Rehabilitation After Stroke

Progression of Stroke Rehabilitation

Rehabilitation for the stroke patients starts in the hospital as soon as the patient's medical condition has been stabilized, usually within 24-48 hours, and begins with promoting independent movement of the limbs by engaging in passive or active "range of motion" exercises. Depending on the severity of the stroke, patients then progress from sitting up to transferring to a chair to standing and bearing their own weight and then walking, with or without assistance. An important goal of this first stage of recovery is restoring functional independence by promoting self care, such as washing, brushing teeth, and taking care of personal needs.

When the patient is ready to be discharged from the hospital, depending on their functional and medical status, they may be discharged either to a rehabilitation facility, a long-term nursing facility, or to their own home for home-based or community based rehabilitation. A member of the health care team, such as a social worker, will meet with the patient and family and help them evaluate what will be most beneficial for the patients continued recovery. Regardless of which option is chosen, it is important that the patient continue to receive as intense a level of rehabilitation as they can tolerate.

The ideal level intensity for greatest efficacy of therapy has not been established, although it appears that younger stroke patients can tolerate greater amounts of exercise than older stroke patients. There is evidence that increased intensity of rehabilitation does influence outcome but attenuates over time, however, there is little understanding of this relationship and the effect on long-term functionality for stroke patients. It has been noted in various studies that greater exercise intensity has a more beneficial effect on lower limb function than for upper limbs.