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Rehabilitation therapy services for stroke patients living at home: systematic review of randomized trials

Mrs Lynn Legg

A stroke is a medical emergency, and anyone suspected of having a stroke should be taken to a hospital immediately so that tests can be run and the correct treatment can be provided as quickly as possible.

A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen. This can be caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain. The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected.
Rehabilitation is the process of helping an individual achieves the highest level of independence and quality of life possible - physically, emotionally, socially, and spiritually. Stroke rehabilitation doesnt reverse or undo the damage caused by a stroke, but rather helps patient to recover from the effects of stroke and relearn skills ; especially on ADLs skills , that aim to improve the level of their independence. Therefore, the quality of patient life will increase in holistic aspect physically, emotionally, socially, and spiritually.

physicians such as a neurologist, physical therapists,

psychiatrists
The stroke rehabilitation team revolves around the patient and family. The team helps set short - and long-term treatment goals for recovery and is made up of many skilled professionals, including t he following: physicians such as a neurologist, physical therapists, psychiatrists (a physician who treats conditions of the nervous system such as stroke) and physiatrist (a physician who specializes in physical medicine and rehabilitation) internists and specialists critical care nurses rehabilitation nurses physical and occupational therapists speech and language pathologists dietitians social workers and chaplains psychologists, neuropsychologists, and psychiatrists case managers

The stroke rehabilitation program:


The outlook for stroke patients today is more hopeful than ever due to advances in both stroke treatment and rehabilitation. Stroke rehabilitation works best when the patient, family, and rehabilitation staff works together as a team. Family members must learn about impairments and disabilities caused by the stroke and how to help the patient achieve optimal function again.

Rehabilitation medicine is designed to meet each person's specific needs; thus, each program is different. Some general treatment components for stroke rehabilitation programs include the following: treating the basic disease and preventing complications treating the disability and improving function providing adaptive tools and altering the environment teaching the patient and family and helping them adapt to lifestyle changes

According to the National Institute of Neurological Disorders and Stroke(NINDS), in general, there are five types of disabilities that stroke can cause: paralysis or problems controlling move ment such as walking or balance and/or swallowing; sensory (ability to feel touch, pain, temperature, or position) disturbances; difficulty using or understanding language; thinking and memory problems, and emotional disturbances. Stroke rehabilitation can help you recover from the effects of stroke, relearn skills, and new ways to perform tasks and depends on many variables, including the following: the cause, location, and severity of stroke the type and degree of any impairments and disabilities from the stroke the overall health of the patient family and community support

Areas covered in stroke rehabilitation programs may include the following:

Patient need:

Example:

Self-care skills, including activities of Feeding, grooming, bathing, dressing, toileting, and daily living (ADLs) sexual functioning Mobility skills Communication skills Cognitive skills Socialization skills Vocational training Pain management Psychological testing Family support Walking, transfers, and self-propelling in a wheelchair Speech, writing, and alternative methods of communication Memory, concentration, judgment, problem solving, and organizational skills Interacting with others at home and within the community Work-related skills Medicines and alternative methods of managing pain Identifying problems and solutions with thinking, behavioral, and emotional issues Assistance with adapting to life styles changes, financial concerns, and discharge planning

Education

Patient and family education and training about stroke, medical care, and adaptive techniques

Choosing a rehabilitation facility:


Rehabilitation services are provided in many different settings, including the following: acute care and rehabilitation hospitals subacute facilities long-term care facilities outpatient rehabilitation facilities in the home by home health agencies

When investigating rehabilitation facilities and services, some general questions to ask include the following: Does my insurance company have a preferred rehabilitation provider that I must use to qualify for payment of services? What is the cost and will my insurance company cover all or part of the cost? How far away is the facility and what is the family visiting policy? What are the admission criteria? What are the qualifications of the facility? Is the facility accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF)? Has the facility handled treatment for this type of condition before? Is therapy scheduled every day? How many hours a day? What rehabilitation team members are available for treatment? What type of patient and family education and support is available? Is there a physician onsite 24 hours a day? How are emergencies handled? What type of discharge planning and assistance is available?