Rehabilitation After Stroke

Selection of a Stroke Rehabilitation Facility

There is growing evidence that the intensity level of stroke rehabilitation is correlated with outcome. Overall, intensive stroke rehabilitation is associated with significantly lower mortality, institutionalization, and dependency. In addition, studies have shown that there is a significant relationship between the intensity of rehabilitation and improvement of daily living activities, walking, and dexterity. Stroke survivors in integrated acute and rehabilitation programs make greater functional gains, are more likely remain at home, have decreased 5-year and 10-year mortality, and better quality of life than patients who are admitted to general medical units for rehabilitation. In the United States, stroke units that are characterized by coordinated interdisciplinary rehabilitation, stroke education and training, and specialized medical and nursing staff also report decreased dependency on others, less frequent institutionalization, and a lower 1-year mortality rate.

While still in acute care in the hospital, rehabilitation focuses on trying to teach the patient to move from the bed to a chair, to learn compensatory techniques that allows them to carry out activities of daily living as independently as possible (such as learning to wash with one hand), and to walk with a walker or a cane. Each of these goals must be modified to address the severity of the stroke and the immediate needs and abilities of the patient. Preventing deconditioning, which develops with prolonged immobility, is a high priority.

Patients who are too disabled to return home and need ongoing medical supervision but who have the stamina and cognitive ability to undergo intensive therapy for 3 hours a day or more usually benefit from inpatient rehabilitation units. Most patients (80%) who go through inpatient rehabilitation facilities are discharged to their homes where they continue with home-based or outpatient rehabilitation. While studies comparing inpatient rehabilitation to generalized hospital care for stroke patients clearly showed benefit for inpatient settings, a study comparing rehabilitation at an inpatient stroke unit with an intensive community-based outpatient stroke rehabilitation facility showed that functional outcomes of patients are comparable. The key in any rehabilitation unit is the intensity level and the interdisciplinary approach to rehabilitation. Clinical trials have shown a significant relationship between the intensity of rehabilitation and increased functionality for activities of daily living, walking, dexterity, and other motor deficits and cognitive deficits.

Questions that patients and families should ask about stroke rehabilitation services include:

• What types of services are provided in the rehabilitation facility?
• Does the rehabilitation facility provide services at the level that the patient needs? For example, is it too demanding or is it demanding enough?
• How much therapy will be provided in the rehabilitation facility?
• Does the program actively involve caregivers and family members?
• Does the patient's health insurance cover rehabilitation services or the facility itself?
• Is the patient responsible for any portion of the charges for rehabilitation services or equipment?
• Is the facility close enough to the patient's home so that family, friends, and/or caregivers can visit easily?
• If it is an outpatient facility, is transportation available for the patient?
• Is the facility certified? What are the credentials of the staff?