Stroke Rehabilitation

If the stroke survivor is medically stable, rehabilitation can begin within one day after the stroke. Rehabilitation should be continued after the person is released from the hospital if needed.

The goal of stroke rehabilitation is to restore as much physical, mental and emotional independence as possible. During rehabilitation, the stroke survivor may have to relearn basic skills such as eating, dressing and walking.

Acute Care: Physical Therapy Following a Stroke

Physical therapists are part of the stroke recovery team. Physical therapy begins very soon after a stroke, most often while you are still in the hospital. Your physical therapist’s main goal is to help you return to your activities at home, at work, and in your community. Evaluation is very important for guiding the treatment of stroke. Your physical therapist will conduct a thorough assessment that includes:

• Taking a health history.
• Discussing your symptoms in detail.
• Detecting risk factors associated with the condition.
• Reviewing lab tests and X-rays or other images.
• Observing your ability to move, stand, walk, and do other movements.
• Conducting a hands-on physical assessment.

After conducting an exam and evaluating your condition, your physical therapist will develop a treatment plan specific to your needs, challenges, and goals. They will work with you to help you achieve the best possible quality of life. Your treatment plan will focus on:

• Improving your ability to move.
• Addressing any pain you might have.
• Offering guidance on ways to prevent problems that may occur after a stroke.

Where do we move from here?

One of the first things your physical therapist will teach you is how to move safely. As you become more mobile, your physical therapist will teach you strengthening exercises and functional activities. Your physical therapist will:

Your physical therapist will:

• Help you improve your balance and walking ability.
• Provide training to your family and caregivers.
• Teach you how to use devices that can help you stay mobile when a stroke has affected your ability to move, walk, or keep your balance (these can include orthoses, prostheses, canes, walkers, wheelchairs, and perhaps even robotics).

Treatment for people with stroke varies. Your specific treatment will depend on the results of your physical therapist’s evaluation and on how long it’s been since your stroke. Recovery from a stroke depends on:

• The size and location of your stroke.
• How quickly you received care.
• The severity of the brain damage at the time of your stroke.
• Your other health conditions.

Your physical therapist will help you regain functional skills to allow you to take part in your specific life activities. Based on your current challenges, your physical therapist may recommend additional therapy transitioning from the acute (hospital) setting. This may include physical therapy in the form of:

• Inpatient rehab.
• Home health.
• Outpatient therapy.

This continued therapy would focus on many aspects of your functional mobility and may include strength, balance, gait (walking), coordination, and sensory reintegration activities.

Emotional and Behavioral Changes After Stroke

After a stroke, survivors often experience emotional and behavioral changes. The reason is simple. Stroke impacts the brain, and the brain controls our behavior and emotions. You or your loved one may experience feelings of irritability, forgetfulness, carelessness, or confusion. Feelings of anger, anxiety, or depression are also common. The good news is many disabilities resulting from stroke tend to improve over time. Likewise, behavioral and emotional changes also tend to improve. Time is on your side.

Depression and Stroke

Depression is a common experience for stroke survivors. It’s often caused by biochemical changes in the brain. When the brain is injured, the survivor may not be able to feel positive emotions. Depression can also be a normal psychological reaction to the losses from stroke.

Common Symptoms of Depression

• Persistent sad, anxious, or “empty” mood.
• Restlessness and irritability.
• Feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness.
• Loss of interest or pleasure in hobbies and activities, including sex.
• Decreased energy and fatigue, and feeling “slowed down”.
• Difficulty concentrating, remembering, and making decisions.
• Insomnia, early-morning awakening, or oversleeping.
• Appetite and/or weight changes.
• Thoughts of death or suicide, or suicide attempts.

If you are experiencing thoughts of suicide, call 988 for immediate help.

Depression may make the rehabilitation process more challenging for survivors to do the hard work required. If five or more of these symptoms persist for longer than two weeks, depression may be the cause.

A good psychologist or psychiatrist can help. Treating depression not only improves the survivor’s mood, it boosts physical, cognitive, and intellectual recovery. Social support is also crucial. Several studies show that depression goes hand in hand with lower levels of support.

Look to your family, friends, a stroke support group, or a combination of resources for help.

Everyone involved in recovery needs to be aware of the survivor’s depression—and ready to respond to it. The right kind of treatment and support can help ease the pain and move the survivor down the road to recovery.

Swallowing and Safe Feeding Techniques

Safe swallowing involves the timely and coordinated transport of food, fluids, and saliva from the mouth through the throat to the stomach. When a swallowing problem (dysphagia) is present, there may be a high risk of food, fluids, and saliva entering the lungs (aspiration). The person may not be aware that this is happening (silent aspiration). Aspiration can be dangerous as it can cause pneumonia. The person may also be at higher risk of choking.

Safe feeding techniques can significantly improve the person’s safety when eating/drinking. The following techniques should be implemented to improve safety when eating and drinking:

• Only offer food and drink when the patient is awake and alert.
• Ensure the person is comfortable and positioned as upright as possible and well supported in bed/chair for oral intake. The head should be level with chin straight.
• Allow the person to self-feed whenever possible.
• Use hand over hand feeding to assist them to feed themselves if needed.
• Make the environment quiet and free from distractions.
• Inform the person what is happening if they need feeding.
• Ensure the person being fed can see the food approaching.
• Sit down at the same level as the person you are feeding.
• Maintain eye contact.
• Be patient, do not rush.
• Do not ask questions, be comfortable with silence.
• Prompt the person to chew/swallow—verbally or with gentle touch.
• Make sure they have swallowed one mouthful before giving the next. Allow time for a second swallow if needed.
• Give small mouthfuls using a teaspoon.
• Plate warmers can be helpful for slow eaters.
• Different/contrasting tastes and temperatures can help with mouth holding and slow eating.
• Offer sips of drink between mouthfuls of food.
• Use a normal cup (avoid straws).
• Provide at least twice daily mouthcare (teeth, dentures, gums and mouth/tongue cleaning)—good oral hygiene is crucial in dysphagia.