Stroke recovery depends on many factors: where in the brain the stroke occurred, how much of the brain was impacted, caregiver support, the quantity and quality of rehabilitation, and how healthy the survivor was before the stroke.

Each of the 5 stages of post-stroke care and rehabilitation is designed to help survivors regain independence and return home as soon as possible. Since everyone experiences recovery based on their own circumstances, medical providers should to assist with rehabilitation options based on each individual’s unique needs.

What Is Stroke Rehabilitation?

Treatment for stroke begins in a hospital with emergency or “acute” care. This takes place the first 3 to 24 hours after onset of stroke. This first step involves helping the patient to survive and preventing another stroke.

The second step of acute care (24 to 72 hours after onset) focuses on understanding the cause of stroke, preventing medical complications, and preparing patients and families for discharge and start of rehabilitation.

Rehabilitation is the next part of treatment. Here the goal is to help patients relearn skills lost when stroke injured part of the brain, with a goal of becoming more independent. Rehab might begin while the patient is still in the hospital or right after discharge.

Science tells us that the most important element in any rehabilitation program is carefully directed, focused, repetitive practice – the kind of practice used when you learn a new skill, like playing the piano or riding a bike – so expect this kind of therapy to form the basis of most rehabilitation programs.

Where Can Stroke Patients Get Rehabilitation Services?

Decisions about rehabilitation services are typically made by the patient, family, and hospital staff at discharge from acute care. Doctors and staff should provide information about local rehabilitation program options, taking into account the patient’s needs and medical condition, but the patient and family make the final choice.

At this point, caregivers and patients should learn the ins and outs of their insurance coverage to clarify what medical and rehabilitation facilities and services are available, determine the length of coverage provided, and what out-of-pocket expenses can be expected.

Rehabilitation services may be provided at the following types of facilities:

• Inpatient Rehabilitation Facilities —Either freestanding or part of a hospital complex, patients stay up to 2–3 weeks. During this time, an organized team of specially trained professionals provides a coordinated, intensive therapy program – often 3 hours a day, 5 to 6 days a week. 

• Nursing Facilities — As with inpatient programs, patients stay overnight at this facility during rehabilitation. Rehabilitation services at nursing facilities vary significantly, so families should get specific information about each option. “Skilled Nursing Facilities” (sometimes referred to as SNFs) typically place emphasis on more intense rehabilitation, while traditional “nursing homes” offer residential care with limited hours of therapy.

• Outpatient Facilities — Often part of a larger medical complex, these facilities offer access to physicians and a full range of rehabilitation professionals without going to a hospital. Patients live at home, but typically visit the facility for several hours a day, 2 to 3 days a week, and receive coordinated and focused therapy sessions. For this to be a viable option, the patient must have access to transportation.

Post-stroke rehabilitation is provided by several types of specially trained professionals, and patients may work with one or all of these:

• Physicians — Patients in stroke rehab have a physician in charge of care. Several kinds of doctors may play this role: family physicians and internists (primary care doctors), geriatric specialists (doctors who work with older patients), neurologists (brain specialists), or physiatrists (specialists in physical medicine and rehabilitation).
• Rehabilitation Nurses — Specializing in nursing care for people with disabilities, rehab nurses coordinate care with the physician and provide direct care to patients.
• Physical Therapists — PT’s evaluate and treat problems with moving, balance, and coordination. They also provide training and exercises to improve things like walking, sitting, picking things up, and moving around without losing balance.
• Occupational Therapists — OT’s provide exercise and practice to help patients relearn critical everyday activities they did before stroke, such as eating, bathing, dressing, or making meals.
• Speech-Language Pathologists — SLP’s help patients recover lost speech and language skills and sometimes learn other ways to communicate. They also work with patients who have swallowing issues (dysphagia), cognitive problems, or aphasia.
• Social Workers — They help patients and families make decisions about rehabilitation and create a plan to return home. Social workers may also arrange for patient and family counseling to help cope with emotional issues that commonly crop up during rehab.
• Psychologists — They are concerned with the mental and emotional health of patients, but are not able to write prescriptions. Psychologists may also treat thinking or memory problems in stroke recovery patients.

Ask the Right Questions to Choose the Best Stroke Rehabilitation Program & Specialists

Stroke patients are the most important person in their treatment, and should have a major say in decisions about their own care. If you are a survivor of stroke or a caregiver, stay well informed about treatment and progress. It’s tempting to sit back and let program staff take charge, but try not to let this happen. To that end, it may help to record information about treatment and progress in a notebook or on a smartphone, and to keep a running list of questions you want to ask. And remember that you always have the right to see your medical records.

The American Stroke Association recommends patients and caregivers ask the following questions when considering rehabilitation program options:

1. Does the program provide the services the patient needs, as specified at discharge?
2. Does it match the patient’s abilities or is it too demanding or not demanding enough?
3. Is it certified and does the staff have the right credentials?
4. What kind of reputation does it have in the community?
5. How does it assure high-quality care?
6. What does the program look for in terms of progress, and how often is that evaluated?
7. How does the setting measure functional recovery, and what outcomes are typical for stroke patients?
8. Is it located where family can easily visit?
9. Does it actively involve the patient and family in rehabilitation decisions?
10. How does it prepare the patient and family for home?
11. What percentage of short-term residents are successfully discharged home?
12. What types of rehab care will my insurance cover within this program?

By learning about the seemingly complex array of rehabilitation specialists and programs, and understanding how to advocate for themselves, stroke patients and their caregivers stand the best chance of getting the most out of the rehabilitation process.

References:

• American Stroke Association: 15 Things Caregivers Should Know After a Loved One Has Had a Stroke
• National Stroke Association: Rehabilitation Therapy After Stroke
• Healthline: Stroke Recovery and Rehab: What to Expect
• NIH National Institute of Neurological Disorders and Stroke (NINDS): Know Stroke Campaign