Stroke – Rehabilitation
Nowhere is teamwork more important than in assisting a stroke survivor with rehabilitation. The key members of the team are the stroke survivor, the primary caregiver (usually a family member) and a host of other professionals. There are a full range of outcomes after a stroke ranging from virtually no signs or symptoms with full independence to someone being severely incapacitated and dependent on others. Rehabilitation is designed for the individual who has individual needs. The one thing that must be understood is that it takes time to regain the functions that have been lost. In many cases most functions can return. It is essential that stroke survivors and their families recognize that many people recover from strokes to live long and rewarding lives.
The American Heart Association, which is concerned with stroke as much as heart and vascular disease reminds us that there are three keys to successful rehabilitation:
- Rehabilitation must begin as soon after the stroke as possible.
- The family can be the affected person's most important form of support during rehabilitation.
- Rehabilitation requires cooperation of professionals, patient and family members.
From the time the stroke survivor is able, generally while in the hospital it is important to immediately begin extensive exercises that are generally ordered by the physician but carried out by nurses, physical therapists, speech therapists and others. These exercises have a single goal, to prevent problems of disuse - this goes for muscles, eating, talking, walking and a host of other tasks that may have been imperiled by the stroke. Family members, particularly the primary caregiver need to learn some of the rudimentary elements of rehabilitation while the survivor is still hospitalized.
Family support is critical to successful rehabilitation. Nobody, especially the survivor asked for the stroke, but how the family is able to help the survivor is very important. This is a stressful time for all, and it taxes all family relationships. Nevertheless, realistic expectations should be made in consultation with the doctors and including the survivor. Plans should be made for the rehabilitation, which very likely will be lengthy, but marked by steady progress. The survivor must be encouraged and always kept in the family circle. One bewildering problem for the family often experienced is emotional lability. Unexplained emotional reactions of the survivor, crying or laughing even irritability are common. Depression is also a very normal reaction to the stroke. These emotions are the result of the stroke and belie the true emotions of the survivor. Memory lapses and loss of concentration are common features of recent stroke survivors. Families must understand these aspects of behavior which tends to improve over time.
Over time rehabilitation can be quite remarkable. It does take a team of professionals and the family to accomplish this. Physicians will assist the family in outlining who can help in this team, various nursing services, different types of therapists, and what the goals - short and long are. The primary caregiver often is given tasks to practice with the survivor and various aids to assist in the completion of the exercises. Constant encouragement and patience are the watchwords.
Post-hospitalization Care: Where?
The December issue of Journal of the American Geriatric Society has a pertinent article dealing with the topic of where stroke survivors do best after hospital discharge. The Seabrook Lecture Series May 22 will be addressing the topic of residential options, and this is particularly relevant to stroke rehabilitation. There are fundamentally four options for families:
- Home with a primary caregiver
- Home with skilled assistants
- Rehabilitation centers
- Nursing homes
As one might expect, patients in a nursing home had higher mortality and lower quality of survival than patients in other settings. This was not solely because of their status prior to hospital discharge. Formal home health care and rehabilitation centers had greater success with rehabilitation. The implication of this report is that where survivors go for rehabilitation after a stroke will affect the overall recovery. Thus, you must discuss this important aspect of rehabilitation with the physician prior to hospital discharge.
Much has been learned about turning what at first seems like a catastrophe into a new life. New roles, new habits, new triumphs, and lasting family bonds and friendships are often the end result of successful stroke rehabilitation.
Keys to Stroke Rehabilitation
- Early start
- Family role is essential
- Teamwork is required
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