Physical Therapy Following a Stroke

This is another version of an article I had written for Our Care Community:

Experiencing a stroke can be a life-changing event for both patients and their families.  Sometimes, a stroke can leave very few aftereffects, but other times, the resulting disability can be severe.  Fortunately, people who experience strokes are surrounded by a qualified medical team which may include physicians, nurses, physical therapists, occupational therapists, speech-language pathologists, respiratory therapists, recreational therapists and social workers.

Effects of a Stroke

A stroke can occur in any area of the brain and the extent of injury can vary greatly.  Depending on the location, size, and type of stroke, patients may experience paralysis on one side of the body, abnormal muscle tone, difficulty controlling one’s movements, difficulty understanding or producing language, impaired balance and body awareness, and difficulty swallowing.   These will cause deficits in a person’s mobility, self-care, communication, eating, and bowel and/or bladder control.  Physical Therapy addresses a patient’s difficulties in moving in bed, transferring to and from bed, balance, walking, and moving about one’s home and community.  The goal of PT after a stroke is to help patients regain as much independence as possible.

Acute Care

People who are hospitalized following a stroke are often surprised to see a Physical Therapist so soon.  Depending on the type and severity of the stroke, Physical Therapy (PT) during an acute care hospital stay can range from activities as simple as tolerating positional changes while maintaining stable vital signs to walking throughout the halls.  Acute care PT may include bed mobility training, stretching, active and passive range of motion, simple therapeutic exercises, training in how to transfer into and out of bed, wheelchair mobility training, and learning to walk (gait training).

Acute Rehabilitation

After the acute hospital stay, patients may be transferred to acute rehab.  During acute rehab, patients will have the opportunity to participate in therapy for approximately 3 hours per day, 6 days per week.  The specialized care that patients receive in acute rehab include exercise programs, PT to improve functional mobility, OT to improve self-care, Speech Therapy to address communication and swallowing issues, Recreational Therapy, and bowel/bladder retraining.  During PT sessions, treatment will focus on regaining as much functional mobility as possible while using the most appropriate assistive device, be it a cane, walker, or wheelchair.

Transitional Care/Skilled Nursing

The PT treatments that occur in a hospital’s transitional care unit (TCU) or in a skilled nursing facility (SNF) are similar to those in acute rehab.  However, the amount of therapy a patient receives may vary, depending on the areas of greatest need.  PT sessions may include stretching, therapeutic exercise, balance training, transfer training, wheelchair mobility training, gait training, and car transfer training.  Upon discharge from the TCU or SNF, patients usually return home or to an assisted living facility, so caregiver training is an important part of PT in these settings.  Durable medical equipment such as a 3-in-1 commode, walker, or wheelchair are also ordered for the patient before discharge so that patients can have all the necessary equipment to use in the home setting.

Home Health PT

When a patient returns home or moves into an assisted living facility, they will often participate in home health PT.  The aim of home health PT is to help a person to function and move safely and as independently as possible in the patient’s home environment.  Treatment sessions may entail a home safety evaluation, re-enacting common daily tasks (such as moving about the home, getting into and out of the shower, carrying laundry, or preparing meals), continuing caregiver training, and prescribing a home exercise program.

Outpatient Physical Therapy

After “graduating” from home health PT, patients may need to participate in outpatient physical therapy to fine-tune their skills.  Outpatient PT occurs in a hospital-based or private clinic and often includes therapeutic exercise, stretching, strengthening, balance training, advanced gait training (often out in the community), and home program prescription.  Upon discharge from outpatient PT, patients are often encouraged to participate in a community-based exercise program such as a guided aquatic exercise class, a balance class at the local senior center, or a daily walking program.

Though having a stroke can be a devastating experience for the patient and family members alike, Physical Therapy helps to return patients to the greatest amount of functional independence as possible.