Rehabilitation after a stroke or brain injury can be a long process, and is different for each individual. Your doctor may recommend different kinds of rehabilitation therapies to help your recovery – for example, physical therapy, occupational therapy, speech therapy, or mental health therapy. The goal of these “allied health” therapies is to reduce the impact of the injury to your brain.
Your doctor and other clinicians assigned to your care will work with you and your family to create a plan of care, which is your planned course of action. Your care plan will evolve depending on your progress over time. Therapy can continue for months or even years after a stroke, and your care plan may involve different allied health professionals at different periods depending on how your needs throughout your recovery journey. For example, when you are first discharged from the hospital, you might require physical therapy to get back to walking independently again. Once you have accomplished that goal, physical therapy might not be necessary anymore, whereas you might still need speech therapy to continue working on your communication skills.
We’ve compiled a list of four allied therapies you might encounter on your recovery journey. They are: physical therapy (PT), occupational therapy (OT), speech and cognitive therapy – usually provided by a Speech-Language Pathologist (SLP) – and mental health counseling. Read on for a description of each.
Physical therapy is commonly prescribed after a sports injury, surgery or accident. However, it can also be a fundamental part of stroke or brain injury rehabilitation too. For example, after a stroke, you may have trouble with muscle control and movement – and the goal of physical therapy is to strengthen your muscles and increase your range of motion. Physical Therapists can help you regain your independence in movement. This means practicing everything from laying down in bed to walking, often overlapping with the goals of your Occupational Therapist (see below). Your Physical Therapist will review your medical history and communicate with you and your doctors about your needs and goals. They will motivate you and develop a plan designed for you and your individual needs! Exercises can be done in the hospital or a rehabilitation center or skilled nursing facility until you reach a stage of independence to be discharged to home. At that point, you might receive home-based therapy or outpatient therapy, or even stop therapy altogether.
Physical therapy is one of the essential rehabilitation therapies, as it can help prevent falls, reduce pain, increase mobility and independence, and improve the ability to participate in activities of daily living such as getting out of bed, using the bathroom independently, and going for walks around the neighborhood. Your exercises will be customized to your abilities and then gradually get more intense to help you regain muscle strength and coordination. Exercises might include standing up and sitting down to work strengthening leg muscles, slowly throwing a ball to practice hand-eye coordination, or learning to walk with an aid such as a cane.
Occupational therapy is similar to physical therapy, but focuses on daily activities and being able to conduct daily tasks more independently, from grooming and showering to eating and cleaning. Occupational Therapists focus on fine motor skills, which can include practicing handwriting, holding a toothbrush, or typing on a computer. Your Occupational Therapist is tasked with assessing your abilities to operate independently and will make recommendations for your safety and independence at home. Occupational Therapists may recommend assistive technology supports, ranging from adaptive writing tools to wheelchair access ramps, to modified keyboards or speech-to-text technology. Occupational therapists may also focus on cognitive therapy, which is described in more detail below.
Speech therapy or speech-language pathology is another fundamental part of the rehabilitation process. A speech-language pathologist (SLP) treats and diagnoses a variety of conditions, including swallowing, speech, language, and cognitive disorders resulting from neurological injuries like a stroke or TBI. Similar to the other allied health therapists, they can work in a variety of settings, at home, in clinics, schools, or right in the hospital.
Dysphagia, or difficulty swallowing, can occur in combination with many neurological events like strokes or TBIs. SLPs help to ensure that you are eating food and drinking liquids that are the right consistency for you to swallow safely and avoid aspiration pneumonia. They may have you complete exercises to strengthen your swallow or improve your coordination as well.
SLPs also address language. After a stroke or the diagnosis of aphasia, you may struggle with producing or comprehending language, either in spoken or written form. SLPs can help you with these challenges by either providing therapy activities (check out Constant Therapy’s Identify picture categories task for an example of an evidence-based exercise an SLP might have you do), or by helping you and your loved ones to learn and implement strategies to improve your communication independence in the community.
Brain injuries can also cause speech disorders such as apraxia or dysarthria, which SLPs can also address. In the case of apraxia, you may struggle with coordinating the movements of the mouth to form speech sounds and combine them into words and sentences. dysarthria, on the other hand, impacts speech due to muscle weakness making it difficult to produce certain sounds. A speech-language pathologist can teach you strategies like slowing down your rate of speech, and can help you to accurately produce sounds, improving how easily others can understand your speech. Check out our Imitate words tasks as an example of a therapy exercise that an SLP might have you do to work on your speech. An SLP can also explore alternative means of communication with you, such as using an augmentative and alternative communication (AAC) device.
Finally, SLPs also can help you with cognitive skills. Again, an SLP might focus on therapy tasks, such as Constant Therapy’s Put steps in order exercise, which works on executive functioning and analytical reasoning. They also might focus on compensatory strategies, or tips and tricks you can use to help you with cognitive challenges throughout your day. If you’re having trouble remembering how to operate your microwave, an SLP might provide you with a visual support reminding you of the steps of how to cook food in the microwave.
A stroke, traumatic brain injury, or other new neurological diagnosis brings significant life changes along with it, and you may be faced with frustrating symptoms such as communication or cognitive disorders. Dealing with these life changes along with new symptoms can be daunting and overwhelming. Research says that about 31% of stroke survivors, and about 50% of people recovering from a moderate to severe TBI, experience episodes of depression. You may wish to seek help adjusting to these changes, and acceptance is a crucial part of recovery. Losing your sense of independence can not only be disheartening and stressful, but frustrating as well. Depending on the recommendations of your mental health therapist, you might consider talk therapy, in individual or group settings with survivors in similar situations. If verbal communication is an obstacle, a speech-language pathologist can help you and your mental health therapist create communication strategies. Just as this can be painful for you as a patient, it can be overwhelming and stressful for friends and family as well. Mental health counseling, as one of the key rehabilitation therapies, can be beneficial to everyone involved, allowing an outlet for these new and challenging emotions.
Navigating the rehabilitation process can be challenging, but therapists of all types have one major goal in mind: to help their patients improve and regain their independence! Progress can seem slow, but these rehabilitation therapies will help. And your family, friends, and therapists are there to help you feel better- emotionally and physically.
Nisha Kassam is an intern at Constant Therapy Health and studies Speech Pathology at Boston University, specializing in Deaf Studies and Spanish. Her experience focuses on understanding disabilities and healthcare, creating a passion for learning more about and improving healthcare disparities.