Recovering From a Stroke

by the Staff at Sunnybrook Rehab and Healthcare
May 2010

Overview
According to the Centers for Disease Control and Prevention (CDC, 2007) stroke is the leading cause of disability in the United States.

The American Heart and Stroke Association report (2008) states that 780,000 new strokes occur annually. Sixty percent of stroke patients survive and require rehabilitation. Thirty percent of patients exhibit severe functional deficits and are unable to perform simple everyday tasks such as bathing, dressing, walking, talking and eating. Forty percent are left with moderate impairments requiring early rehabilitation. Post-stroke rehabilitation is recommended for most stroke survivors, however, more than 60 percent of patients do not receive it. The need for further research is vital to further understand why many individuals choose not to seek rehabilitative care.

Rehabilitation usually begins while in the hospital once the patient is medically stable. Patients are discharged from the hospital to one of the following rehabilitation services: a rehab hospital, post-acute rehab facility, at home through home health agencies, and an outpatient facility. In the acute setting this process can start 24 hours following the stroke. The goals of a post-stroke recovery program are: controlling risk factors; preventing complications; improving function; modifying social/vocational environment; and achieving self-sufficiency. Recent studies have shown that delay in onset of the rehabilitation process correlates with decreased outcomes.

The domains of stroke recovery are three fold:

Physical — including cognition and function;
Psychological — including self-concept, stigma of disability and health perception; and
Social — including new roles and relationships.

Risks and Complications of Future Strokes
The American Heart Association’s program Get With The Guidelines — Stroke (GWTG-S), identify many evidenced-based quality measures at or by discharge from the hospital after having a stroke. One of the quality indicators is measuring the percentage of patients and/or their caregivers who were given education materials addressing: risk factors, warning signs, activation of emergency assistance, need for follow up after discharge and medications prescribed. In addition, challenges and barriers to accessing rehabilitation also need to be explored prior to discharge from the hospital as patients surviving their first stroke are at high risk to have another stroke.

After the therapists assess the patient’s functional status the treatment regimen is guided by the presence of early complications. A few examples of early intervention techniques might be: airway clearance including breathing and coughing techniques; joint range of motion and positioning techniques; muscle tone; protection of the skin; edema management and prevention of contractures.

Functional Mobility Training Maximizes Independence and Self-Sufficiency
Functional mobility training includes: general conditioning/neuro-developmental exercises; bathing, dressing, bed transfer and gait training; positioning techniques; and adaptive/orthotic equipment training. The impact of cognitive and communication impairments such as memory loss, inability to swallow and speech impairments place the patient at high risk for falls, isolation and depression. Swallowing training (dysphagia therapy) is also an integral part of the treatment with the goal of the resident achieving a safe swallow with the least restrictive diet and independent eating. In addition, the literature supports the use of some non-traditional interventions such as: constraint-induced movement therapy; biofeedback techniques; robotic training and functional electrical stimulation in the acute and chronic stroke populations.
/p>

Social/ Home Ramifications
Ordinary daily tasks need to be done in a different way post stroke. The patient’s home environment usually requires modifications. Routines and roles are changed and the family is challenged to help their loved one remain as self-sufficient as possible.

Considering the physical, psychological and social consequences of stroke, patients require a multi team approach to rehabilitation. Physicians, nurses, social workers, recreational and rehab therapists, psychologists and dieticians provide a continuum of comprehensive treatment starting from acute to post-acute care to home health and/or out-pt care. In addition, family members become primary caregivers who are knowledgeable about rehab techniques, adaptive devices/orthotics, home modifications and who also need respite/support from this role as well.

Sources: Cynthia Bautista, PhD, RN; V.Hill Hermann et. al 2010
To contact Sunnybrook Healthcare and Rehabilitation Specialists, visit sunnybrookhc.com or call 919.231.6150.