What is stroke rehabilitation?
The purpose of rehabilitation is to return the stroke patient to their life and level of function that existed before the stroke. The success of that goal depends upon the underlying health of the patient and severity of the stroke.
Rehabilitation may take weeks and months and usually requires a team approach for success. Physical therapists, occupational therapists, and speech pathologists will coordinate care with the primary health care professional and physical medicine and rehabilitation specialists.
Some of the treatments are directed to prevent life-threatening complications. For example, speech pathologists may help with swallowing to prevent aspiration pneumonia. Physical therapists may concentrate on strength and balance to prevent falls. Occupational therapists may find ways to allow the patient to perform daily activities from personal hygiene to cooking in the kitchen.
Many patients with significant stroke deficits may require admission to a rehabilitation hospital and/or longer term nursing facility prior to returning home. Unfortunately, some patients will have had too severe a stroke to be offered that opportunity.
What is the prognosis for a person that suffers a stroke?
Stroke remains a major killer in the United States and worldwide. In the U.S., 20% of stroke patients will die within a year. However, with the ability to intervene with thrombolytic therapy to reverse the stroke and with more aggressive rehabilitation, the goal is to increase patient survival and function after recovery.
Specialized stroke centers, hospitals that have the doctors, equipment, and resources to intervene quickly and treat strokes aggressively, have shown to increase stroke survival and patient function and recovery. These hospitals are certified by The Joint Commission, the American Stroke Association, and the health departments of some states. It is to your advantage to know which hospitals in your area are designated stroke centers because they will have the specialists and equipment needed to minimize diagnosis to treatment times.
There are many complications that can develop in stroke patients and some may not be able to return to full employment because of disability. Patients are affected physically with decreased body function, mentally with decreased cognition, and emotionally with depression and anxiety.
The return to function depends upon the severity of the stroke, what parts of the brain and body have stopped working, and what complications develop. Patients who lose their ability to swallow may develop aspiration pneumonia when food or saliva is inhaled into the lungs causing infection. Patients who have difficulty moving can develop pressure sores and infection due to skin breakdown.
Seizures may be a complication in up to 10% of patients. The more severe the stroke, the more likely that seizures may develop.
Which specialties of doctors treat stroke?
Stroke care involves many providers as the patient travels through the care process.
Care for a stroke patient may begin with prehospital providers (first responders, EMTs, paramedics) who recognize stroke symptoms and activate a stroke response.
Emergency physicians begin the evaluation and may help make the decision to administer TPA. Neurologists, neurosurgeons, interventional radiologists may also be involved in the decision to treat the stroke patient with TPA or clot retrieval, if the latter is an option at the hospital.
Critical care specialists help stabilize the patient after TPA is given. For patients who are not candidates for TPA, they are often admitted to a hospitalist.
Rehabilitation physicians, physical therapists and occupational therapists are involved after the acute event has resolved.
Finally, the primary care provider would look after the patient long-term.
Can strokes be prevented?
Prevention is always the best treatment, especially when the illness can be life-threatening or life-altering. Ischemic strokes are most often caused by atherosclerosis, or hardening of the arteries, and carry the same risk factors as heart attacks (myocardial infarction, coronary artery disease) and peripheral vascular disease. These include high blood pressure, high cholesterol, diabetes, and smoking. Stopping smoking and keeping the other three under lifelong control greatly minimizes the risk of ischemic stroke.
Patients who have had a transient ischemic attack (TIA) are often prescribed medications to decrease their risk of a subsequent stroke. These include medications to lower blood cholesterol levels and control blood pressure. In addition, antiplatelet medications may be prescribed to make platelets less likely to promote blood clot formation. These include aspirin, clopidogrel (Plavix), and dipyridamole/aspirin (Aggrenox).
Patients with a TIA are usually evaluated for carotid stenosis or narrowing of the carotid artery. Surgery to open critically narrowed carotid arteries (termed endarterectomy) may decrease stroke risk.
Lifelong control of high blood pressure decreases the risk of hemorrhagic stroke.
Atrial fibrillation is the most common cause of embolic stroke. Ideally the heart rhythm can be converted to normal sinus rhythm but in those patients whose hearts are chronically in atrial fibrillation, anticoagulation or “blood thinning” minimizes the risk of blood clot formation in the heart and subsequent embolization and stroke. The drug that is prescribed depends upon the specific patient and their individual situation. Patients who are prescribed apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), or warfarin (Coumadin), decrease the chance of a stroke but are at risk for bleeding complications.
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