A stroke occurs when the blood supply to the brain is disrupted, resulting in oxygen starvation, brain damage and loss of function. As result of the brain damage, symptoms can include temporary or permanent partial paralysis (typically only to one side of the body), balance problems and impairments in speech, comprehension and memory. In addition, muscle spasms and pain are common complications of a stroke. The extent and location of the “dain bramage” determines the severity of the stroke, which can range from “dust me off” to “did you see the train that hit me?”. One in six people will have a stroke in their lifetime and approximately two-thirds of these individuals will survive and require rehabilitation. The goals of rehabilitation are to help survivors become as independent as possible and to attain the best possible quality of life.
Q: When should rehabilitation therapy begin?
A: Therapy should begin as soon as a stroke patient is stable, many times within 24 to 48 hours after a stroke. This first stage of rehabilitation typically occurs in the hospital and often requires continued therapy in an inpatient or outpatient setting to maximize the outcomes and recovery. Stroke rehabilitation can continue from a few days up to more than a year depending on the severity and type of stroke suffered.
Q: How can physical therapy help after a stroke?
A: Physical therapists specialize in treating motor and sensory impairments. They are key players in helping stroke patients regain the use of stroke-impaired limbs. They often teach strategies such as repetitive use of impaired limbs, administration of sensory stimulation, assessing and developing range of motion exercises and using restraint of the healthy limb to assist in patient recovery and encourage brain plasticity.
The focus of physical therapy often includes practicing isolated muscle movements, challenging motor cortex by frequently switching from one kind of movement to another, and creating complex movements that require a great deal of coordination and balance that will assist in muscle re-education, for activities such as walking up or down stairs or maneuvering safely between obstacles. For those who are not strong enough to hold themselves up, the physical therapist may incorporate hydrotherapy to regain function in the affected limb by using the water to increase buoyancy and decrease the weight requirement of the patient, while also providing sensory stimulation when doing exercises in the water.
According to the largest United States’ stroke rehabilitation study, researchers compared two common approaches to assist stroke patients in improving their walking ability. One method included training on a body-weight supported treadmill, and the other consisted of working on strength and balance exercises at home with a physical therapist. Both types of therapy intervention revealed similar improvements in the individual’s ability to walk by the end of one year. In addition, the study indicated that continued functional improvements were seen as late as one year post-stroke, which negates the old ideas that minimal recovery is gained after 6 months. The trial study indicated that 52% of the participants made significant improvements in walking, everyday function and quality of life, regardless of severity of the impairment, or whether treatment started at 2 or 6 months after the stroke.
Q: What does an occupational therapist help with?
A: Like physical therapists, occupational therapists are concerned with improving motor and sensory abilities, and ensuring patient safety in the post-stroke period. They are concerned with retraining the skills needed for activities of daily living, such as personal grooming, preparing meals, housecleaning and can even assist with getting patients driving and back on the road. OT’s emphasize strategies to improve coordination, including with those patients with apraxia (the inability to perform specific purposeful movement despite normal muscle strength), by breaking down a complex activity into its smaller parts and/or recommending changes to the environment that can facilitate completion of daily living tasks, like replacing buttons with velcro on clothing or footwear to allow for increased independence while getting dressed or putting on shoes. Occupational therapists also help people make modifications in their homes to increase safety, remove barriers, and facilitate physical functioning, such as installing grab bars in bathrooms to help reduce falls. They are also likely to educate family members on keeping their loved on in a routine to build on the patient’s rote memory of doing things in the same order to prevent forgetting a step or activity.
Research has shown that patients who receive OT services are more likely to regain function in their daily lives and are better equipped to return to independent living. A quality occupational therapy treatment and intervention can significantly improve a stroke patient’s recovery, tackling both the physical and cognitive impairments that linger following the stroke. Since the OT spends a significant amount of time with the stroke survivor during treatment, they are in a great position to recommend a consultation with a speech-language pathologist if the patient is experiencing ongoing difficulty swallowing or presents with speaking or language difficulties.
Q: Are speech therapy services essential after stroke?
A: Although some stroke survivors will recover in the areas of speech and language immediately following a stroke, the help of a speech-language pathologist (SLP) make it possible for improvement to be made well beyond the initial time frame. SLP’s target specialized techniques to assist people with retraining communication skills. Speech therapists develop intensive exercises such as repeating therapist-modeled words, practicing following directions, and completing reading or writing exercises in order to identify appropriate compensatory strategies for continued remediation. Specific techniques for improving language skills may include use of symbols, gesturing, or sign language to circumvent major language disabilities. Ongoing advances in computer technology have led to the development of new types of equipment and speaking devices to enhance communication.
One of the most serious complications of stroke is the onset of difficulty communicating. Many stroke patients experience a decrease in speaking ability, which include aphasia (the inability to understand or express speech and language), dysarthria (unclear articulations of speech) and dyspraxia (inability to move oral muscles correctly to form words). Research shows about 25 – 40% of stroke patients suffer from aphasia, and while it does not affect intelligence, aphasia can impair the patient’s ability to speak and understand others, while also impeding their abilities to read and write.
Language impairments are not the only specialties of the speech language pathologists. They can also help people with dysphagia (impaired ability to swallow). They use special types of imaging techniques to study swallowing patterns of stroke survivors and identify the exact source of the swallow impairment. Potential swallowing difficulties may include a delayed swallowing reflex, an inability to manage food once placed inside the mouth, or poor sensation of food residue in the cheeks after swallowing. Sometimes, simply correcting posture or modifying body position during eating can result in significant improvement. SLP’s make recommendations for certain textures of foods and liquids that can be modified to make swallowing easier (i.e., thin liquids, which often cause choking, can be thickened). Training of compensatory swallow strategies and new eating habits like taking small bites and chewing slowly can also help alleviate dysphagia.
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Q: Are there any other therapists I should consult?
A: Approximately 25% of all strokes occur in people between the ages of 45 and 65. For people in this age group, returning to work is often a major concern. Vocational therapists, much like career counselors, can help survivors with residual disabilities identify vocational strengths and develop résumés that highlight those strengths. They also can help identify potential employers, assist in specific job searches, and most importantly, educate disabled individuals about their rights and protections as defined by the Americans with Disabilities Act of 1990. Vocational therapists frequently act as mediators between employers and employees to negotiate the provision of reasonable accommodations in the workplace.
Recreation therapists utilize a range of activities to help patients make improvements in the physical, cognitive, emotional, social, and leisure areas of their lives. They assist patients in developing skills, knowledge and behaviors for daily living and community involvement and work with the patient to incorporate specific interests into therapy to achieve optimal outcomes that transfer to real life situations. Research supports the concept that people with satisfying lifestyles will be happier and healthier. The recreation therapy interventions include individualized therapy sessions, as well as treatment in small group settings, and co-treatments in conjunction with physical, occupational or speech therapists. This therapy can help people with a variety of disabilities to develop and use their leisure time to enhance their health, independence, and quality of life.
Navigating the road of life following a stroke can leave you feeling lost in the wilderness, but stroke rehabilitation can help get you back on the path to greater independence. There are a variety of specialists who are expertly trained to give you all the directions and guidance you need to keep you moving forward and lessen the burden associated with caring for a stroke survivor. Please be sure to consult with your doctor regarding the need for rehabilitation and other interventions that are available.
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