In hospital or nursing facility rehabilitation programs,
the patient 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 to maintain
skills that help recovery. Part of the time is spent
relearning skills (such as walking and speaking) that
the person had before the stroke. Part of it is spent
learning new ways to do things that can no longer be
done the old way (for example, using one hand for tasks
that usually need both hands).
The goals of rehabilitation depend on the effects of
the stroke, what the patient was able to do before the
stroke, and the patient's wishes. Working together,
goals are set by the patient, family, and rehabilitation
program staff. Sometimes, a person may need to repeat
steps in striving to reach goals.
If goals are too high, the patient will not be able
to reach them. If they are too low, the patient may
not get all the services that would help. If they do
not match the patient's interests, the patient may not
want to work at them. Therefore, it is important for
goals to be realistic. To help achieve realistic goals,
the patient and family should tell program staff about
things that the patient wants to be able to do.
Being able to walk, at least with a walker or cane,
is a realistic goal for most stroke survivors.
Being able to take care of oneself with some special
equipment is a realistic goal for most.
Being able to drive a car is a realistic goal for
some.
Having a job can be a realistic goal for some people
who were working before the stroke. For some, the
old job may not be possible but another job or a volunteer
activity may be.
Reaching treatment goals does not mean the end of recovery.
It just means that the stroke survivor and family are
ready to continue recovery on their own.
Because every stroke is different, treatment will be
different for each person. Rehabilitation is provided
by several types of specially trained professionals.
A person 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 to 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 family members
how to help with exercises for the patient and how
to help the patient move or walk, if needed.
Occupational therapist. Occupational therapists provide exercises and
practice to help patients 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 patients get
back language skills and learn other ways to communicate.
Teaching families how to improve communication is
very important. Speech-language pathologists also
work with patients who have swallowing problems
(dysphagia).
Social worker. Social workers help patients and families make
decisions about rehabilitation and plan the return
to the home or a new living place. They help the
family answer questions about insurance and other
financial issues and can arrange for a variety of
support services. They may also provide or arrange
for patient and family counseling to help cope with
any emotional problems.
Psychologist. Psychologists are concerned with the mental
and emotional health of patients. 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 patients
with these problems.
Therapeutic recreation specialist.
These therapists help patients 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.
Other professionals may also help with the patient's
treatment. An orthotist may make special braces
to support weak ankles and feet. A urologist may
help with bladder problems. Other physician specialists
may help with medical or emotional problems. Dietitians
make sure that the patient has a healthy diet during
rehabilitation. They also educate the family about
proper diet after the patient leaves the program.
Vocational counselors may help patients go back
to work or school.
Rehabilitation professionals, the patient, and the
family are vitally important partners in rehabilitation.
They must all work together for rehabilitation to succeed.
In many programs, a special rehabilitation team with
a team leader is organized for each patient. The patient,
family, and rehabilitation professionals are all members.
The team has regular meetings to discuss the progress
of treatment. Using a team approach often helps everyone
work together to meet goals.
If you are a stroke survivor in rehabilitation, keep
in mind that you are the most important person in your
treatment. You should have a major say in decisions
about your care. This is hard for many stroke patients.
You may sometimes feel tempted to sit back and let the
program staff take charge. If you need extra time to
think or have trouble talking, you may find that others
are going ahead and making decisions without waiting.
Try not to let this happen.
Make sure others understand that you want to help
make decisions about your care.
Bring your questions and concerns to program staff.
State your wishes and opinions on matters that affect
you.
Speak up if you feel that anyone is "talking
down" to you; or, if people start talking about
you as if you are not there.
Remember that you have the right to see your medical
records.
To be a partner in your care, you need to be well informed
about your treatment and how well you are doing. It
may help to record important information about your
treatment and progress and write down any questions
you have.
If you have speech problems, making your wishes known
is hard. The speech-language pathologist can help you
to communicate with other staff members, and family
members may also help to communicate your ideas and
needs.
Most patients find that rehabilitation is hard work.
They need to maintain abilities at the same time they
are working to regain abilities. It is normal to feel
tired and discouraged at times because things that used
to be easy before the stroke are now difficult. The
important thing is to notice the progress you make and
take pride in each achievement.
If you are a family member of a stroke survivor, here
are some things you can do:
Support the patient's efforts to participate in
rehabilitation decisions.
Visit and talk with the patient. You can relax together
while playing cards, watching television, listening
to the radio, or playing a board game.
If
the patient has trouble communicating (aphasia), ask
the speech-language pathologist how you can help.
Participate in education offered for stroke survivors
and their families. Learn as much as you can and how
you can help.
Ask to attend some of the rehabilitation sessions.
This is a good way to learn how rehabilitation works
and how to help.
Encourage and help the patient to practice skills
learned in rehabilitation.
Make sure that the program staff suggests activities
that fit the patient's needs and interests.
Find out what the patient can do alone, what the
patient can do with help, and what the patient can't
do. Then avoid doing things for the patient that the
patient is able to do. Each time the patient does
them, his or her ability and confidence will grow.
Take care of yourself by eating well, getting enough
rest, and taking time to do things that you enjoy.
To gain more control over the rehabilitation process,
keep important information where you can find it. One
suggestion is to keep a notebook with the patient. Some
things to include are provided in the sample that follows.
The information contained in this
web site is not a substitute for medical advice or treatment.
Consultation with your doctor or health care professional is recommended.
About Stroke
format.
If
the patient has trouble communicating (aphasia), ask
the speech-language pathologist how you can help.
