Most people who’ve had a stroke can expect a hopeful future because of the many advances in treatment and rehabilitation. Fewer people die of stroke now than in the past. Effective treatments are also helping to prevent disability. Rehabilitation for stroke has made many advances in restoring much of a patient’s former functioning.
Stroke is a sudden and often catastrophic event that is the leading cause of long-term disability, and the fifth-ranking cause of death in the United States (US). Strokes affect more than 800,000 people every year in the US. About 10% of stroke survivors recover almost completely; 25% recover with minor impairments; 40% have moderate to severe impairment, and 10% require care in a long-term care facility such as a nursing home. About 70% of stroke survivors require rehabilitation. Let’s look at what happens in stroke rehabilitation programs.
What is a stroke?
There are two types of strokes:
- Ischemic stroke occurs when the blood supply to the brain is interrupted or reduced due to a blocked artery. The brain doesn’t get enough oxygen and nutrients, causing brain cells to start dying within minutes.
- Hemorrhagic stroke causes brain damage when a blood vessel leaks or bursts causing bleeding inside and around the brain.
Symptoms of stroke can include some or all of these:
- Speech - trouble speaking, slurring words, unable to understand what others are saying, and confusion
- Paralysis - sudden numbness of the face, arm or leg; often affects just one side of the body
- Vision - problems seeing in one or both eyes, seeing double, or suddenly blurred or blackened vision in one or both eyes
- Trouble walking - stumbling or losing your balance, dizziness, or sudden loss of coordination
Seek immediate medical attention if you notice any symptoms of stroke, even if they seem to come and go, or stop completely. Here’s a FAST way to check someone for possible stroke:
- Face droop - one side droops when person tries to smile
- Arm droop - raise both arms; one arm drifts downward or is unable to rise
- Speech - is slurred or strange
- Time to call 911 immediately if you observe any of these symptoms
The longer a stroke goes untreated and the brain is deprived of oxygen, the greater the brain damage and disability. Getting immediate treatment can reduce brain damage, complications, and permanent disabilities.
Disabilities caused by stroke can include:
- Paralysis or problems controlling movement, walking, balance, swallowing, or loss of bladder or bowel control (incontinence)
- Sensory disturbances in touch, pain, temperature, or position, and may include numbness, feeling of heaviness, tingling or prickling in a paralyzed or weakened limb
- Trouble using or understanding language happens to about 25% of stroke survivors
- Thinking and memory problems may include a dramatically shortened attention span, deficits in short-term memory, inability to learn new tasks, engage in complex mental activities, or follow instructions
- Emotional disturbances can include fear, anxiety, frustration, anger, depression, and a sense of grief over physical and mental losses
- Chronic pain can occur as a result of mechanical problems caused by muscle weakness or lack of movement in an immobilized joint (“frozen” joint), or as a result of stroke-induced damage to the nervous system (neuropathic pain)
What is rehabilitation for stroke?
Rehabilitation for stroke, or "rehab," helps the patient work toward regaining as much function, independence, and quality-of-life as possible. Rehab helps you recover from the effects of stroke, relearn skills, and develop new ways to do things. Most rehab focuses on physical problems to restore physical functioning, but it can also include physical, emotional, social, and spiritual help.
Equally important in rehab is protecting the patient from developing medical problems such as pneumonia, urinary tract infections, injury due to fall, or clot formation in large veins.
Research has documented that stroke recovery was more complete for patients who participated in a focused stroke rehabilitation program, compared to patients who did not participate.
The brain has the ability to rewire its circuits after a stroke. Functions that are controlled in specific areas of the brain that were damaged by the stroke, can move to other brain regions (neuroplasticity). This can promote improved function over months to years. Even though rehabilitation doesn’t reverse brain damage, it can substantially help a stroke survivor achieve the best long-term outcome.
Stroke rehab works best when the patient, family, and rehab staff work together as a team. Family members need to learn about the physical and mental changes caused by stroke, and how to help the patient regain as much functional ability as possible.
Realistic rehabilitation goals depend on these factors:
- Cause, location, and severity of stroke
- Extent of any impairments or disabilities from the stroke
- Patient’s overall health
- Amount of support from family and community resources
Each patient’s needs are unique. Stroke rehab treatment plans vary but each is designed to meet a patient’s unique needs. Some of the more common rehab tasks include:
- Treat the basic disease that may have caused the stroke; prevent complications
- Treat physical disability and improve functioning
- Teach patient to use adaptive tools; make adaptations to their environment to compensate for physical deficits
- Teach the patient and family how to adapt to lifestyle changes
What happens during rehabilitation for stroke?
Your individual rehab plan will depend on your degree of disability and parts of your body the stroke affected.
Physical activities to improve functioning can include:
- Exercises to improve muscle strength and coordination
- Mobility training teaches how to transfer, and use a walker, wheelchair, or ankle brace
- Constraint-induced therapy restrains the unaffected limb while moving the affected limb to improve its function
- Range-of-motion exercises ease muscle tension and restore mobility
Technology-assisted physical activities include:
- Electrical stimulation applied to weakened muscles causes them to contract, and helps re-educate the muscles
- Robotic devices assist impaired limbs with performing repetitive motions to regain strength and function
- A wireless activity monitor can help increase physical activity
- Video games and computer-based therapies involve interacting with a simulated, real-time environment
Cognitive and emotional activities may include:
- Occupational and speech therapy can help with lost cognitive abilities, memory, problem-solving, social skills, judgment, and safety awareness.
- Speech therapy can help regain lost abilities in speaking, listening, writing and comprehension.
- Psychological evaluation, counseling or participation in a support group.
- You may be prescribed an antidepressant or medication that affects alertness, agitation or movement.
How soon after the stroke does rehabilitation begin?
The sooner rehab can begin, the better the patient’s chances of recovering skills and abilities. Generally, it can begin within two days of the stroke, if the patient’s condition is stable. It usually continues after leaving the hospital.
Where can I get rehabilitation for stroke?
Rehabilitation for stroke is provided in many different facilities. Many people start their rehabilitation while still in the hospital. Your stroke rehab options include:
- Inpatient rehabilitation units within a hospital or clinic, can be freestanding or part of a larger hospital system. An intensive rehab program may last two to three weeks.
- Outpatient therapy while living at home may be provided by a hospital system or clinic. You may go there two or three days a week for a few hours of therapy.
- Rehab hospital with individualized inpatient therapy.
- Home therapy from a home health agency allows greater flexibility for the patient, but you probably won’t have access to specialized equipment. Insurance companies strictly control who qualifies for home-based therapy.
- Long-term care facility that provides therapy and skilled nursing care. Some skilled nursing facilities specialize in rehab, and others offer less-intensive therapy options.
Your doctor can advise you about the best option for your needs after hospital discharge. Ask these questions for each facility you are considering:
- Admission criteria?
- Costs?
- Will my insurance cover the costs?
- Does my insurance company have a preferred provider for rehab and am I required to use them to qualify for payment of services?
- How far away is the facility? How often can my family visit?
- What are the facility’s qualifications? Is it accredited by the Commission on Accreditation of Rehabilitation Facilities?
- Has the facility provided treatment for this type of condition?
- Is therapy scheduled every day? How many hours?
- What rehab team members will provide my treatment?
- What type of patient and family education is available?
- Is there a doctor on site 24 hours a day?
- How are emergencies handled?
- What type of discharge planning is available?
How long does rehabilitation for stroke last?
Most stroke survivors need some form of long-term stroke rehabilitation. Rehab can last months or years after the stroke. The length of rehab depends on how severe your stroke was and if you had any complications. Your rehab treatment plan will likely change during rehab as you relearn skills and your needs change. Patients who continue to work on their rehab plan can continue to make improvements over time.
Does health insurance pay for rehabilitation for stroke?
Before you leave the hospital, you’ll work with hospital social workers or discharge planners, and your care team to determine your best rehabilitation setting that your health insurance will pay for.
Who provides rehabilitation for stroke?
Stroke rehabilitation involves a variety of specialists:
- Doctors may include your primary care doctor, neurologists (nervous system), and physiatrists (specialists in physical medicine and rehab). They will provide overall guidance for your rehab.
- Rehabilitation nurses specialize in caring for people with limitations. They can help with managing bowel and bladder complications of a stroke, teach you about routine medical self-care, and how to incorporate newly learned skills into your daily routine.
- Physical therapists help you relearn activities such as walking, sitting, standing, lying down, keeping your balance, and the process of switching from one type of movement to another.
- Occupational therapists help you relearn hand and arm use for daily skills such as bathing, dressing, cooking, and eating. They also address swallowing, cognitive issues, and home safety.
- Speech and language pathologists help patients who have problems understanding speech or written words, or forming speech. You’ll relearn language and speaking skills, or learn other forms of communication, and develop tools to address memory, thinking and communication problems. They also teach problem-solving and social skills.
- Social workers connect you to community resources, financial help, and new living arrangements, if needed.
- Psychologists assess your thinking skills and address any mental and emotional health concerns.
- Recreation therapists help you resume the activities and roles you enjoyed before your stroke.
- Vocational counselors can help you with return-to-work issues, including help finding potential employers and doing job searches.
- Registered dietitians will address good food choices to improve overall health.
What factors affect the outcome of stroke rehabilitation?
Stroke recovery varies widely from person to person. It's hard to predict how many abilities you’ll recover and how long it will take. Recovery can be a difficult, long and frustrating experience. Improvement can continue for a year to 18 months after the stroke if the patient works hard both in and outside of rehab sessions.
In general, successful stroke rehabilitation depends on:
- Timing of rehab – the sooner it begins, the better chances you will have to regain lost skills and function
- Physical factors include the stroke’s severity and amount of brain damage it caused
- Cognitive or physical limitations
- Age – younger people usually recover better than the elderly
- Support you receive from family and friends
- Adjustments or renovations in the home environment (and work environment) to increase independence and safety
- Motivational factors include your willingness and ability to adhere to rehab activities, and practice them outside of rehab sessions
- How quickly you started rehab after your stroke
- Severity of other medical problems unrelated to stroke
- The skills of your rehab team, and intensity of the rehab program
