Rehabilitation should start immediately after a stroke, during acute admission and even at the ICU. At this stage, early assessment, planning, and initial management are done. Many of the clinical problems that are faced by the stroke patients are related to the immobility and reconditioning imposed by prolonged bed rest during acute stroke care.
Once the stroke is completed (not in evolution) and the patient is medically stable, rehabilitation can be further progressed.
The functions of stroke rehabilitation are as follows:
- Prevention, recognition, management of co-morbid illness and concomitant medical complications.
- Training for maximal functional independence
- Facilitating psychological coping and adaptation by the patient and family.
- Promoting community reintegration, including resumption of home, family, recreational, and vocational activities.
- Enhancing quality-of- life.
Stroke Rehabilitation is multi-disciplinary and team-based in approach.
The Neurologist and the Physiatrist,psychiatrists are in-charge of the stroke rehab team. They initially evaluate the impairments, disabilities, and handicap of the stroke patient, design the appropriate rehabilitation program, and coordinate the functions of the team members. They also coordinates with otherconcerned medical specialists.
The Physical Therapist (PT) helps restore the gross physical functioning and motor skills of the patient, such as walking and joint range of motion.
The Occupational Therapist (OT) helps the patient relearn the skills needed for everyday living such as eating, toileting, dressing and self-care. They also provide vocational training to help return the patient to his/her occupation.The Speech Therapist (ST) helps the patient cope with any cognitive, language, and speech problems that result from the stroke.The team helps both the patient and family members deal with adverse psychological effects of a stroke, such as anxiety and depression.
Depending on the severity of the stroke, rehabilitation can take place in a rehabilitation unit in the hospital, a rehabilitation center, at the outpatient department, at a facility with skilled nursing care, or even at home. The team of doctors will determine the most appropriate rehabilitation setting for a particular patient.
In terms of recovery, generally about 10% of stroke survivors recover almost completely; 25% recover with minor impairments; 40% experience moderate to severe impairments requiring special care; and 10% require care in a nursing home or other long-term care facility.The majority of improvements occur within the fi rst month after the stroke. Signifi cant improvements will continue to be seen during the next three to six months. Beyond six months, there may be some slow improvements.
The stroke patient can do any exercise except isometrics or Valsalva maneuver (which increases abdominal pressure). These activities tend to increase the blood pressure which is to be avoided as much as possible in stroke patients. Isometric exercises are exercises wherein there is no change in muscle length against an opposing force or resistance. Valsalva maneuver is forceful voluntary exertion wherein one tries to move his/her bowels.
Mild stroke patients can return to normal activities but moderate to severe stroke require careful monitoring before, during & after exercise.
A stroke patient should undergo disability assessment before he/she is allowed to return to work. If the stroke is mild the patient can return to his/her usual work with the necessary precautions. In moderate stroke the patient would need a change in his/her work so vocational exploration should be done to assess what type of work he/she can shift to. In severe stroke the patient would have a difficult time returning to work and roles may have to be reversed.
The patient should have undergone rehabilitation medicine intervention (physical therapy, occupational therapy, speech therapy & psychological counseling) and should be aware of the necessary precautions observed during work.
A stroke patient can engage in sex provided that he/she
- has been cleared neurologically
- is medically stable
- has no undue signs of fatigue or breathlessness
- regularly takes his/her medications
- regularly monitors his/ her vital signs especially blood pressure
- partner may be aware of the needs and dificulties that might arise during the sexual activity.
At Wockhardt, we care for your well being. We strongly recommend practicing prevention and securing health. In a world where lifestyle evolves by the day, it is essential to stay in the pink of health. Wishing you and your family good health and happiness always.
The information in the booklet is not intended as a substitute for medical advice but is to be used as an aid in understanding ailment. Always consult your doctor about your medical condition.