Stroke Rehabilitation

In order to help your loved one recover as fully as possible from a stroke, you need to understand the rehabilitation process.

A stroke rehabilitation program could be the key to helping your loved one recover from the effects of a stroke, but remember that rehab isn’t for everyone. Some stroke survivors don’t need rehabilitation because the stroke was mild or they have fully recovered. Others may be too disabled to participate.

If your loved one’s doctor doesn’t recommend rehabilitation, that doesn’t mean that there’s no hope for recovery. While your loved one may be too weak for rehabilitation right now, he or she may benefit from a gradual period of rest and recovery. Then you can consider rehabilitation at a later time. Some stroke survivors, however, remain too disabled to participate in rehabilitation, and they are better helped by maintenance care at home or in a nursing facility.

Many stroke survivors, however, can be helped by rehabilitation, and if your loved one falls into this category, then the doctor and other hospital staff will provide information and advice about rehabilitation programs. Your loved one’s health care team should be familiar with rehabilitation programs in the area and they will be able to answer any questions about them. Many communities offer some—or all—of the following rehabilitation options:

Hospital Programs

Special rehabilitation hospitals or rehabilitation units in acute care hospitals may provide complete rehabilitation services. While a stroke survivor is hospitalized, an organized team of specially trained professionals provides rehabilitation therapy. Hospital programs usually are more intense than other programs and require more effort from the patient.

Nursing Facility Programs

As in hospital programs, the stroke survivor stays at a facility during rehabilitation. Nursing facility programs are very different from each other, so it is important to get specific information about each one. Some provide a complete range of rehabilitation services; others provide only limited care.

Outpatient Programs

Outpatient programs allow a stroke survivor who lives at home to get a full range of services by visiting a hospital outpatient department, outpatient rehabilitation facility, or hospital day program. If your loved one is able to take advantage of outpatient rehabilitation, make sure to find out what kind of transportation services—if any—the program offers. If transportation services are unavailable, you will have to plan for someone to drive your loved one to his or her appointments.

Home-Based Programs

Allows the stroke survivor to live at home and receive rehabilitation services from visiting professionals. An important advantage of home programs is that survivors learn skills in the same place where they will continue to use them. If your loved one is able to receive rehabilitation at home, you may need to arrange for yourself or another family member to be present to help provide care.

Individual Rehabilitation Services

Many stroke survivors do not need a complete range of rehabilitation services. Instead, they may need an individual type of service, such as regular physical therapy or speech therapy. These services are available from outpatient and home-care programs.

Before your loved one is discharged from the hospital, you both should talk to doctors and discharge planners about rehabilitation. They can help you choose the services or programs that best fit your loved one’s needs. As you and your loved one consider rehabilitation options, make sure that both of you are comfortable with the type of program you choose. If your loved one has any concerns about his or her rehabilitation program, they should be discussed with hospital staff.

Also remember that your loved one 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.
 
What Happens During Rehabilitation

In hospital or nursing facility rehabilitation programs, your loved one 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 for him or her to maintain skills that help recovery. Part of the time is spent relearning skills (such as walking and speaking) that your loved one had before the stroke. At other times, your loved one will be learning new ways to do things that can no longer be done the old way (for example, using one hand for tasks that usually require both hands).

You will find that rehabilitation is a shared learning experience between you and your loved one, as well as other friends and family members who actively participating. The goals of rehabilitation depend on the effects of the stroke, what your loved one was able to do before the stroke, and his or her wishes.

Working together, you, your loved one, and the program staff will set a series of rehabilitation goals. If goals are set too high, your loved one will not be able to reach them. If they are set too low, he or she may not get all the services that would help. If the goals do not match your loved one’s interests, he or she may not want to work at them. Therefore, it is important for goals to be realistic. To help achieve realistic goals, you and your loved one should tell program staff about things that he or she wants to be able to do. And don’t get discouraged if your loved one needs to repeat several steps while striving to reach his or her goals.

Rehabilitation Specialists

Several different types of specially trained professionals provide rehabilitation. Your loved one may work with any or all of these:

Physician

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 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 caregivers how to help with exercises and how to help their loved ones move or walk, if needed.

Occupational Therapist

Occupational therapists provide exercises and practice to help survivors 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 stroke survivors regain language skills and learn other ways to communicate. Teaching caregivers and families how to improve communication is very important. Speech-language pathologists also work with survivors who have swallowing problems (dysphagia).

Social Worker

Social workers help stroke survivors, their caregivers, and families make decisions about rehabilitation and plan the return to the home or a new living place. They can help answer questions about insurance and other financial issues and can arrange for a variety of support services. They may also provide or arrange for counseling to help cope with any emotional problems.

Psychologist

Psychologists are concerned with the mental and emotional health of stroke survivors. 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 these problems.

Therapeutic Recreation Specialist

These therapists help survivors 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

An orthotist may make special braces to support weak ankles and feet. A urologist may help with bladder problems. Other specialists may help with medical or emotional problems. Dietitians make sure that the survivor has a healthy diet during rehabilitation, and they also educate survivors and caregivers about proper diet after the patient leaves the program. Vocational counselors may help stroke survivors go back to work or school.

Paying For Rehabilitation

Medicare and other health insurance policies will help pay for rehabilitation. Medicare is the federal health insurance program for Americans age 65 or over and for certain Americans with disabilities. It has two parts: hospital insurance (known as Part A) and supplementary medical insurance (known as Part B). Part A helps pay for home health care, hospice care, inpatient hospital care, and inpatient care in a skilled nursing facility.

Part B helps pay for doctors’ services, outpatient hospital services, durable medical equipment, and a number of other medical services and supplies. Social Security Administration offices across the country take applications for Medicare and provide general information about the program.

In some cases, Medicare will help pay for outpatient services from a participating comprehensive outpatient rehabilitation facility. Covered services include physicians’ services; physical, speech, occupational, and respiratory therapies; counseling; and other related services. In order to qualify, a physician needs to certify that your loved one requires skilled rehabilitation services.

Medicaid is a federal program that is operated by the states, and each state decides who is eligible and which health services are offered. Medicaid provides health care coverage for many people who cannot otherwise afford it as well as people who are eligible because they are older, blind, or disabled.

These programs have certain restrictions and limitations, so it’s important for you and your loved one to find out exactly what your insurance will cover. The hospital’s social service department can answer questions about insurance coverage and can help with financial planning.

© Copyright FamilyCare America, Inc. All Rights Reserved.

Adapted from Recovering After a Stroke, AHCPR Publication No. 95-0664, prepared by the Agency for Healthcare Policy and Research.

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