits-all model. To understand which types of therapies are available to you or your loved one, let’s examine how common symptoms are treated by different types of therapy:

TIA Symptoms

If TIAs occur, patients may note gradual changes in the way they walk, understand others, or respond behaviorally. In many cases, TIA symptoms are difficult to recognize as they are often attributed to the aging process or are considered to be related to a current health condition.

Sensory Deprivation

Stroke survivors often experience sensory deprivation, feeling prickly or tingling sensations in their weakened limbs. When this occurs, the symptom is referred to as paresthesias. In addition, survivors may lose their ability to control the bladder muscles or bowels as well.

Chronic Pain

Nervous system damage can be the basis for neuropathic pain, resulting in chronic discomfort in specific areas of the body. One of the areas affected in this respect is the thalamus, the part of the body that processes sensory details and relays them to the brain. Pain can also be associated with weakness or paralysis. For example, patients who experience paralysis in the arm frequently feel a radiating type of pain.

Rehabilitation is necessary to correct pain or discomfort as a lack of movement can cause what is referred to as a “frozen” joint. A caregiver uses a therapy, called passive movement, which involves flexing the paralyzed arm in order to lessen the pain.

Speech and Swallowing Difficulties

Besides using physical therapy for rehabilitation purposes, treatment may extend to occupational and speech therapies. Approximately 25 percent of stroke survivors experience speech impairments or aphasia. Patients may also find it difficult to swallow – a condition that is known as dysphagia.stroke-rehab-cognition

Cognitive Challenges

Stroke rehabilitation may also include the treatment of apraxia. Apraxia is defined as an inability to follow and carry out the steps needed to proceed with a task. When apraxia affects one’s speech, it is known as dyspraxia, a disorder that makes it difficult for a patient to say what he or she wants to convey.

Psychiatric Care

In addition, stroke patients frequently require psychological or psychiatric care, as they often feel one of a variety of emotions. Feelings of anxiety or depression can emerge that result from either psychological trauma or damage to the brain.

What Does a Typical Rehab Healthcare Team Look Like?

Proper stroke rehabilitation involves the skills of physicians, nurses, physical therapists, recreational therapists, speech and language professionals, occupational therapists, and mental healthcare specialists. Understanding each role is key to working effectively with your team.

Rehab Physicians prevent a second stroke from occurring by managing the patient’s blood pressure and eliminating or reducing such risk factors as obesity, alcohol consumption, and smoking. Neurologists and psychiatrists are also part of the rehabilitation team.

Nurses in rehab facilities help stroke survivors regain their ability to carry out the activities of daily living or ADLs. Sensory or motor disabilities are treated by physical therapists, while occupational therapists help stroke survivors relearn such basic “occupational” skills as meal preparation, housekeeping, and personal grooming.

Speech therapists or pathologists assist aphasic patients in learning how to speak and assimilate information. They also help patients whose swallowing has been affected by a stroke. Rehabilitation for a stroke patient should begin within 48 hours of the event.

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Chapter 4: Types of Stroke Rehabilitation

Types of Stroke Rehabilitation

At facilities like Rehab Select, a team of rehabilitation specialists forms to help you achieve your goal. A post-stroke rehab team offers numerous techniques to help build momentum toward your recovery. We’ll discuss some of the six stroke rehabilitation methods and their benefits here.

Speech-Language Therapy

Speech and language pathologists help patients recover their ability to communicate and swallow after a stroke. They also help improve skills related to reading and writing. In speech and language therapy, you practice techniques to help you relearn or find alternative methods for communication.

Most strokes affect only one side of the brain. The left side of the brain is normally tasked with controlling speech and understanding language. So, if a stroke affects the left side of the brain, it is possible for it to affect that person's ability to speak or to understand what is being said. This is part of a condition known as aphasia.

Aphasia can cause problems with speaking, listening, reading, writing, understanding speech, and, thinking of words when speaking or writing. The exact symptoms involved with a particular patient depend on the type and severity of the injury to the brain. It affects about 20 percent of stroke patients.

Techniques Used:

Some of the techniques used to improve swallowing include body positioning, tongue strengthening exercises, and dietary modifications. Your therapist can teach you how to prepare food, engage your swallowing muscles, and sit properly to make swallowing easier. 

If you experience problems communicating, such as constructing sentences, comprehending, or remembering words, your therapist uses a variety of approaches to improve your skills. For example, they can teach you breathing and cadence exercises to improve sentence formation and speech coordination. Word meaning and repetition practice help you build new neural pathways between words and their meanings. 

Benefits:

Learning how to speak again is just like learning a new language. With practice, word associations become stronger, and your conversation and comprehension skills improve. Those communication skills are vital for relationships, work, and everyday activities.

Swallowing skills help you avoid the choking issues, malnourishment concerns, and embarrassment associated with not being able to swallow.

The speech therapist can also help you use your remaining abilities to the fullest, to restore language abilities where possible, to work around remaining language problems, and to learn other ways to get the message across.

Families are usually a major part of the therapy since they communicate with the patient on a daily basis. They have to learn how to communicate with the patient and to help them on the road to recovery. They should speak to the patient as an adult and include them in ongoing conversations. They should encourage communications of all sorts, whether by word, by gesture, or by drawing.

Physical Therapy

An individualized physical therapy program helps stroke patients regain their physical function or compensate for physical deficits after a stroke. Strokes often cause temporary or permanent paralysis on one side of the body, and the purpose of physical therapy is to improve mobility and movement where there’s impairment.

Techniques Used:

Physical therapy for stroke often involves strength and mobility training and range-of-motion exercises. A physical therapist can help you improve the function of impaired limbs with motor relearning techniques and ambulation. They may also incorporate e-stimulation and other therapies into their treatment plans.

Benefits: 

Physical therapy helps keep affected muscles and nerves stimulated even before you’re able to use them again. Once you’re able to move about, physical therapy helps you retrain your brain and regain control of your body. Balance and coordination help you avoid falls while mobility exercises and assistive devices allow you to perform your daily activities again.

The brain cannot regenerate any cells lost during the stroke, but physiotherapy can help the brain reorganize existing cells to compensate for the loss (neuroplasticity), according to the Stroke Association. This requires a full physical recovery plan that includes:

  • Exercise
  • Massage
  • Learning new skills
  • Electrical treatment
  • Manipulation

The amount of time a person and their physiotherapist spend on each part of the recovery plan is determined by the doctor and therapist. They will devise a plan that helps the patient reach new goals and retain normalcy in a safe and controlled environment.

“Stroke patients will have some natural recovery without rehab, but there is quite a bit of evidence that formal rehabilitation helps patients recover faster and better than they would otherwise,” comments Dr. E.S. Claflin of the University of Michigan. 

Key benefits of physical therapy after a stroke include: 

  • Improved overall strength and mobility 
  • Preventing muscle atrophy
  • Better quality of life
  • More independence 
  • Better mood 

Occupational Therapy

Occupational therapy focuses on restoring your ability to perform routine daily activities, such as cooking, driving, doing household chores, and grooming. An occupational therapist also helps you overcome physical limitations, adapt your living spaces, and avoid safety concerns.

Techniques Used:

Perceptual training is one technique often used in occupational therapy to help patients with sensory and perceptual deficits. This type of training helps stroke patients overcome visual impairments, perception problems, or one-sided paralysis.

Repetitive activities are another method used to help stroke survivors relearn how to perform necessary tasks. For example, your therapist may break up tasks into single activities (i.e., cracking, whisking, then folding eggs) and have you repeat each activity. Then, you practice performing the activities in sequence until you master the skill (i.e., cooking scrambled eggs).

Benefits:

The main goal of occupational therapy is to restore your independence and improve your quality of life after a stroke. The stroke therapy equips you with the proper tools to make a safe, effective return home.

Neurological Therapy

Neurological therapies help improve cognitive and motor impairments caused by brain and nerve damage from a stroke. These therapies can improve recovery and reduce symptoms. 

Techniques Used:

Magnetic brain stimulation is a new, promising neurological treatment for stroke patients. The noninvasive stroke therapy stimulates nerve cells to encourage neuroplasticity and brain healing. Brain exercises for stroke recovery may also be included in your treatment plan. They include brain teasers, puzzles, music, and creative projects.

Benefits:

The neuroplasticity of our brains allows them to change, adapt, and learn new patterns at any age. Magnetic brain stimulation appears to help patients walk and move better after a stroke while brain exercises help sharpen your cognitive function.

Mirror Therapy

Mirror therapy is a technique for one-sided paralysis or weakness. Your therapist has you move your unaffected limb and watch it in a mirror. Your brain processes the movement in the mirror as though it’s happening to the affected limb. Eventually, you may notice improvements in your control of the affected side.

Techniques Used:

During mirror therapy, most people do small hand, arm, and fine motor skill exercises with the mirror. Not only does this improve strength and coordination in the unaffected limb, but it also enhances motor control on the affected side. 

Benefits:

During mirror therapy, the brain perceives the affected side moving in the mirror and starts to rewire itself as though it truly is moving. With time, this process may improve strength and mobility on your weak or paralyzed side.

Recreational Therapy

Like occupational therapy, recreational therapy helps you return to the activities you enjoy or learn new ones, specifically recreational activities. Your occupational therapists help you spend your leisure time doing things that improve your mood or provide health benefits.

Techniques Used:

Recreational therapists use many of the techniques used during physical, speech, and occupational therapy to help you successfully participate in leisure time activities. You use the communication skills from speech therapy to interact with others and the physical abilities gained from physical and occupational therapies to perform activities.

Benefits:

Returning to your hobbies is a gratifying feeling. Your recreational activities give meaning and purpose to your time. They help you enjoy your days. What you do in your leisure time can also help you recover faster and improve your feelings of social connection.

How Inpatient Rehab Facilities Help with Your Post-Stroke Care Plan

An inpatient post-stroke care plan is a basic, personalized rehabilitation plan to help stroke patients regain as much function and independence as possible before they return home. Here are some of the ways inpatient facilities provide support to stroke survivors:

Improve Progress

Inpatient facilities like Rehab Select use evidence-based approaches to design personalized treatment for stroke patients to ensure the best possible outcome for you or your loved one. Your team looks at which treatments are going to be the most beneficial to maximize recovery.

Immediate, intensive care provides the best outcome after a stroke. Without quick, multi-disciplinary stroke care, you could potentially experience slower recovery than necessary. 

Give You Access to Well-Rounded Care

Inpatient facilities provide around-the-clock, on-site, specialized care. This type of care is convenient for both caretakers and patients and also offers more comprehensive support for the patient. Your team will likely schedule a minimum of three hours of therapy several days per week. This is the level of intensity that is most beneficial for your recovery. Attending back-to-back treatments at the same location also improves your chances of recovery.

All your caretakers communicate and meet regularly too so they're on the same page and can support the other’s therapy. Your care plan may be adjusted over time to keep pace with your progress. 

Offer Specialized Treatment for Stroke Patients

Ideally, the inpatient rehab facility you choose should specialize in post-stroke care. The providers at Rehab Select, for example, offer physical, occupational, speech, and any other necessary therapies as well as doctors and nurse practitioners who specialize in stroke recovery. These highly-skilled practitioners all work with stroke patients regularly, so they're the best equipped to meet your needs.

Provide Additional Outside Resources

The staff of an inpatient stroke rehab program are knowledgeable about community programs and other resources you may need outside of the rehab facility. Your providers can make referrals to additional medical specialists who might be beneficial. They can also put you in contact with resources you might not know are available, including in-home help and support groups.

Your care plan continues after you leave the facility, for the rest of your life, and typically includes ongoing care and these supplementary resources. Your inpatient providers will show you what your long-term post-stroke care plan looks like after your stay.

How to Choose The Right Stroke Rehab Facility 

If you, or your loved one, has suffered a stroke, you may feel uncertain about which type of facility would be the best fit. The American Stroke Association recommends that in general, patients who have suffered a serious stroke should participate in intensive inpatient rehab for as long as possible.

Skilled Nursing Facilities are appropriate when patients no longer need full-time hospital care but are not yet well enough to return home. Outpatient rehab is suitable only if the patient has enough support at home to ensure their safety while they recover, or if the patient is only experiencing mild side effects after a stroke. At-home therapy has the disadvantage that no professional equipment is available; however, in some cases, it may be beneficial for the patient to receive care in their own home to become confident in their daily routine once more. 

Questions to Ask When Choosing a Stroke Rehab Facility 

Some people find choosing a stroke rehab facility overwhelming. Here are some questions that you should resolve before selecting a rehab facility for you or your loved one:

Questions for Your Insurance Provider: 
  • What rehabilitation services are covered by the patient’s medical policy? 
  • What is the maximum amount of rehab that the patient can receive? 
  • What rehab facilities are in your insurance network? 
  • Are there any additional financial resources available?
  • Who will cover unexpected additional medical costs?stroke-rehab-questions
To Ask the Rehab Facility (Based on Guidelines from the American Stroke Association): 
  • Do they offer a specialist stroke rehab program? 
  • How many patients are currently receiving stroke rehab care? 
  • How will progress be evaluated? 
  • How do they measure functional recovery? 
  • What treatments are available? 
  • Where will rehab take place? 
  • How do they assure the quality of care for each patient? 
  • Are they certified to treat stroke patients? 
  • What percentage of short-term stroke rehab patients are discharged home? 
  • What support do they offer family members and caregivers? 
  • What psychological support is offered to stroke patients? 
  • How do they prevent falls? 
  • How do they prevent recurrent strokes? 
  • What specialist training do the nurses, therapists and support staff have?
  • Which professionals will be involved in patient care? 
  • How frequently will the patient see a physician? 
  • Do they offer 24-hour medical supervision? 
  • What will the patient schedule look like?  

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Chapter 5: Advances in Stroke Rehabilitation

Advances in Stroke Rehabilitation

The good news is that there have been several recent breakthroughs in stroke recovery and rehabilitation, which may lead to significant improvements in the quality of life and health outcomes of stroke patients. Here are five of the most important:

Thrombectomy After 6 Hours

A thrombectomy is a surgical procedure to remove a blood clot from a blood vessel, usually a cerebral artery. Previously, it was thought that thrombectomies were only a viable option for patients within the first 6 hours of the stroke. However, trials have revealed that thrombectomy can be helpful for patients even up to 24 hours after the stroke, improving the likelihood that they will recover functional independence. Coupled with guidelines from the American Heart Association, encouraging Emergency Medical Service professionals to take stroke patients to hospitals where thrombectomies can be performed, this discovery should reduce the severity of stroke symptoms for many patients.

Neuromodulation, a term usually referring to the process of modifying and/or stimulating neuronal activity in the brain tissue of stroke patients, is already in frequent use during post-stroke rehab. 

Vagus Nerve Stimulation

A study reported in the Stroke journal found that, when coupled with physical rehabilitation, a new kind of treatment called vagus nerve stimulation could more than double the rate of recovery for patients with impaired upper limbs. During the pilot study, patients were implanted with a medical device that delivered electrical impulses to their vagus nerve, a long nerve that controls varied tasks including heart rate, peristalsis, sweating and several muscle movements, including speech. Vagus nerve stimulation seems to work by providing a boost to the neurons involved in muscle movements. While more research is needed, this new development could have significant positive implications for stroke rehabilitation.stroke-rehab-shock-therapy

Repetitive Transcranial Magnetic Stimulation

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive procedure, in which an electrode is held near the patient's head, and magnetic pulses are sent through to the brain. It has been used for over 20 years for the treatment of severe depression. Research has found that it can also form a highly effective component of stroke rehabilitation. In a study published in Frontiers in cellular neuroscience, researchers demonstrated that: "High-frequency rTMS in stroke patients can be used to promote functional recovery by inducing the endogenous repair and recovery mechanisms of the brain."

Virtual Reality

New neuromodulation techniques are not the only applications of innovative technology for stroke rehab. Virtual reality systems may also be useful in helping restore brain function after strokes. These tools offer several benefits to stroke patients:

  • They are a cost-effective way of continuing rehabilitative treatment in their own homes once they have completed an in-patient program;
  • They allow patients to direct their rehab treatment, meaning that they can control the pace themselves;
  • As they are based on gaming principles, they are often fun to use and helpfully habit-forming.

Umbilical Cord Infusions

Research published in the Journal of Stem Cells Translational Medicine found that a single infusion of umbilical cord blood was both safe and helpful in the treatment of ischemic strokes. Umbilical blood is rich in mesenchymal stem cells, the parent cells of all tissue cells in the human body, and therefore, the cells most helpful in the treatment of brain injuries. The discovery was based on previous research which found that an infusion of infant blood could help slow the process of brain aging in animals; researchers theorized that umbilical cord blood might, therefore, stimulate the development of new neuronal activity in stroke patients.

How Technology is Changing Stroke Recovery Programs

There are many ways that technology is having a positive impact on the way people recover from stroke. These recovery techniques are designed to repair the brain by using a concept known as neural plasticity; the brain’s ability to repair itself after sustaining damage.

One of the most common kinds of stroke rehabilitation technologies is known as functional electrical stimulation, or FES. FES affects the way that nerve cells fire by treating them with electric currents, which can allow stroke victims to regain the functionality that they once had.

Another way that technology is impacting stroke rehabilitation is through the use of video games. Video games, especially ones that use motion sensing technology like the Nintendo Wii, are ideal for stroke recovery because they allow patients to practice some of the same motions they are attempting to regain ability in: lifting, swinging and grabbing. Video games also allow stroke patients to practice their motor skills, as many of them require good hand-eye coordination in order to be completed properly.

Why Video Games Are Great for Stroke Victims

Video games are a great option because they add a fun, light element to an extremely serious condition. They also provide patients with a form of rehabilitation that, while challenging, is also enjoyable for them.stroke-rehab-video-games

Video game rehabilitation for strokes is successful for the same reason that other kinds of rehabilitation are successful: a concept called neuroplasticity. This concept is related to the brain’s ability to improve its function in a certain area to compensate for injuries in other areas. Combined with consistent exercise, neuroplasticity allows stroke patients to recover some of the functionality they lost. Video games also help stroke victims improve their hand-eye coordination, another area that can be negatively impacted after a stroke occurs.

Conclusion

With so much information at your disposal, it may be hard to decide where to start. Having a firm grasp of the complex ways that stroke can impact daily living and how stroke rehabilitation can help is the first step. It’s a lot to take in, but you don’t have to go through it alone. Finding the right stroke rehabilitation program and professional team means that you will have a support network to guide you through each step. 

With many stroke rehab programs, it can be difficult to know which one to choose. Rehab Select’s specialized rehab facilities have helped hundreds of patients recover after a stroke. The goal is to restore the patient to their daily life as quickly as possible while thinking about the quality of life of every patient. At Rehab Select, each individualized stroke therapy program is designed to preserve patient dignity and help restore their self-confidence and autonomy. 

Choosing the right rehab facility may be one of the most important decisions stroke patients and their loved ones have to make. Finding a rehab center that best serves the patient’s needs and reflects their budget, symptoms, and physical and mental condition can have a major impact on the rate of their recovery. 

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