Stroke Rehabilitation: Getting Inpatient Care At Friederts

Stroke rehabilitation is a multidisciplinary treatment that helps patients regain their independence and improve their quality of life. The treatment is tailored to the patient's specific needs and can include physical therapy, occupational therapy, speech therapy, and mental health support. Rehabilitation programs focus on improving strength, function, and mobility, while also addressing any physical limitations and pain caused by the stroke. The goal is to help patients relearn skills and adapt to their new circumstances. Inpatient rehabilitation is typically recommended for patients experiencing changes in physical function, mobility, speech, cognition, and personal independence. This intensive form of rehabilitation often involves daily therapy sessions and 24-hour medical care.

Inpatient rehabilitation facilities: 24-hour care, supervised by a rehabilitation physician

Inpatient rehabilitation facilities provide 24-hour care supervised by a rehabilitation physician. These facilities are often free-standing rehabilitation hospitals or rehabilitation units within acute care hospitals. They offer intensive rehabilitation programs for patients requiring close medical supervision and coordinated care from doctors, therapists, and other healthcare providers.

To be admitted to an inpatient rehabilitation facility, a doctor must certify that you have a medical condition necessitating intensive rehabilitation. This can include recovery from serious surgery, illness, or injury. The cost of inpatient rehabilitation care may be covered by Medicare Part A (Hospital Insurance), provided that certain criteria are met.

Inpatient rehabilitation facilities provide a range of services, including physical therapy, occupational therapy, and speech-language pathology. The rehabilitation team typically consists of physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. They collaborate to address the specific needs of each patient.

The length of stay in an inpatient rehabilitation facility can vary depending on the patient's progress and the intensity of the rehabilitation program. Some patients may require a slower course of rehabilitation, while others may tolerate more intensive therapy. It is important for patients and their families to be actively involved in discharge planning and to consider the level of functional impairment when deciding on the next steps after leaving the hospital.

Inpatient rehabilitation is particularly beneficial for individuals who can benefit from close monitoring by a physician and can handle a rigorous rehabilitation schedule. The typical length of a hospital stay after a stroke is five to seven days, during which a rehabilitation plan is formulated based on the patient's specific needs and the effects of the stroke.

Rehabilitation team: physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses

Rehabilitation Team

The rehabilitation team plays a crucial role in helping stroke patients regain their physical, cognitive, and emotional functions. The team typically includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses, each contributing their expertise to the patient's recovery.

Physiatrists

Physiatrists, also known as rehabilitation physicians, specialize in physical medicine and rehabilitation. They lead the rehabilitation team and work closely with other specialists to develop comprehensive treatment plans. Physiatrists focus on restoring the patient's functional abilities, managing pain, and improving overall quality of life. They provide daily guidance and interaction with the patient, ensuring that the rehabilitation goals are met.

Neurologists

Neurologists are experts in the nervous system and brain, specializing in treating strokes and other cerebrovascular diseases. They play a crucial role in diagnosing and treating strokes, as well as providing post-stroke care. Neurologists understand the mechanisms behind stroke-related brain injuries and can suggest customized treatments targeting the affected areas of the brain. Their expertise is vital in helping patients regain motor skills and cognitive functions.

Physical and Occupational Therapists

Physical and occupational therapists work together to help patients regain motor skills, mobility, and the ability to perform daily activities. Physical therapy may include motor-skill exercises, mobility training, range-of-motion therapy, and other activities to improve physical function. Occupational therapy focuses on guided motor-skill exercises and also addresses vision and cognition (thinking) skills. These therapists help patients retrain their bodies and adapt to new ways of performing everyday tasks.

Speech-Language Pathologists

Speech-language pathologists are essential for patients experiencing speech, communication, or swallowing disorders after a stroke. They work with patients to improve their ability to speak, communicate, and swallow. Additionally, they address cognitive issues like memory loss and problem-solving, which are common after a stroke.

Nurses

Nurses are integral to the rehabilitation team, providing direct patient care and monitoring the patient's condition. They work closely with the physiatrist and other specialists to ensure the patient's health and safety throughout the rehabilitation process. Nurses also play an educational role, teaching patients and their families how to manage their medical condition and addressing psychological and emotional challenges that arise during recovery.

The rehabilitation team works collaboratively, meeting daily to discuss the patient's condition and progress. They tailor the treatment plans to the patient's specific needs and goals, ensuring that the rehabilitation process is effective and holistic.

Rehabilitation goals: improving strength, function, mobility, and reducing pain and physical limitations

Stroke rehabilitation is an important part of recovery after a stroke. The goal is to help the patient relearn skills lost or damaged by the stroke and to regain independence and improve their quality of life.

Improving Strength

Progressive resistance exercises can improve upper-limb strength and function without increasing tone or pain in individuals with stroke. Aerobic exercise can also improve active range of movement available post-stroke, possibly by enhancing motor relearning.

Improving Function and Mobility

Motor-skill exercises can help improve muscle strength and coordination. Mobility training can involve learning to use mobility aids, such as a walker, canes, wheelchair or ankle brace.

Constraint-induced therapy involves restraining an unaffected limb while the patient practises moving the affected limb to help improve its function.

Range-of-motion therapy can ease muscle tension (spasticity) and help regain range of motion.

Reducing Pain and Physical Limitations

Shoulder pain is common among stroke survivors. It is usually on the side of the body affected by the stroke and can be caused by the weight of the arm pulling and stretching the soft tissues. Physiotherapy can help prevent this by ensuring the arm and shoulder are positioned correctly.

Spasticity, or hypertonia, is a common complication of stroke. It can lead to permanently shortened muscles, known as contractures, which can limit the range of motion in the joint. Physiotherapy exercises can help to keep muscles and joints flexible and reduce the possibility of contractures.

Inpatient Rehabilitation

Inpatient rehabilitation will usually begin within 24-48 hours after the stroke occurrence. The duration of rehab can vary widely depending on the severity of the stroke and related complications.

Inpatient rehabilitation will involve a variety of specialists, including physicians, rehab nurses, physical therapists, occupational therapists, speech and language pathologists, social workers, psychologists, therapeutic recreation specialists, and vocational counsellors.

Discharge plan: inpatient rehab, subacute rehab, or home with outpatient rehab

Deciding on a discharge plan for stroke rehabilitation can be a challenging task, and it is essential to carefully consider the various options available, including inpatient rehab, subacute rehab, or home with outpatient rehab. Here is an overview of each option to help guide your decision-making process:

Inpatient Rehabilitation Facilities (IRFs):

Inpatient rehab facilities provide 24-hour intensive care for stroke survivors under the direct supervision of a rehabilitation physician. Patients typically stay in these facilities for around two to three weeks and participate in coordinated rehabilitation programs. These programs often include daily physical, occupational, and speech therapy for at least five days a week, with a minimum of three hours of therapy per day. IRFs can be independent facilities or part of a larger hospital complex. Medicare Part A covers medically necessary care in IRFs if a doctor certifies the need for intensive rehabilitation, continued medical supervision, and coordinated care.

Subacute Rehabilitation (SAR):

Subacute rehab is a time-limited inpatient care option for individuals recovering from an illness or injury. It is typically provided in licensed skilled nursing facilities (SNFs), which may be affiliated with a hospital or independently operated. SAR aims to improve functioning and facilitate a safe discharge back to the patient's home or previous living arrangement. Therapy in SAR facilities is tailored to individual needs, with some patients receiving up to three hours of therapy per day. The length of stay in SAR can vary from a few days to several weeks, depending on the patient's condition and insurance approval.

Home with Outpatient Rehab:

Outpatient rehab is an option for patients who can return home after hospitalization but still require ongoing rehabilitation services. Outpatient rehab can be provided in a facility or clinic, which may be connected to a hospital, or it can be delivered directly in the patient's home. Home-based rehab offers convenience, especially for those with transportation challenges, but it may lack specialized equipment available in facilities. Outpatient rehab should begin as soon as possible after discharge, ideally within 48 to 72 hours, and should include an interdisciplinary team of specialists.

When considering the most suitable discharge plan, it is important to involve the patient and their family in the decision-making process. Factors to consider include the intensity of rehabilitation required, the availability of social support, patient preferences, and the financial implications of each option. Additionally, it is essential to assess the patient's functional rehabilitation needs and ensure that the chosen setting can adequately support their recovery goals.

Post-stroke recovery: physical, cognitive, and emotional challenges, requiring ongoing care and support

Post-stroke recovery: physical, cognitive, and emotional challenges requiring ongoing care and support

The road to recovery after a stroke is often long and challenging, requiring ongoing care and support to address the physical, cognitive, and emotional impacts of the stroke. The first three months after a stroke are considered the most critical for recovery, with most patients making the most progress during this period. However, it's important to recognize that recovery is a highly individual process, and the timeline can vary significantly from person to person.

Physical Challenges

Physical challenges following a stroke can include weakness, paralysis, and difficulty with activities of daily living (ADL) such as bathing or preparing food. Physical therapy plays a crucial role in helping individuals regain function and independence. This may involve exercises to improve strength, balance, and coordination, as well as task-specific training to improve functional abilities.

Cognitive Challenges

Cognitive challenges are also common after a stroke, with approximately 60% of individuals experiencing some form of cognitive impairment during the acute stages of recovery. These impairments can include memory problems, attention deficits, executive functioning difficulties, and language or speech disorders. Cognitive rehabilitation, led by speech-language pathologists, occupational therapists, and neuropsychologists, aims to address these deficits and improve overall cognitive function. This may involve restorative approaches to improve impaired functions, as well as compensatory strategies to help individuals adapt to ongoing challenges.

Emotional Challenges

Emotional challenges, such as depression, impulsivity, and psychological distress, are also prevalent after a stroke. These issues can impact both the patient and their caregivers, and ongoing support from rehabilitation psychologists or neuropsychologists is often necessary to help manage these challenges.

Ongoing Care and Support

The type of ongoing care and support an individual receives after a stroke will depend on their specific needs and level of functional impairment. Some individuals may transition to an inpatient rehabilitation unit or independent rehabilitation facility, where they can receive physician monitoring and intensive therapy. Others may opt for a subacute rehabilitation facility, which offers a slower pace of rehabilitation. Outpatient rehabilitation clinics also play a crucial role, providing ongoing therapy and support to individuals as they adjust to life after a stroke.

Regardless of the setting, a coordinated, multidisciplinary approach to stroke rehabilitation is essential. This may include ongoing involvement from primary care physicians, rehabilitation physicians (physiatrists), physical therapists, occupational therapists, speech therapists, neurologists, and rehabilitation psychologists. This team-based approach ensures that all aspects of an individual's recovery are addressed, maximizing their potential for improvement and helping them adapt to any permanent lifestyle changes.

Frequently asked questions