Stroke Rehabilitation
- Stroke is the leading cause of disability.
- 40% of the patients are left with moderate functional impairments and 15%- 30% with severe disability.
- Effective treatment interventions initiated early after stroke can enhance the recovery process and minimize functional disability.
- Improved functional outcomes for patients also contribute to patient satisfaction and reduce potential costly long term expenditure.
- The most important goal of the of the clinical practice guidelines for the management of stroke rehabilitation is to provide a scientific evidence base, for practice interventions and evaluation.
- The rehabilitation needs and goals for individual with stroke vary considerably. For some the goal may be to return to full independence and resume all previous life activities. For others the goal may be merely to return home with family assistance.
- The challenge for the health care system is to determine what kind of rehabilitation, in what setting meets this individual needs in a cost effective fashion.
- Ten years ago, the role of the acute Neuro Physiotherapist was predominantly concerned with assessment, rapport building and provision of fine tuned treatment. Length of stay in hospital was often 2-3 weeks. With major pressure on the hospital, the length of stay in acute setting for neurological patients has decreased with patient moving into the rehabilitation setting in ten days. During this time the Neuro PT needs to be able to implement an effective assessment and utilize analytical diagnostic and prognostic tools.
The primary goals of the rehabilitation are to prevent complications minimize impairments and maximize functions,
- Secondary prevention is fundamental in preventing stroke recurrence as well as coronary vascular events and coronary heart disease mediated death.
Stroke rehabilitation begins during the acute hospitalization, as soon as the diagnosis of the stroke is established and life threatening problems are under control.
- The highest priorities during this early phase are to prevent a recurrent stroke and complications, ensure proper management of general health functions, mobilize the patient, encourage resumption of self care activities and provide support to the patient and family.
- One conclusion of a systemic review of 38 research trial is that early rehabilitation therapy appears to have a strong relationship to improve functional outcome at hospital discharge and follow up.
- It is also recommended that patient and family caregiver education be provided in an interactive and written format.
Initial assessment includes:
- Risk factor for stroke recurrence
- Medical co-morbidities
- Level of consciousness and cognitive status
- Brief swallowing assessment
- Skin assessment and risk for pressure ulcers
- Bowel and bladder function
- Mobility with respect to the patients needs for assistance in movements
- Risk of D.V.T.
- Emotional support for the family and caregivers
Assessment of ADL & IADL
ADL IADL
MOBILITY HOME MANAGEMENT
- Bed mobility - Shopping
- Wheel chair - Meal planning
- Transfer - Meal preparation
- Ambulation - Cleaning
SELF CARE COMMUNITY LIVING SKILLS
- Dressing - Driving
- Bathing - Shopping
- Grooming
- Feeding
- Toileting
COMMUNICATION HEALTH MANAGEMENT
ENVIOMENTAL HARDWARE SAFETY MANAGEMENT
- Keys
- Light switch
- Facets
Initial Management:
- Stabilized passive movement
- Bed Mobility Exercises
- Chest Physiotherapy SOS
- Pressure sores management
- Shoulder pain precautions
- Bed postures
- Independence in ADL and IADL
POST STROKE REHABILITATION
- Post acute stroke is defined as the period of time immediately after the discharge from acute care.
- At that point the stroke patient has achieved medical stability and the focus of the care becomes rehabilitation.
- Stroke rehabilitation after discharged from the acute care can be conducted in Inpatient rehabilitation hospitals or rehabilitation units in acute care hospitals, nursing facilities, the patients home, or out patient facilities.
- Better clinical outcomes are achieved when post acute stroke patients who are candidate for rehabilitation receive coordinated, multidisciplinary evaluation and intervention.
- Post acute care should be delivered in a setting in which rehabilitation care is formally coordinated and organized.
- Post acute stroke care should be delivered by a variety of treatment disciplines experienced in providing post stroke care, to ensure consistency and the risk of complications.
Patients with severe stroke and / or maximum dependence and poor prognosis for functional recovery.
- Patients who have had a severe stroke or who are maximally dependent in ADL, S and who have a poor prognosis for functional recovery are not candidate for rehabilitation intervention.
Family and caregivers should be educated in the care of these patients, which may include the following:
- Prevention of recurrent stroke
- Signs and symptoms of potential complications and psychological dysfunctions
- Medication administration
- Assisted ADL tasks (e.g. Transfers, bathing, positioning, dressing, feeding, toileting and grooming.)
- Swallowing techniques, nutrition and hydration.
- Care of indwelling catheter
- Skin care
- Contracture
- Use of feeding tube
- Home exercise (ROM)
- Sexual functioning
This page has been contributed by Sachin Zalani, a NeuroPhysiotherapist at Indore in India. He can be reached on +91-9425915656 or on sachinphysio@yahoo.co.in
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