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.
