Stroke rehabilitation: What to expect as you recover
Stroke rehabilitation (stroke rehab) is an important part of recovery after stroke. Find out what's involved in stroke rehabilitation.
The goal of a stroke rehabilitation program is to help you relearn skills you lost when stroke affected part of your brain. Stroke rehabilitation can help you regain independence and improve yourquality of life.
The severity of stroke complications and each person's ability to recover lost abilities varies widely. Researchers have found that the central nervous system is adaptive and can recover some functions. They also have found that it's necessary to keep practicing regained skills.
What's involved in stroke rehabilitation?
There are numerous approaches to stroke rehabilitation, some of which are still in the early stages of development. Behavioral performance in any area, such as sensory-motor and cognitive function, is most likely to improve when motor activity is willful, repetitive and task specific.
Stroke rehabilitation may include some or all of the following activities, depending on the part of the body or type of ability affected.
Physical activities:
- Strengthening motor skills involves using exercises to help improve your muscle strength and coordination, including therapy to help with swallowing.
- Mobility training may include learning to use walking aids, such as a walker or canes, or a plastic brace (orthosis) to stabilize and assist ankle strength to help support your body's weight while you relearn how to walk.
- Constraint-induced therapy, also known as forced-use therapy, involves restricting use of an unaffected limb while you practice moving the affected limb to help improve its function.
- Range-of-motion therapy uses exercises and other treatments to help lessen muscle tension (spasticity) and regain range of motion. Sometimes medication can help as well.
Technology-assisted physical activities:
- Functional electrical stimulation involves using electricity to stimulate weakened muscles, causing them to contract. This may help with muscle re-education.
- Robotic technology uses robotic devices to assist impaired limbs with performing repetitive motions, helping them regain strength and function. A recent large study showed no clear advantage to using robotic technology to improve motorrecovery after stroke.
- Wireless technology, such as a simple activity monitor, is being evaluated for its benefit in increasing post-stroke activity.
- Virtual reality, such as the use of video games, is an emerging, computer-based therapy that involves interacting with a simulated, real-time environment.
- Noninvasive brain stimulation. Techniques such as transcranial magnetic stimulation (TMS) have been used with some success to help improve a variety of motor skills.
Cognitive and emotional activities:
- Therapy for communication disorders can help you regain lost abilities in speaking, listening, writing and comprehension.
- Psychological evaluation and treatment may involve testing your cognitive skills and emotional adjustment, counseling with amental health professional, or participating in support groups.
- Medications are sometimes used to treat depression in people who have had a stroke. Drugs that affect movement are also used.
Experimental therapies:
- Biological therapies, such as stem cells, are being investigated, but should only be used as part of a clinical trial.
- Alternative medicine treatments, such as massage, herbal therapy and acupuncture, are being evaluated.
When should stroke rehabilitation begin?
The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills. However, your doctors' first priority is to stabilize your medical condition and control life-threatening conditions. They also take measures to prevent another stroke and limit any stroke-related complications.
It's common for stroke rehabilitation to start as soon 24 to 48 hours after your stroke, during your acute hospital stay. If your medical problems continue for longer, your doctors may wait to begin your rehabilitation.
How long does stroke rehabilitation last?
The duration of your stroke rehabilitation depends on the severity of your stroke and related complications. Although some stroke survivors recover quickly, most need some form of stroke rehabilitation long term, possibly months or years after their stroke.
Your stroke rehabilitation plan will change during your recovery as you relearn skills and your needs change. With ongoing practice, you can continue to make gains over time.
The length of each stroke rehabilitation therapy session varies depending on your recovery, severity of your symptoms and responsiveness to therapy.
Recovery & Rehabilitation
Current statistics indicate that there are more than 7 million people in the United States who have survived a stroke or brain attack and are living with the after-effects. These numbers do not reflect the scope of the problem and do not count the millions of husbands, wives and children who live with and care for stroke survivors and who are, because of their own altered lifestyle, greatly affected by stroke.
The very word "stroke" indicates that no one is ever prepared for this sudden, often catastrophic event. Stroke survivors and their families can find workable solutions to most difficult situations by approaching every problem with patience, ingenuity, perseverance and creativity.
Early Recovery
There's still so much we don't know about how the brain compensates for the damage caused by stroke or brain attack. Some brain cells may be only temporarily damaged, not killed, and may resumefunctioning. In some cases, the brain can reorganize its own functioning. Sometimes, a region of the brain "takes over" for a region damaged by the stroke. Stroke survivors sometimes experience remarkable and unanticipated recoveries that can't be explained. General recovery guidelines show:
- 10 percent of stroke survivors recover almost completely
- 25 percent recover with minor impairments
- 40 percent experience moderate to severe impairments requiring special care
- 10 percent require care in a nursing home or other long-term care facility
- 15 percent die shortly after the stroke
Rehabilitation
Rehabilitation actually starts in the hospital as soon as possible after the stroke. In patients who are stable, rehabilitation may begin within two days after the stroke has occurred, and should be continued as necessary after release from the hospital.
- A rehabilitation unit in the hospital
- A subacute care unit
- A rehabilitation hospital
- Home therapy
- Home with outpatient therapy
- A long-term care facility that provides therapy and skilled nursing care
The goal in rehabilitation is to improve function so that the stroke survivor can become as independent as possible. This must be accomplished in a way that preserves dignity and motivates the survivor to relearn basic skills that the stroke may have taken away - skills like eating, dressing and walking.
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