Types of Therapy Centers for Stroke Recovery
Medical Rehabilitation Center
Depending on the severity of the condition of your loved one, he/she may have to remain in the hospital for quite some time. During this time, you have to decide whether he/she is well enough to return home when discharged, or if he/she must go to a rehab center. Although difficult, you have to make the decision based on the best interest of the person affected. Your first instinct may be to take them home and help them recover on their own. But sometimes, this is not a possibility. Your loved one may first have to go to a medical rehab, if there are other underlying issues that must be addressed due to or accompanying the stroke, or a regular rehab to begin the recovery process. First, realize this is a big step. Although your loved one is not well enough to go home, he/she is well enough to leave the hospital and receive proper care on a less monitored basis. Do not simply go to the closest place; do your research. Understand that sometimes it may be necessary to stay on top of things so that the survivor gets the best attention possible. Do not be afraid to speak up. Do not be afraid to ask multiple times for something to get done if that is what it takes!
At these rehabilitation centers, the main focus is their medical conditions. Sometimes, survivors will have to recover medically first before they can participate in any therapy at all. When this is the case, a medical rehabilitation center is the answer. Here, although they will not be monitored as closely as in a hospital setting, there will still be doctors on site and nurses caring for the patients. They will help treat any medical issues the patient may have, and when well enough, they will start rehabilitation process. This will begin with an evaluation to determine what is best for the patient. This will allow them to have a better sense of what type of therapy they can start. Can the person sit up? Is he/she able to focus at all? What type of mobility does the person have? Do they make eye contact? Are they able to eat?
Rehabilitation Center or Home Therapy?
If it is not necessary for the survivor to be medically monitored more closely, it will be at the discretion of the survivor and his/her family to decide whether or not he/she will receive home therapy care or center therapy.
If someone is able to care for the survivor around the clock (if necessary) you may choose to have home therapy. If this is the case, you can have home nurses come to your home as well to monitor health---including drawing blood, monitoring blood pressure and heart rate, taking their temperature, and discussing any other health concerns you may have. This is generally done weekly, but home therapists will usually check heart rate, blood pressure, and temperature each time they do therapy--both before and after. This type of therapy is better for those people who feel more comfortable at home, and those who are determined to push themselves a little harder (or have loved ones who are willing to push them a little harder) to make progress. It is often (but not always necessarily) less intense but it will depend on each patient and their abilities. Therapy can consist of physical, occupational, and/or speech depending on the needs of the individual. It may be two or three times a week, depending on the capability of the survivor. Either way, a goal should be to eventually move over to out-patient therapy for optimal results. This is usually more intense and will promote better results for physical and social development. They have more tools and accessibility in a therapy center, as well as others who are going through the same recovery process so it is good to (if possible) revert to this type of therapy after some time.
In-Patient Therapy: Acute vs. Sub-acute
Depending on what the survivor can do, he/she will be a part of acute or sub-acute therapy (some centers offer both acute and sub-acute and patients can move between depending on progress and health). Acute therapy consists of at least three hours of therapy a day with the intention of the survivor eventually transitioning back to a home setting. Patients have to be accepted into acute therapy sessions which is based on both health and physical ability. These centers have both a physician and a registered nurse on site and require support of loved ones to help the recovery process along. This type of therapy focuses on helping survivors to become more independent members of the community, getting them ready to return to work if planned, and live more independently. Sub-acute therapy is less intense than acute, and patients will usually participate in at least one hour and less than three hours of therapy a day.
Out-patient therapy is generally a goal for most people. When survivors are well enough to live at home without as much help and are independent enough to get to and from therapy a few times a week while living at home, this is a good route. It can sometimes take months (or years) to get to this point depending on the ability of the stroke survivor.
Regardless of which therapy you choose, it will be less intense to start. It will begin with an evaluation. Therapists will never do more than what they feel the patient can handle. It may seem redundant or small sometimes but each stride is essential in working up their strength and ability toward improvement. Therapy is an essential part of stroke recovery and each small step is a huge stepping stone toward full recovery.
Therapy: The Beginning
If they have not done so already, they may perform a swallow test at the rehab. This will determine whether or not the patient is able to eat on his/her own. They may need a feeding tube, or be on a thickened liquid diet in the beginning so as to ensure the safety of the survivor. But rest assured, swallowing function could improve and the survivor may be able to move on to pureed foods, then soft foods, and then regular foods and finally thin liquids and all foods. The therapist will work on this with your loved one, as well as determine how many hours (or minutes) therapy will be on this level. Sometimes, only a few minutes of therapy may not seem like a lot but it is crucial in the healing process. For example, my father spent the first few weeks not being able to respond much at all to the speech therapist. They would ask him to follow simple directions and he was not able to. They would ask him to repeat some words and the sounds he came out with were not even closely related. Physical therapists would sit him up and he would become immediately nauseous and dizzy and have to lie back down after only a few short minutes. But as days and weeks went by, the sounds he made were more closely and closely related to the words, and the time he would be able to spend sitting up would slowly but surely increase.
It was the most difficult process I have ever been a apart of. I hated to see my father so confused, and so completely out of it. I felt that he was going to be embarrassed about the things he could not do, and that he was never going to recover from the blurbs and daze he was in. But little by little, it did get better. I made notes about his recovery process each week and it was only then that I realized the progress he was actually making. It may not have seemed like a lot but seeing on paper that he was only able to sit up for five minutes, then fifteen minutes, and then thirty minutes, and finally an hour it was actually quite marvelous the progression he was making! Words got closer and closer to the correct ones, small sentences began to form (even if they did not make quite that much sense), and clarity began to form. Even something as simple as being able to focus on the television for a moment at a time (whereas before the television was on and he was completely oblivious to it). Also, once I spoke to him about being embarrassed about things he could not do in the beginning, he told me that he did not quite remember and that he was not embarrassed but instead just confused. He knew what the correct answer or motion was but it was not coming out correctly. In the very beginning, he did not recognize that it was not the correct command. It was not until weeks later that he began to realize when a word would come out that was not the correct one, or a direction he was following was not what he was told to do. Thankfully, my dad has a wonderful sense of humor and through that we were able to joke about little things like saying dog instead of daughter and hot instead of cold. What could have been very upsetting (and it was still sometimes) was turned into humor and helped us to get through it.
Believe me when I tell you, though, I know how extremely difficult it is to watch your loved one go through what seems to be the most difficult time of their life. If I knew, two years later, the progress he would make, I would feel so much better. So my goal is to let you know that although it is so hard, it will get easier. It does not depend on the amount of time from the stroke, and it does not completely depend on the area of the brain that was affected or the severity of the stroke. It depends on the will of the survivor, and the support of his/her loved ones. I know that if my dad was not as determined as he was, and if we were not on top of the doctors and nurses to do things differently or check him for different infections or issues that we noticed, the progress would not have been so grand. If we were not there to tell him it was okay, to show him different ways to cope and work around his challenges, and just simply there for moral support I do not think he would have come so far. At the same rate, if he was not as willing to get better, to go back to work, and to come home to us, I do not think he would have progressed as much. Just reminding them of their independence and telling them how far they have come will be so helpful. I still do not think my dad realizes how far he truly has come. When he gets frustrated with the mobility of his right hand (which was completely immobile in the beginning) or has trouble coming out with a word and begins to get discouraged, I remind him of how far he truly has come.
Do not necessarily make what the doctors say about progression truth. They told my dad he was never going to be able to eat again. He had a feeding tube for a little over a month before he progressed to thickened liquids (and boy did he hate those!). But his swallow function got stronger and his wounds healed so that he was able to push himself to keep trying. He now eats regular food (thank goodness, because he LOVES his food). They told him he may never be able to walk again, and after a few months he was able to walk with a cane (and now walks with no assistance at all!). The worst thing that the doctors told us, and perhaps the most important thing that I want you to take away from this is that progress will slow down after about six months. This is untrue. I think the most progress was in the first six months, because it was when he gained mobility in his arm and leg back, and began to speak and walk. However, this was only the beginning! What came next was amazing. He would be able to come out will full sentences (though sometimes slurred), he corrected his mouth droop, he began to be able to follow simple directions, his perseverance pushed him to gain the strength he needed to no longer need a cane and be able to use his arm for simple things such as balancing himself or holding something for a short amount of time. After his surgery which was just about a year after the stroke (to reverse his ostomy) the progress was even more enhanced! He was able to endure three hours of therapy, his speech gets better and better every single day whereas you can almost not even tell he had a stroke in the first place, he is much more independent, and stronger than he was even before the stroke! So do not let the doctors make you feel as though your loved one will only progress during the first few months. Instead of dreading that six month mark, we should have welcomed it with open arms. Because he continued to get better, and still continues to get better each and every day. We just passed the two year mark since my dad has had his stroke. He is doing wonderfully and continues to improve every single minute of every single day. Stroke recovery is limitless, and your loved one can come as far as he/she is willing to push him/herself to go!