Requip For Stroke Recovery: A Viable Option?

Stroke recovery can be a long and challenging process, requiring rehabilitation to rebuild strength, capability, and confidence. The road to recovery depends on many factors, such as the speed of treatment, the severity of the stroke, and any pre-existing medical conditions. Rehabilitation focuses on improving motor skills, limiting the use of the unaffected limb, and easing muscle tension. This may involve occupational therapy, which can help stroke patients lead independent lives, return to work, and self-manage their condition. Treatment for an ischemic stroke may include medicines and procedures to break up blood clots and restore blood flow to the brain. Hemorrhagic strokes, on the other hand, may be treated with blood pressure medication and procedures to stop bleeding and reduce pressure on blood vessels in the brain.

The importance of quick treatment

When it comes to stroke recovery, time is of the essence. The faster a person receives treatment, the better their chances of recovery are. Immediate treatment can minimize the long-term effects of a stroke and even prevent death. This is because a stroke is an emergency situation that requires urgent medical attention. The sooner treatment begins, the more likely it is that the person will recover.

For ischemic strokes, which are caused by blood clots and make up about 87% of all strokes in the United States, the main treatment is a medication called tissue plasminogen activator (tPA). This drug must be administered within 3 hours of the onset of stroke symptoms to be effective. In some cases, it may be given up to 4.5 hours after symptoms begin, but research in this area is still ongoing. tPA works by breaking up blood clots that block blood flow to the brain, thereby improving blood flow and reducing potential damage.

Starting rehabilitation as soon as possible after the initial treatment is also vital for stroke recovery. At leading medical institutions like Johns Hopkins, rehabilitation begins around 24 hours after a stroke. The rehabilitation team includes a range of specialists such as physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. They work together to assess the patient's condition and provide therapy as often as every hour during the first day or two. The rehabilitation process focuses on helping patients regain their ability to perform activities of daily living (ADL), such as bathing or preparing food.

The first three months after a stroke are considered the most crucial for recovery, with most patients making significant progress during this period. This is when spontaneous recovery may occur, where a skill or ability that seemed lost suddenly returns as the brain finds new ways to perform tasks. However, setbacks can also occur during this time, such as pneumonia, a heart attack, or a second stroke, which can impact the rehabilitation process. Therefore, it is essential to act quickly and seek immediate treatment to maximize the chances of a successful recovery.

First aid and recovery

If you suspect that someone is having a stroke, it is important to act quickly. Call 911 or your local emergency services immediately. While waiting for emergency services to arrive, you can perform first aid if needed. Place the person in a safe and comfortable position, lying on their side with their head slightly raised and supported in case they vomit. Check if they are breathing, and if not, perform chest compressions or CPR. If they are having difficulty breathing, loosen any restrictive clothing. If they are bleeding from a fall, apply pressure to the wound. Observe the person carefully for any changes and be prepared to describe their symptoms and when they started to the emergency operator.

The first stage of stroke recovery is acute care, which takes place in a hospital. During this stage, the patient's condition is assessed, stabilized, and treated. The typical length of a hospital stay after a stroke is five to seven days. The stroke care team will evaluate the effects of the stroke to determine the rehabilitation plan.

Rehabilitation is typically the next stage of stroke recovery. It may take place in the hospital or an inpatient rehabilitation center, or it may be outpatient if the stroke complications are not severe. The rehabilitation team includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. They work with the patient to improve motor skills, encourage mobility in the affected limb, and ease muscle tension. Occupational therapists assess the impact of the stroke on the patient's motor function, coordination, sensation, visual perception, and cognition, as well as their ability to perform daily tasks. They help patients set goals and find solutions to address meaningful everyday activities, enabling them to lead independent lives.

Occupational therapy

The Role of Occupational Therapists

Occupational therapists are qualified healthcare professionals who often work with other specialists as part of a multidisciplinary stroke team. This team may include physiotherapists, speech and language therapists, doctors, nurses, and social workers.

Assessment

After a stroke, an occupational therapist will assess the impact on the patient's motor function, coordination, sensation, visual perception, and cognition. They will also evaluate the patient's ability to perform activities of daily living (ADLs), such as getting out of bed, washing, or making a hot drink. This assessment helps identify areas of difficulty and set goals for recovery.

Treatment

Treatment focuses on improving motor control and hand function in the affected upper limb, maximizing the patient's ability to perform self-care and domestic tasks, and teaching strategies to manage cognitive, perceptual, and behavioral changes. Therapists may also prepare the patient's home and work environment for their return.

Specific Interventions

• Home Modifications: Therapists can recommend adjustments to ensure the patient's safety at home, such as adding doorknob extenders or using non-slip bathmats to reduce the risk of falling.
• Rehabilitation Exercise Programs: Targeted exercises to practice at home, aimed at stimulating neuroplasticity and strengthening neural connections in the brain.
• Task-Specific Training: Practicing specific tasks, such as reaching into a cupboard or turning doorknobs, to improve function in the affected muscles through repeated activity.
• Constraint-Induced Movement Therapy (CIMT): Restraining the non-affected limb to promote the use of the affected limb, stimulating the brain and activating neuroplasticity.
• Electrical Stimulation: Using non-invasive electrodes to send electrical impulses to affected muscles, helping to reactivate them and stimulate the connection between the brain and muscles.
• Mirror Therapy: Placing a mirror to reflect the non-affected side and hide the affected side, helping patients visualize typical movement and stimulating brain areas associated with movement.
• Mental Practice: Mentally rehearsing movements, such as picturing oneself moving the affected arm through daily activities, to spark neuroplasticity and strengthen neural connections.
• Activities of Daily Living Training: Practicing ADLs during therapy allows therapists to identify challenges, address safety concerns, and recommend adaptive strategies.
• Adaptive Equipment Recommendations: Recommending and educating patients on the use of adaptive equipment, such as a sock aide, reacher, or long-handled sponge, to complete daily tasks safely and effectively.
• Sensory Re-education: Retraining the brain to process and respond to different sensations, such as textures and temperatures, which are commonly affected after a stroke.
• Cognitive Training and Adaptation: Cognitive training exercises and adaptive techniques, such as memory games or writing down reminders, to address cognitive challenges and improve attention, sequencing, and problem-solving skills.
• Fine Motor Activities: Fine motor coordination and strengthening activities, such as manipulating small objects or using a hand therapy ball, to improve fine motor skills often affected by stroke.
• Work Accommodations: Recommending shorter work hours, breaks, ergonomic equipment, and other adjustments to facilitate a smooth return to work, addressing increased fatigue and other post-stroke challenges.

Long-Term Recovery

Outpatient or community-based occupational therapy may be required after hospital discharge to continue improving independence in activities of daily living. This can include refining balance, hand-eye coordination, and strength, as well as addressing any long-term needs.

The overall goal of occupational therapy is to help stroke patients regain their independence, improve their quality of life, and enable them to participate in meaningful activities and roles.

Inpatient and outpatient rehabilitation

Rehabilitation is an important element of stroke care. The type of rehabilitation program a patient undergoes depends on the severity of their stroke, their specific needs, and their ability to participate. Inpatient rehabilitation may be necessary for those who need intense 24-hour care, while others may benefit from outpatient programs or home-based rehabilitation.

Inpatient Rehabilitation

Inpatient rehabilitation facilities (IRFs) provide hospital-level care to stroke survivors who need intense 24-hour supervision by a rehabilitation physician. Patients usually stay in the facility for around two to three weeks, participating in a coordinated rehabilitation program that includes physical, occupational, and speech therapy for at least five days a week. IRFs can be independent facilities or part of a large hospital complex.

Hospital programs are another form of inpatient rehabilitation, provided through rehabilitation hospitals or acute care hospital units. These programs are typically more intensive and demanding for the patient.

Nursing facility programs are similar to hospital programs in that the patient resides in the facility during rehabilitation. However, these programs vary widely in the services they provide.

Long-term acute care hospitals offer extended medical and rehabilitation care to patients with complex needs, such as those requiring regular ventilation. These hospitals treat a small number of stroke patients, providing 24-hour nursing support and rehabilitation services as needed.

Outpatient Rehabilitation

Outpatient programs allow patients to live at home while receiving a full range of services by visiting a hospital outpatient department, outpatient rehabilitation facility, or day hospital program. This gives patients access to a wide range of treatments and therapists.

Home-based programs also allow patients to reside in their homes while receiving rehabilitation services from visiting professionals. One advantage of home-based rehabilitation is that patients learn skills in the same environment where they will apply them. However, a disadvantage is the lack of specialised equipment available in facilities. Tele-rehabilitation has emerged as a viable option for continued rehabilitation support, offering remote monitoring, feedback, and care plans.

Individual Rehabilitation Services

Many stroke survivors may not require a comprehensive rehabilitation program but may instead need specific types of services, such as regular physical therapy or speech therapy. These services can be provided through outpatient and home care programs.

The financial impact of a stroke

The economic burden of stroke includes direct medical costs, such as inpatient, outpatient, and home care, as well as indirect costs resulting from loss of productivity due to prolonged rehabilitation, temporary or permanent disabilities, and death. In Europe, it is estimated that the cost of informal care was €1.3 billion, the cost of health care was €27 billion, and the cost due to lost productivity following a stroke was €12 billion in 2017. In the United States, indirect costs amounted to 66% of the total costs, with the cost of productivity loss and the cost caused by premature death being $38.1 billion and $30.4 billion, respectively.

Frequently asked questions