|What Is Stroke Rehabilitation?
It is a formal program run by many hospitals to help people deal with the effects of stroke. The goal of rehabilitation is to restore as much independence to the patient as possible by improving physical, emotional and cognitive (mental) function. Ideally rehabilitation, as part of stroke recovery, should begin in hospital and continue for as long as it is beneficial after release. A rehab program provides patients with access to a highly skilled set of health care providers including physical, occupational and speech therapists, as well as doctors, nutritionists and psychologists. As one of the main stroke risk factors is having a history of stroke, it is important to work with specialists, not only to improve your quality of life but also as a method of future stroke prevention. Post-stroke rehabilitation usually begins within 24 to 48 of the stroke. The first step is to promote independent movement because many individuals are seriously weakened or paralyzed. Patients are prompted to change positions frequently in bed and to engage in a range of motion exercises. Tasks issued gradually become more demanding as the patient responds to therapy. Once the patient is released from hospital the program will continue on an in- or out-patient basis. For some patients rehabilitation may be ongoing for months or even years.
What Are The Rehabilitation Options?
The degree of rehabilitation necessary will depend on the severity of disability in the patient, their stamina, available funding, insurance coverage and access to local facilities. The following is a review of the most common options prepared by the National Stroke Association:
|Acute inpatient care in rehab hospitals
||24/7 medical care with full rehab services
||Hospital or special rehab unit at hospital
||Several hours every day
||Stroke survivors who have developed severe medical problems
|Sub acute facilities
||Daily nursing care with a fairly wide range of rehab services
||Rehab center at hospital or a nursing facility
||Less frequent and demanding than acute programs but continue for longer periods of time
||Survivors who have severe disabilities but who cannot handle acute programs in a hospital
|Long-term care facilities
||1 or more treatment area
||Nursing facility or nursing home
||2-3 days a week
||Survivors who have their medical problems under control but still require 24/7 care
||1 or more treatment area
||Outpatient center, day adult center or doctor's office
||2-3 days a week
||Survivors who have their medical problems under control, enough to live at home.
|Home care programs
||Specific rehab service in 1 or more treatment area
||Patients who live at home but are unable to travel to a rehab center
Rehabilitation Healthcare Team
While taking part in a rehabilitation program you are likely to be assisted by a team of specialists including:
Doctors who specialize in diseases of the brain and spinal cord. They are usually involved with the diagnosis of stroke, reviewing CT and MRI scans. They are also involved in stroke treatment.
Doctors who specialize in enhancing and restoring function to those with disabilities following illness, injuries or accidents.
A specially trained nurse who helps patients adjust to life after stroke. They can advice on the management of high blood pressure and diabetes, as well as offer advice on symptoms of stroke for the future.
Physical Therapists (PT)
Helps patients who have balance and movement problems. They suggest exercise programs to strengthen the muscles to improve standing and walking ability.
Occupational Therapists (OT)
These specialists help patients adapt to their new circumstances by teaching new strategies to manage daily activities such as eating, dressing, washing, cooking or writing.
Speech-Language Pathologists (SLP)
Help patients with speaking, reading or writing difficulties to relearn these skills. Therapists can sometimes help 'train' other areas of the brain to take over function once performed by dead tissue.
Provides survivors with healthy eating plans and information on natural remedies for stroke.
Social workers can help survivors make decisions about rehab programs and advise about insurance coverage and support services in the home.
This doctor manages and treats patients who have memory, thinking and behavioral problems after stroke.
These therapists encourage patients to take part in recreational activities that promote movement and thinking abilities, such as swimming, visiting museums, learning to draw or paint. Most therapeutic specialists work out of community based organizations at senior centers and organize adult day programs.
What Does Speech Therapy Involve?
If you were offered speech therapy it is because you have problems with communicating, thinking or swallowing (or in severe cases, all 3 areas). Speech and language therapy involves learning techniques to improve and compensate for these problems. Two conditions are particularly common in stroke survivors - dysarthria and aphasia. Suffering aphasia means you can think clearly but have problems processing language to either understand or talk to others. Dysarthria means you can no longer pronounce words (they come out slurred) because of trouble with the muscles in the mouth or face. Speech therapy can help improve these conditions as well as teach alternative methods of communication such as pictures or gestures. Therapists can also help people with memory loss or thinking problems.
What Does Occupational Therapy Involve?
Occupational therapists help stroke survivors with disability to adapt to their new circumstances in order to achieve a maximum degree of independence. They usually carry out an assessment of the patient's house and offer advice on how to make it safer and more manageable. A decision will be made as to what assistance they need by way of appliances - such as wheelchair, downstairs bathroom and chair lift. They can also provide a list of equipment which can help with everyday living (similar to arthritis aids). Therapists will spend time with patients teaching them new ways to dress, eat and bath.
What Does Physical Therapy Involve?
A physical therapist will develop an individualized treatment plan for patients, based on an initial evaluation of the patient's ability, strength, endurance and range of motion. The patient will be supervised throughout their exercise program which is carried out at the nearest rehabilitation center. Therapists can help survivors regain the use of stroke-impaired limbs. Disabled patients tend to avoid the use of impaired limbs and this behavior is called learned non-use. By forcing patients to repetitively use those limbs, this action encourages brain plasticity and helps them regain some use.
Where Are Rehabilitation Centers Located?
Inpatient Rehabilitation Units
These are located in or on the complex of large hospitals. Patients stay in these facilities for about 2 to 3 weeks and engage in an intensive rehabilitation program. Therapy is performed at least 3 hours a day, 5 or 6 days a week.
Often part of large hospital complexes these units offer a full range of rehabilitation services. Patients typically attend 3 days a week for several hours and return home at night.
Rehabilitative services available at nursing facilities are generally not as comprehensive as impatient or outpatient units. Nursing facilities provide a greater emphasis on rehabilitation whereas traditional nursing homes emphasize residential care. Facilities tend to offer fewer hours of therapy compared to in- or outpatient facilities.
Home Based Programs
This type of program is more suitable for patients who only require treatment from one type of therapist or those who live too far away from a center. The major disadvantage is the lack of specialized equipment but the advantage is the person can practice their skills in their own environment. Medicare patients must meet Medicare homebound requirements to qualify for this service (lack of transport does not qualify).
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How Much Does It Cost?
Rehab programs are expensive so it is important to find out which portion of your bill your health insurance will cover and what you will need to pay out of pocket. The average cost of care for a patient for the first 90 days after stroke is $15,000. For those who suffered a severe stroke (10 percent) this rises to $35,000. The costs breakdown as:
Initial hospitalization: 43 percent
Rehabilitation Program: 16 percent
Physician Costs: 14 percent
Hospital Readmission: 14 percent
Drugs and other expenses: 13 percent