Stroke Rehab / CVA
What’s involved in stroke rehabilitation?
There are numerous approaches to stroke rehabilitation, some of which are still in the early stages of development. Behavioral performance in any area, such as sensory-motor and cognitive function, is most likely to improve when motor activity is willful, repetitive and task specific.
Stroke rehabilitation may include some or all of the following activities, depending on the part of the body or type of ability affected.
- Strengthening motor skills involves using exercises to help improve your muscle strength and coordination, including therapy to help with swallowing.
- Mobility training may include learning to use walking aids, such as a walker or canes, or a plastic brace (orthosis) to stabilize and assist ankle strength to help support your body’s weight while you relearn how to walk.
- Constraint-induced therapy, also known as forced-use therapy, involves restricting use of an unaffected limb while you practice moving the affected limb to help improve its function.
- Range-of-motion therapy uses exercises and other treatments to help lessen muscle tension (spasticity) and regain range of motion. Sometimes medication can help as well.
When should stroke rehabilitation begin?
The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills. However, your doctors’ first priority is to stabilize your medical condition and control life-threatening conditions. They also take measures to prevent another stroke and limit any stroke-related complications.
It’s common for stroke rehabilitation to start as soon 24 to 48 hours after your stroke, during your acute hospital stay. If your medical problems continue for longer, your doctors may wait to begin your rehabilitation.
How long does stroke rehabilitation last?
The duration of your stroke rehabilitation depends on the severity of your stroke and related complications. Although some stroke survivors recover quickly, most need some form of stroke rehabilitation long term, possibly months or years after their stroke.
Your stroke rehabilitation plan will change during your recovery as you relearn skills and your needs change. With ongoing practice, you can continue to make gains over time.
The length of each stroke rehabilitation therapy session varies depending on your recovery, severity of your symptoms and responsiveness to therapy.
HOW PHYSICAL THERAPISTS HELP
Physical therapists are part of the stroke rehabilitation team. Rehabilitation begins very soon after a stroke; your physical therapist’s main goal is to help you return to your activities at home, at work, and in your community.
After examining you and evaluating your condition, your physical therapist will develop an individualized plan to help you achieve the best possible quality of life. The plan will focus on your ability to move, any pain you might have, and ways to prevent problems that may occur after a stroke.
One of the first things your physical therapist will teach you is how to move safely from your bed to a chair, and to perform exercises in bed. As you become more mobile, your physical therapist will teach you strengthening exercises and functional activities.
Later, your physical therapist will:
- Help you improve your balance and walking.
- Fit you with a wheelchair, if needed.
- Provide training to your family and caregivers.
- Train you in how to use devices that can help you keep mobile when a stroke has affected your ability to move, walk, or keep your balance: orthoses, prostheses, canes, walkers, wheelchairs, and perhaps even robotics.
Treatment for stroke varies. Your specific treatment will depend on the results of your physical therapist’s evaluation, and on how long it’s been since you had your stroke. Recovery from a stroke depends on the size and location of the stroke, how quickly you received care, and your other health conditions. Your physical therapist will help you regain functional skills to allow you to participate in your specific life activities.
Relearning How to Use Your Upper Body, How to Walk, and How to Perform Daily Activities
Your physical therapist will design an exercise and strengthening program based on tasks that you need to do every day, selecting from a variety of treatments. Physical therapist researchers are at the forefront of innovating many of these techniques:
- Constraint-induced movement therapy (CIMT). CIMT is used to strengthen an arm affected by the stroke. Your physical therapist will apply a mitten or a sling on your strong arm to keep you from fully using it. This constraint “forces” you to use your arm or hand affected by the stroke to perform daily tasks, which helps build your strength and control. CIMT requires that the constraint be used for several hours a day, several days a week to be successful.
- Functional electrical stimulation (FES). This treatment helps move your muscles if they are very weak. For instance, your physical therapist might use FES to treat a painful or stiff shoulder.
- Motor imagery and mental practice. These tools are used to help strengthen the arms, hands, feet, and legs. Working with your physical therapist, you will “rehearse” a movement without actually performing it, which stimulates the part of your brain that controls the movement.
- Positioning. Proper positioning helps reduce any muscle pain, spasms, slowness, or stiffness that can result from stroke. Your physical therapist will teach you how to safely move (“transfer”) from a sitting to a standing position, and how to support yourself when sitting or lying down, using foam wedges, slings, and other aids.
- Virtual reality and interactive video games may be used to provide experiences similar to real life. Using a keyboard and mouse, a special wired glove, or sensors on your body, you can practice daily tasks as your therapist helps you “rewire” your brain and nerve connections. Your therapist may teach you how to continue these activities at home.
- Partial body weight support (BWS). BWS is used to help support you as you walk, usually on a treadmill. Your physical therapist will gradually decrease the amount of support as your posture, strength, balance, and coordination improve.
- Biofeedback. This treatment helps make you aware of how your muscles work and how you might be able to have better control over them. Your therapist will attach electrodes to your skin to provide measurements of muscle activity that are displayed on a monitor. Your physical therapist will work with you to help you understand and change those readings.
Your needs will change over time, and your physical therapist may consider using aquatic therapy, robotics, or support devices to assist in your recovery. Even after rehabilitation is completed in a facility, your physical therapist will contiThe goal of a stroke rehabilitation program is to help you relearn skills you lost when stroke affected part of your brain. Stroke rehabilitation can help you regain independence and improve your quality of life.
The severity of stroke complications and each person’s ability to recover lost abilities varies widely. Researchers have found that the central nervous system is adaptive and can recover some functions. They also have found that it’s necessary to keep practicing regained skills.