Getting the Most Out of Rehabilitation

Programs | Goals | Specialists |  Maximizing benefits

What the patient can do

The person who has had a stroke is the most important person in the treatment and should have a major say in decisions about care. This is hard for many people who have had a stroke. There is the temptation to sit back and let the professionals take over.

Stroke survivors may need extra time to think and to communicate.

-	Make sure that others understand that you want to help make decisions.
-	Bring your questions and concerns to program staff.
-	State your wishes and opinions on matters that affect you.
-	Speak up if you feel that anyone is "talking down" to you; or, if people start talking about you as if you aren't in the room.
-	Remember that you have the right to see your medical records.

What the family can do

-	Support the patient's efforts to participate in rehabilitation decisions.
-	Visit and talk with the patient. You can relax together while playing cards, watching television, listening to the radio or playing a board game.
-	If the patient has trouble communicating (aphasia), ask the speech-language pathologist how you can help.
-	Attend some of the rehabilitation sessions. This is a good way to learn how to help.
-	Encourage and help the patient practice skills learned in rehabilitation.
-	Make sure that the program staff suggests activities that fit the patient's needs and interests.
-	Find out what the patient can do alone, what the patient can do with help, and what the patient can't do. Then avoid doing things for the patient that he or she can do. Each time the person manages alone, ability and confidence grow.

Discharge planning

The process of discharge planning begins early during rehabilitation. It involves the patient, family and rehabilitation staff. The purpose of discharge planning is to maintain the benefits of rehabilitation after the patient has been discharged from the program. Patients are usually discharged from rehabilitation soon after their goals have been reached. The process can include:

-	Making sure that the stroke survivor has a safe place to live after discharge.
-	Deciding what care, assistance or special equipment will be needed.
-	Arranging for more rehabilitation services in the home, such as visits by a home health aide.
-	Choosing the health care provider who will monitor the person's health and medical needs.
-	Determining the caregivers who will work as a partner with the patient to provide daily care and assistance at home, and teach them the skills they need.
-	Discussing any sexual concerns the stroke survivor and spouse may have. Many people who have had strokes enjoy active sex lives.

Preparing the home

Many stroke survivors can return to their own homes after rehabilitation. Others need to live in a place with professional staff such as a nursing home or assisted living facility. An assisted living facility can provide residential living with a full range of services and staff.

It's a good idea for the stroke survivor to go home for a trial visit before being discharged. This will help identify problems that need to be discussed or corrected.

Some changes might need to be made for safety. For example, changing rooms so the person can stay on one floor or moving scatter rugs or small pieces of furniture that cause falls. Grab bars and seats may need to be installed in tubs and showers.

Special equipment

Cane - Many people who have had strokes use a cane. For people with balancing problems canes with three or four "feet" are available.
Walker - A walker provides more support than a cane. Several designs are available for people who can only use one hand and for different problems with walking or balance.
Braces - Braces help a person to walk by keeping the ankle and foot in the proper position and giving support to the knee.
Wheelchair - Wheelchairs can be customized to fit the user's needs and abilities. These will need to be determined before purchasing.
Aids for bathing, dressing and eating - Examples are grab bars and nonskid tub and floor mats, velcro fasteners on clothes and placemats that don't slide on the table.
Communication aids - These range from small computers to homemade communication boards. The person who has had the stroke, family and rehabilitation staff should decide together what special equipment is needed. Medicare or health insurance will often help pay for the equipment.

Tips for reducing stress

Going home after a stroke can be a challenge. It may be hard for the stroke survivor to use skills learned in rehabilitation in a new environment. Caregivers have many new responsibilities and less time to enjoy their own activities. The challenges of adjusting to stroke cause stress for both caregivers and people who have had a stroke. Following are some tips for coping with stress:

-	Take stroke recovery and caregiving one day at a time and be hopeful.
-	Remember that adjusting to the effects of stroke takes time. Appreciate each small gain as you discover better ways of doing things.
-	Caregiving is learned. Expect that knowledge and skills will grow with experience.
-	Experiment. Until you find what works for you, try new ways of doing activities of daily living, communicating with each other, scheduling the day and organizing your social life.
-	Plan for breaks so that you are not together all of the time. Plan activities that get you both out of the house.
-	Ask family members and friends to help in specific ways and commit to certain times to help. This gives others a chance to help in useful ways.
-	Read about the experience of other people in similar situations. Your public library has life stories by people who have had a stroke as well as books for caregivers.
-	Join or start a support group for stroke survivors or caregivers. www.stroke.org.
-	Be kind to each other. If you sometimes feel irritated, this is natural and you don't need to blame yourself, but don't take it out on the other person. Talk about feelings with a friend, rehabilitation professional, or support group.
-	Plan and enjoy new experiences and don't look back. Avoid comparing life as it is now with how it was before the stroke.

Tips for communicating

-	When it's hard for the stroke survivor to communicate, be patient. Allow time before finishing sentences or helping fill gaps in speech.
-	Use short sentences and add hand and face signals.
-	Be sure the stroke survivor can see both your hands and face when you talk. Talk to the side not affected by the stroke.
-	Keep the television and the radio off when you're communicating.

Sources for this report include the National Institute of Neurological Disorders and Stroke and Consumer Guide No. #16 AHQR pub. no. 95-0664 US Agency For Healthcare Research and Quality.

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