STROKE REHABILITATION

 Stroke rehabilitation: What to expect as you recover

Stroke rehabilitation (stroke rehab) is an important part of recovery after stroke. Find out what's involved in stroke rehabilitation.

The goal of a stroke rehabilitation program is to help you relearn skills you lost when stroke affected part of your brain. Stroke rehabilitation can help you regain independence and improve your quality of life.

The severity of stroke complications and each person's ability to recover lost abilities varies widely. Researchers have found that the central nervous system is adaptive and can recover some functions. They also have found that it's necessary to keep practicing regained skills.

What's involved in stroke rehabilitation?

There are numerous approaches to stroke rehabilitation, some of which are still in the early stages of development. Behavioral performance in any area, such as sensory-motor and cognitive function, is most likely to improve when motor activity is willful, repetitive and task specific.

Stroke rehabilitation may include some or all of the following activities, depending on the part of the body or type of ability affected.

Physical activities:

• Strengthening motor skills involves using exercises to help improve your muscle strength and coordination, including therapy to help with swallowing.
• Mobility training may include learning to use walking aids, such as a walker or canes, or a plastic brace (orthosis) to stabilize and assist ankle strength to help support your body's weight while you relearn how to walk.
• Constraint-induced therapy, also known as forced-use therapy, involves restricting use of an unaffected limb while you practice moving the affected limb to help improve its function.
• Range-of-motion therapy uses exercises and other treatments to help lessen muscle tension (spasticity) and regain range of motion. Sometimes medication can help as well.

Technology-assisted physical activities:

• Functional electrical stimulation involves using electricity to stimulate weakened muscles, causing them to contract. This may help with muscle re-education.
• Robotic technology uses robotic devices to assist impaired limbs with performing repetitive motions, helping them regain strength and function. A recent large study showed no clear advantage to using robotic technology to improve motor recovery after stroke.
• Wireless technology, such as a simple activity monitor, is being evaluated for its benefit in increasing post-stroke activity.
• Virtual reality, such as the use of video games, is an emerging, computer-based therapy that involves interacting with a simulated, real-time environment.
• Noninvasive brain stimulation. Techniques such as transcranial magnetic stimulation (TMS) have been used with some success to help improve a variety of motor skills.

Cognitive and emotional activities:

• Therapy for communication disorders can help you regain lost abilities in speaking, listening, writing and comprehension.
• Psychological evaluation and treatment may involve testing your cognitive skills and emotional adjustment, counseling with a mental health professional, or participating in support groups.
• Medications are sometimes used to treat depression in people who have had a stroke. Drugs that affect movement are also used.

Experimental therapies:

• Biological therapies, such as stem cells, are being investigated, but should only be used as part of a clinical trial.
• Alternative medicine treatments, such as massage, herbal therapy and acupuncture, are being evaluated.

When should stroke rehabilitation begin?

The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills. However, your doctors' first priority is to stabilize your medical condition and control life-threatening conditions. They also take measures to prevent another stroke and limit any stroke-related complications.

It's common for stroke rehabilitation to start as soon 24 to 48 hours after your stroke, during your acute hospital stay. If your medical problems continue for longer, your doctors may wait to begin your rehabilitation.

How long does stroke rehabilitation last?

The duration of your stroke rehabilitation depends on the severity of your stroke and related complications. Although some stroke survivors recover quickly, most need some form of stroke rehabilitation long term, possibly months or years after their stroke.

Your stroke rehabilitation plan will change during your recovery as you relearn skills and your needs change. With ongoing practice, you can continue to make gains over time.

The length of each stroke rehabilitation therapy session varies depending on your recovery, severity of your symptoms and responsiveness to therapy.

Where does stroke rehabilitation take place?

You'll probably begin stroke rehabilitation while you're still in the hospital. Before you leave, you and your family will work with hospital social workers and your care team to determine the best rehabilitation setting depending on your needs, what insurance will cover, and what is most convenient for you and your family. These options include:

• Inpatient rehabilitation units. These facilities are either freestanding or part of a larger hospital or clinic. You may stay at the facility for several weeks as part of an intensive rehabilitation program.
• Outpatient units. These facilities are often part of a hospital or clinic. You may spend several hours a day at the unit, but return home each night.
• Skilled nursing facilities. The type of care available at a nursing facility — sometimes referred to as a nursing home — varies. Some facilities specialize in rehabilitation, while others offer less-intense therapy options.
• Home-based programs. Having your therapy at home allows greater flexibility than other options. One drawback is you likely won't have access to specialized rehabilitation equipment. In addition, insurance strictly controls who qualifies for home-based therapy.

Talk to your doctor and family about the best option for you.

Who participates in your stroke rehabilitation team?

Stroke rehabilitation involves a variety of specialists.

Some specialists help with physical needs, including:

• Physicians include your primary care doctor as well as specialists in physical medicine and rehabilitation (physiatrists) and neurologists. They help guide your care and prevent complications. They also help you to gain and maintain healthy lifestyle behaviors to avoid another stroke.
• Rehabilitation nurses specialize in caring for people with limitations to activities. They help incorporate skills learned in physical, occupational and speech therapy into your daily routines. They also can offer options for managing bowel and bladder complications of stroke.
• Physical therapists help you relearn movements such as walking and keeping your balance.
• Occupational therapists help you relearn functional hand and arm use for daily skills, such as bathing, tying your shoes or buttoning your shirt. They can also address safety issues in your home, and help with cognitive organizational tasks.

Other specialists focus on cognitive, emotional and vocational skills, including:

• Speech and language pathologists help improve your language skills and ability to swallow. They may also teach you how to use compensation tools to address memory, thinking and communication problems.
• Dietitians assist you with creating healthy menus, including heart-healthy, low-fat and low-salt foods.
• Social workers help connect you to financial resources, as well as help you plan for new living arrangements, if necessary, and identify community resources.
• Psychologists assess your thinking skills and help address your mental and emotional health concerns.
• Therapeutic recreation specialists help you resume activities and roles you enjoyed before your stroke, including hobbies and community participation.
• Vocational counselors help you address return-to-work issues if this is a goal. They can provide information about the Americans with Disabilities Act (ADA) to help with workplace accommodations, if needed.

What factors affect the outcome of stroke rehabilitation?

Because stroke recovery varies from person to person, it's hard to predict how many abilities you might recover and how soon. In general, successful stroke rehabilitation depends on:

• Physical factors, including the severity of your stroke in terms of both cognitive and physical effects
• Emotional factors, such as your motivation and mood, and your ability to stick with rehabilitation activities outside of therapy sessions
• Social factors, such as the support of friends and family
• Therapeutic factors, including an early start to your rehabilitation and the skill of your stroke rehabilitation team

Generally the rate of recovery is greatest in the acute and post-acute periods — weeks and months after a stroke. However, there is evidence that performance can improve well into the chronic phase, or years later.

Stroke rehabilitation takes time

Recovering from a stroke can be a long and sometimes frustrating experience. It's normal to face difficulties along the way. Dedication and willingness to work toward improvement will help you gain the most benefit.

Source: By Mayo Clinic Staff