Quality of Life Issues in Stroke Rehabilitation

The deficits and disabilities resulting from stroke severely impact all aspects of the stroke survivor's life. Mobility, communication, independence, self-care, self image, leisure activities, travel and other dimensions of daily living all undergo a change. Enabling the patient to maximize the function that remains intact and compensate for deficits that will not change is the cornerstone of rebuilding their quality of life. Socialization and activities are important for the stroke survivor as they positively impact depression, cognition, balance, dexterity, pain management, and also maintain or increase independence and self-image.

During and after the rehabilitation process, the stroke survivor may need various types of equipment to help them manage their activities of daily living. It is best if these are ready in the home before the patient arrives so that there is immediate continuity from practice within the rehabilitation setting, which adds to the survivor's feeling of independence. Some of the equipment to consider includes:

• A cane to aid walking
• A three legged cane to aid with difficulty in balance while walking
• A walker which provides more support than a cane and can be adapted for patients with specific disabilities of hand or foot
• Ankle or foot braces (othotics) which provide support for the knees and help keep the ankle and foot in the correct position for standing or walking
• Wheelchair for survivors who either cannot walk safely at all or may not be able to walk longer distances - wheelchairs can be customized to fit specific needs of the survivor
• Communication aids such as a communication board, computer, or other devise to communicate the needs of the patient and help them interact with people around them
• Devices to aid in activities of daily living such as non-skid rugs or mats
• A chair on wheels which fits over the toilet
• Handrails next to any steps in or around the outside of the home

A physical therapist, occupational therapist, or rehabilitation specialist will be able to counsel the family or caregiver regarding the special equipment that the patient may require and will be able to offer suggestions regarding implementation.

It is very important to address the issue of safety in the patient's environment, especially at home. For example, balance deficit and paralysis or paresis of a leg can cause falling, tactile deficits can cause a patient not to realize they have injured themselves, and communication deficits place a patient at risk if he/she is unexpectedly alone or separated from a caregiver.

Some of the steps that can be taken to protect the patient from these types of situations include:

• Giving the patient a card to carry at all times with contact information of his/her family, and/or caregiver or friends
• Giving the patient a card to keep at all times indicating that the person has suffered a stroke and may not be able to respond to questions, or may be confused or disoriented
• Giving the patient a cell phone so that if he/she is separated or lost, a family or caregiver can call, or if necessary, a stranger would be able to immediately contact family members.
• In the home, blocking access to potentially dangerous areas, such as glass doors and stairways
• Supervising the patient during bathing
• Removing sharp objects from rooms in which the patient moves about to prevent injury from handling them or tripping over them
• Locking from the inside all doors leading outside if the patient is disoriented and may wander
• Placing grab-bars in the bathroom near the toilet and in the shower
• Placing a railing near all stairs in the house on the side of the patient's unaffected arm
• Keeping as much open space as possible on the floor in rooms where the patient walks around. Remove clutter and either remove furniture with sharp corners or cover the corners with foam or another soft material.
• Helping the patient reintegrate into the community, through participation in social activities, leisure activities, physical activities are important for physical, emotional, and cognitive progress. It also gives the patient something to look forward to and raises their morale.
• Inviting friends over helps survivors participate in preparing and planning activities and adds to their self-confidence.

There needs to be close communication between the patient's family or caregiver and the health insurance carriers to understand the extent of rehabilitation services that are allowed under the patient's policy. Also family members may need to consider meeting with a financial planner to help calculate the expenses involved in caregiving, medications, remodeling of the home to accommodate the patient, wheelchair accessibility, and other items that may not covered by insurance.