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Rehabilitation After Stroke: What Can Be Done?

Posted Aug 24 2008 1:49pm
ANNOUNCER: A stroke is always devastating but it is not necessarily fatal.

THOMAS KWIATKOWSKI, MD: About half of all patients who have a stroke will have a moderate to severe stroke that will leave them with permanent symptoms that will affect their life. About another 25% will have very mild symptoms that will allow them to live a relatively normal life. And about 20 to 30% of patients will die from their stroke at one year.

ANNOUNCER: The road back to a normal life can be difficult and takes work, but it can be done.

THOMAS KWIATKOWSKI, MD: Even patients who have moderate to severe symptoms can benefit from rehab, and that is something that we recommend for all patients who can cooperate with rehab, that often can improve the disability that your stroke has caused, so that then you can learn to perform many of the activities that you did prior to having your stroke.

ANNOUNCER: While recovery may take a long time, it's important to get started as soon as possible.

ROSE GONZAGA-CAMFIELD, RN: We try to have the team of other disciplines involved, like physical therapy and occupational therapy, as early as less than 72 hours.

THOMAS KWIATKOWSKI, MD: That is continued, depending upon on the severity of the patient symptoms, up to several weeks. And if you have a moderate to severe stroke, you would typically go to an inpatient rehab facility, where you would have several hours a day of intensive rehab.

If your stroke is more mild, you might be discharged from the hospital and then, as an outpatient, go to a rehab center.

If you have a paralyzed limb; if you don't start doing rehab early on, you will develop what we call contractures, where your muscles become very tight and then it becomes very difficult to get them to be loose again and able to be moved.

So we really want to start rehab early enough so that you don't develop contractures, that you don't develop other complications of your stroke, such as bed sores or severe infections due to lack of activity.

ANNOUNCER: Since stroke can affect any one of a number of functions including movement, speech and comprehension, it's necessary to have a team of experts work with patients.

THOMAS KWIATKOWSKI, MD: If a patient has a very severe motor weakness or a weakness in their limbs, we can offer them physical therapy that will them improve the tone of the muscles that have been affected. It may even help them regain some of the strength that was lost as part of the stroke.

If someone has difficulty with speech following a stroke, they often will benefit from speech therapy where we can help them learn to speak again. And this is a process that takes a long period of time but still can result in significant improvement in patients who have had a significant impairment of their speech as part of their stroke.

ANNOUNCER: Often remaining disabilities need to be addressed by finding ways around the problem.

THOMAS KWIATKOWSKI, MD: There's also another type of rehab that we call occupational therapy where patients who may be left with certain deficits or disabilities such as a weak leg or a weak arm, they are taught new ways to do simple tasks in life. So they are taught new ways on how to dress themselves, new ways on how to walk, often with assistance. New ways on how to cook so that even with their disability, they can learn to do many what we call activity of daily living that they previously were able to do, but now, obviously, in a different way.

ANNOUNCER: However, rehab is not always a smooth process.

THOMAS KWIATKOWSKI, MD: Some strokes affect your ability to understand or to comprehend. And for those types of patients, it's very hard to get them to cooperate with rehab, because they don't understand what rehab is all about. So if someone has a very severe stroke that includes what we call aphasia, where they lose their ability to understand simple questions, those patients would have a lot of difficulty with rehab.

ROSE GONZAGA-CAMFIELD, RN: The majority of these patients are very depressed. The fact that they're never the same again, no matter what. And I cannot emphasize enough that the family who are supportive on the patient, they have a better positive outlook in their recovery. So the positive outlook of a patient after a stroke while they are on the rehab program is very, very important.

ANNOUNCER: While there are certain physical limitations that may remain, it's important that patients work in rehab to make the most improvement possible.

ROSE GONZAGA-CAMFIELD, RN: Patients always ask you, "Will I get better? And if I get better would I resume the movement of my hand or my leg?" And we tell them, "It's up to you to help yourself. The expectation of a positive attitude is very important."

ANNOUNCER: Experts urge that as long as patients have the will to improve, they should stick with it.

THOMAS KWIATKOWSKI, MD: Rehab is a long process. And successes are made in small steps, so that you need to be very patient and family members need to be very supportive. To regain the ability to speak, to regain the ability to walk, to regain the ability to perform simple activities, such as dressing yourself or feeding yourself, may take several weeks to learn how to regain those skills.

ROSE GONZAGA-CAMFIELD, RN: I cannot tell my patient, "Your rehab is only good for three and then after that you won't get better." We tell them, "If you feel that you are improving, go for it. Continue on."

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