Stroke is a medical emergency that occurs about every 40 seconds in the United States and affects more than 795,000 people each year. Though advances in stroke treatment have reduced the overall death rate, stroke remains a leading cause of long-term disability in the U.S.
For this reason, it’s critical to recognize the signs and symptoms of stroke and alert 911 immediately to ensure patients having a stroke receive life-saving and disability-sparing treatments. These should be followed by appropriate post-stroke follow-up medical and rehabilitative care.
What Happens During a Stroke Hospitalization?
Patients are typically first evaluated in the emergency room. There, they undergo a rapid evaluation to determine candidacy for acute ischemic stroke therapy, which typically consists of an intravenous clot-busting drug called tPA or a surgical procedure to remove a large clot causing the stroke.
Upon admission, patients receive a thorough assessment with a multidisciplinary team identifying stroke risk factors and are placed on appropriate medical treatments. Patients also receive a comprehensive assessment to understand rehabilitative needs with the aims of reaching functional independence or not requiring assistance to perform daily tasks.
Once medically stable, arrangements are made to transition to the next phase of stroke care, which for many patients is stroke rehabilitation.
[RELATED: What Are the Warning Signs of a Stroke?]
Post-stroke rehabilitation is a structured program led by a multidisciplinary group of specialists consisting of doctors, nurses, therapists and psychologists that help stroke patients relearn skills that were lost during stroke. Approximately two-thirds of Americans who suffer stroke do not recover completely during their hospitalization and require some level of rehabilitation.
The spectrum of post-stroke disability is quite broad, ranging from mild non-disabling deficits to complete paralysis with loss of speech, language, swallowing, balance, sensation, vision or balance. Rehabilitation plans are individualized depending on the patient’s needs and continuously reassessed to maximize recovery throughout the duration of care.
Who Makes Up My Stroke Rehabilitation Team?
The complexity of stroke necessities includes a diverse group of caregivers to promote recovery and reduce the risk of recurrent stroke. Here are some members of the stroke rehabilitation team:
— Neurologist focuses on stroke risk reduction and symptom management.
— Physiatrist is a rehabilitation specialist who leads a team of therapists to design a patient-centric recovery plan.
— Physical therapist guides therapy pertaining to strength, walking and other physical activities.
— Occupational therapist guides therapy targeting activities of daily living, such as preparing meals, dressing and other day-to-day tasks.
— Speech therapist directs exercises pertaining to speech, swallowing, language, reading and writing.
— Neuropsychologist evaluates and treats mood or behavior changes that may result from stroke.
— Social worker and case manager facilitate coordination of post-acute care and shares community resources with patients.
— Nurses facilitate care in rehabilitation facilities and connect patients with their outpatient care team.
Stroke patients will meet some or all of the above team members depending on their symptoms as they progress through stroke rehabilitation.
Where to Receive Post-Stroke Rehabilitation
Stroke rehabilitation is not a ‘one-size-fits-all’ approach. Patients can receive therapy in different facilities or at home, depending on their need.
Here are places where patients commonly receive stroke recovery:
— Outpatient therapy is for patients who are medically stable who have not completely recovered from stroke but can stay and move about safely at home or with family members. Outpatient therapy facilities have a range of equipment from weights or pools to simulators.
— Home therapy is for patients who have limited ambulatory capabilities and require minimal monitoring. Speech, physical and occupational therapists bring equipment to the patient’s home, and additional resources are available such as home nursing or a home health aide to assist patients and their families with patient care.
— Inpatient rehabilitation facility, or IRF, is a rehabilitation hospital for patients who have functional disabilities and medical complexity who are able to tolerate about 3 hours of therapy a day, 5 days a week minimum. IRFs often have home-like areas such as kitchens or bedrooms where patients can relearn skills prior to transitioning to home.
— Skilled nursing facilities, or SNFs, are appropriate for stroke patients who have significant cognitive and functional impairments due to stroke. Stroke patients at SNFs are cared for by physicians, nurses and therapists.
— Long-term acute care hospitals, or LTACHs, care for the most critically ill stroke patients and focus on respiratory care in addition to physical, occupational and speech therapy as tolerated.
The COVID-19 pandemic significantly reduced access to routine health care and possibly led to less people seeking medical attention for strokes. In light of this, hospitals and rehabilitation facilities have undertaken strategies such as routine COVID-19 testing, temperature checks, frequent sanitation, distancing, limited visitation and questionnaires to ensure patients have access to safe stroke rehabilitation.
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