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Support and Recovery

Family Support

One of the most critical elements in a stroke survivor's rehabilitation from stroke is the strength and commitment of their primary support system, usually from their family. Family acceptance is crucial in helping a person understand that just because they need assistance is no reason to feel ashamed or unworthy.

Family members can be particularly helpful when it comes to identifying the best ways to psychologically motivate the patient. Family members may also be particularly adept at interpreting communications and signs when speech impairments are present.

Social Support

The stroke survivor may find that talking to and interacting with other stroke survivors can be tremendously helpful, and they will benefit from the social interaction.

Social interaction plays a huge role in emotional and physical healing. It is also one of the greatest benefits of a local stroke support group, the opportunity to be around people with great attitudes. Stroke survivors often find that the positive attitude and empathy from a local stroke support group is exactly what they needed to accept who they have become.

Some of the good that a local stroke support group does happens simply by them getting out of their homes. It helps just to see different faces, hear different voices. A local stroke support group might be the perfect antidote to watching TV.

But for some stroke survivors, getting out is a problem. Fortunately, Internet support groups, like The Stroke Network, are becoming increasingly common and offer many of the benefits that emotional support and information swapping that local stroke support groups offer.
 


Questions about rehabilitation? 

Below are some questions you want answered prior to sending your loved to a rehabilitation facility.  Rehabilitation is extremely important for the stroke survivor so having a basic understanding of what it is all about will be helpful. 

1.  What medical professionals specialize in post-stroke rehabilitation?
     a.  Physicians

     b.  Rehabilitation Nurses

     c.  Physical Therapists
     d.  Speech-Language Pathologists
     e.  Occupational and Recreational Therapists
     f.  Vocational Therapists
2.  Where can a stroke patient get rehabilitation?
3.  What are inpatient rehabilitation units?
4.  What are outpatient units?
5.  What are rehabilitation services at nursing facilities?
6.  What are home-based rehabilitation programs?
7.  What research is being done?
8.  Where can I get more information?


 


 

What medical professionals specialize in post-stroke rehabilitation?

Post-stroke rehabilitation involves physicians; rehabilitation nurses; physical, occupational, recreational, speech-language, and vocational therapists; and mental health professionals.

 

Physicians

Physicians have the primary responsibility for managing and coordinating the long-term care of stroke survivors, including recommending which rehabilitation programs will best address individual needs. Physicians are also responsible for caring for the stroke survivor's general health and providing guidance aimed at preventing a second stroke, such as controlling high blood pressure or diabetes and eliminating risk factors such as cigarette smoking, excessive weight, a high-cholesterol diet, and high alcohol consumption.

Neurologists usually lead acute-care stroke teams and direct patient care during hospitalization. They sometimes remain in charge of long-term rehabilitation. However, physicians trained in other specialties often assume responsibility after the acute stage has passed, including physiatrists, who specialize in physical medicine and rehabilitation.

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Rehabilitation nurses

Nurses specializing in rehabilitation help survivors relearn how to carry out the basic activities of daily living. They also educate survivors about routine health care, such as how to follow a medication schedule, how to care for the skin, how to manage transfers between a bed and a wheelchair, and special needs for people with diabetes. Rehabilitation nurses also work with survivors to reduce risk factors that may lead to a second stroke, and provide training for caregivers.

Nurses are closely involved in helping stroke survivors manage personal care issues, such as bathing and controlling incontinence. Most stroke survivors regain their ability to maintain continence, often with the help of strategies learned during rehabilitation. These strategies include strengthening pelvic muscles through special exercises and following a timed voiding schedule. If problems with incontinence continue, nurses can help caregivers learn to insert and manage catheters and to take special hygienic measures to prevent other incontinence-related health problems from developing.

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Physical therapists

Physical therapists specialize in treating disabilities related to motor and sensory impairments. They are trained in all aspects of anatomy and physiology related to normal function, with an emphasis on movement. They assess the stroke survivor's strength, endurance, range of motion, gait abnormalities, and sensory deficits to design individualized rehabilitation programs aimed at regaining control over motor functions.

Physical therapists help survivors regain the use of stroke-impaired limbs, teach compensatory strategies to reduce the effect of remaining deficits, and establish ongoing exercise programs to help people retain their newly learned skills. Disabled people tend to avoid using impaired limbs, a behavior called learned non-use. However, the repetitive use of impaired limbs encourages brain plasticity and helps reduce disabilities.

Strategies used by physical therapists to encourage the use of impaired limbs include selective sensory stimulation such as tapping or stroking, active and passive range-of-motion exercises, and temporary restraint of healthy limbs while practicing motor tasks. Some physical therapists may use a new technology, transcutaneous electrical nerve stimulation (TENS), that encourages brain reorganization and recovery of function. TENS involves using a small probe that generates an electrical current to stimulate nerve activity in stroke-impaired limbs.

In general, physical therapy emphasizes practicing isolated movements, repeatedly changing from one kind of movement to another, and rehearsing complex movements that require a great deal of coordination and balance, such as walking up or down stairs or moving safely between obstacles. People too weak to bear their own weight can still practice repetitive movements during hydrotherapy (in which water provides sensory stimulation as well as weight support) or while being partially supported by a harness. A recent trend in physical therapy emphasizes the effectiveness of engaging in goal-directed activities, such as playing games, to promote coordination. Physical therapists frequently employ selective sensory stimulation to encourage use of impaired limbs and to help survivors with neglect regain awareness of stimuli on the neglected side of the body.

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Occupational and recreational therapists

Like physical therapists, occupational therapists are concerned with improving motor and sensory abilities. They help survivors relearn skills needed for performing self-directed activities-occupations-such as personal grooming, preparing meals, and housecleaning. Therapists can teach some survivors how to adapt to driving and provide on-road training. They often teach people to divide a complex activity into its component parts, practice each part, and then perform the whole sequence of actions. This strategy can improve coordination and may help people with apraxia relearn how to carry out planned actions.

Occupational therapists also teach people how to develop compensatory strategies and how to change elements of their environment that limit activities of daily living. For example, people with the use of only one hand can substitute Velcro closures for buttons on clothing. Occupational therapists also help people make changes in their homes to increase safety, remove barriers, and facilitate physical functioning, such as installing grab bars in bathrooms.

Recreational therapists help people with a variety of disabilities to develop and use their leisure time to enhance their health, independence, and quality of life.

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Speech-language pathologists

Speech-language pathologists help stroke survivors with aphasia relearn how to use language or develop alternative means of communication. They also help people improve their ability to swallow, and they work with patients to develop problem-solving and social skills needed to cope with the aftereffects of a stroke.

Many specialized therapeutic techniques have been developed to assist people with aphasia. Some forms of short-term therapy can improve comprehension rapidly. Intensive exercises such as repeating the therapist's words, practicing following directions, and doing reading or writing exercises form the cornerstone of language rehabilitation. Conversational coaching and rehearsal, as well as the development of prompts or cues to help people remember specific words, are sometimes beneficial. Speech-language pathologists also help stroke survivors develop strategies for circumventing language disabilities. These strategies can include the use of symbol boards or sign language. Recent advances in computer technology have spurred the development of new types of equipment to enhance communication.

Speech-language pathologists use noninvasive imaging techniques to study swallowing patterns of stroke survivors and identify the exact source of their impairment. Difficulties with swallowing have many possible causes, including a delayed swallowing reflex, an inability to manipulate food with the tongue, or an inability to detect food remaining lodged in the cheeks after swallowing. When the cause has been pinpointed, speech-language pathologists work with the individual to devise strategies to overcome or minimize the deficit. Sometimes, simply changing body position and improving posture during eating can bring about improvement. The texture of foods can be modified to make swallowing easier; for example, thin liquids, which often cause choking, can be thickened. Changing eating habits by taking small bites and chewing slowly can also help alleviate dysphagia.

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Vocational therapists

Approximately one-fourth of all strokes occur in people between the ages of 45 and 65. For most people in this age group, returning to work is a major concern. Vocational therapists perform many of the same functions that ordinary career counselors do. They can help people with residual disabilities identify vocational strengths and develop resumés that highlight those strengths. They also can help identify potential employers, assist in specific job searches, and provide referrals to stroke vocational rehabilitation agencies.

Most important, vocational therapists educate disabled individuals about their rights and protections as defined by the Americans with Disabilities Act of 1990. This law requires employers to make "reasonable accommodations" for disabled employees. Vocational therapists frequently act as mediators between employers and employees to negotiate the provision of reasonable accommodations in the workplace.

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Stroke Warning Signs

bullet Sudden numbness or weakness of the face, arm or leg, especially on one side of the body   
bullet Sudden confusion, trouble speaking or understanding   
bullet Sudden trouble seeing in one or both eyes   
bullet Sudden trouble walking, dizziness, loss of balance or coordination   
bullet Sudden, severe headache with no known cause



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Original date 3/1/96 Revised 9/24/14