When should a stroke patient start rehabilitation?
- Rehabilitation should begin as soon as a stroke patient is stable, sometimes within 24 to 48 hours of the event.
- Rehabilitation can begin in the hospital but is very dependent on the patient's unique circumstances.
- In the largest U.S. study of stroke rehabilitation to date, researchers found that 52 percent of the participants significantly improved in walking, everyday function and quality of life, regardless of how severe their impairment or whether training began at two or six months after the stroke.
More than 795,000 Americans suffer a stroke each year. About two-thirds survive. They need rehabilitation (rehab) to help them recover successfully.
What is post-stroke rehabilitation?
Rehab helps stroke survivors relearn skills lost to brain damage, such as walking. They also learn new ways to cope with resulting disabilities. For example, they may need to learn to bathe and dress using only one hand. Rehab may include physical therapy, speech therapy, and occupational therapy.
Rehab begins after a person's condition has stabilized. That is often within 24 to 48 hours of the stroke.
What disabilities can result from a stroke?
Generally, strokes cause
- paralysis or problems controlling movement
- sensory disturbances, including pain
- problems using or understanding language
- problems with thinking and memory
- emotional disturbances
The types and degrees of disability depend on which area of the brain is damaged and how much. Since every stroke is different, it is difficult to compare one person's disability to another.
Paralysis or problems controlling movement
Paralysis is one of the most common stroke disabilities. It usually occurs on the side of the body opposite the damaged side of the brain. So a stroke on the left side of the brain affects the right side of the body. It may affect the face, an arm, a leg, or the entire side of the body. Stroke patients may have problems with swallowing, posture, balance and walking, or grasping objects.
Sensory disturbances including pain
Stroke patients may lose the ability to feel touch, position, pain, or temperature. They also may be unable to recognize objects they are holding, or even their own arm or leg. Some experience pain, numbness, or tingling and prickling in paralyzed or weakened limbs.
Incontinence is fairly common right after a stroke. Survivors often are unable to sense the need to urinate, cannot control bladder or bowel muscles. Permanent incontinence is uncommon.
Also, stroke survivors frequently suffer chronic pain syndrome. The brain may send false pain signals in the limb or side with the sensory loss. The most common syndrome is thalamic pain. This is caused by a stroke to the thalamus, which processes sensory information from the body to the brain. It can be difficult to treat even with medications.
Lastly, patients with seriously weakened or paralyzed arms may experience moderate to severe pain radiating outward from the shoulder. The tendons and ligaments become fixed in one position from prolonged lack of movement.
Problems using or understanding language
Stroke may injure the brain's language-control centers. The result is called aphasia. There are several types:
- Expressive aphasia–you know what you want to say, but you have trouble saying or writing what you mean
- Receptive aphasia–you hear the voice or see the print, but you can't make sense of the words
- Global aphasia–you can't speak, understand speech, read or write
Problems with thinking and memory
Stroke may damage parts of the brain responsible for memory, learning, and awareness. Survivors may have shortened attention spans or suffer short-term memory loss. They also may be unable to plan, comprehend meaning, learn new tasks, or engage in other complex mental activities.
After a stroke, many people feel fear, anxiety, frustration, anger, sadness, and a sense of grief for their physical and mental losses. The physical damage to the brain causes emotional disturbances and personality changes. Depression is the main emotional problem. Problems include:
- sleep disturbances
- changes in eating patterns leading to sudden weight loss or gain
- lethargy, social withdrawal, and irritability
- self-loathing and suicidal thoughts
Post-stroke depression is treatable. Antidepressant medications and psychological counseling can help.
Post-stroke rehab involves several kinds of health professionals.
- Physicians manage long-term care. They care for the patient's general health, including prevention measures to prevent a second stroke. Neurologists and physiatrists—physicians specializing in physical medicine—are involved in stroke rehab.
- Rehabilitation nurses help survivors relearn the basics of daily living.
- Physical therapists assess a survivor's strength, endurance, range-of-motion, gait abnormalities, and sensory deficits. They design programs to regain motor control. They help survivors regain use of stroke-impaired limbs, teach how to compensate for reduced abilities, and devise exercise programs to help retain new skills. Examples of physical therapy activities include learning to walk up or down stairs or move safely between obstacles.
- Occupational therapists help survivors relearn personal care, cooking, cleaning, and other tasks. They also aid people in making changes in their homes to help physical functioning and safety (such as installing grab bars in bathrooms and removing barriers).
- Recreational therapists help people with disabilities develop and use leisure time to enhance their quality of life.
- Speech-language pathologists help stroke survivors with aphasia relearn language or develop alternative means of communication. They also help people to swallow better, and develop the problem-solving and social skills necessary for coping after a stroke.
- Vocational therapists are like career counselors. They help stroke patients to identify their vocational strengths and assist in job searches. They also educate disabled individuals about their rights and protections under the Americans with Disabilities Act.
- Mental health professionals assist stroke victims with depression and other problems.