Where does stroke rehabilitation take place?

You'll probably begin stroke rehabilitation while you're still in the hospital. Before you leave, you and your family will work with hospital social workers and your care team to determine the best rehabilitation setting depending on your needs, what insurance will cover, and what is most convenient for you and your family. These options include:

  • Inpatient rehabilitation units. These facilities are either freestanding or part of a larger hospital or clinic. You may stay at the facility for several weeks as part of an intensive rehabilitation program.
  • Outpatient units. These facilities are often part of a hospital or clinic. You may spend several hours a day at the unit, but return home each night.
  • Skilled nursing facilities. The type of care available at a nursing facility — sometimes referred to as a nursing home — varies. Some facilities specialize in rehabilitation, while others offer less-intense therapy options.
  • Home-based programs. Having your therapy at home allows greater flexibility than other options. One drawback is you likely won't have access to specialized rehabilitation equipment. In addition, insurance strictly controls who qualifies for home-based therapy.

Talk to your doctor and family about the best option for you.

Who participates in your stroke rehabilitation team?

Stroke rehabilitation involves a variety of specialists.

Some specialists help with physical needs, including:

  • Physicians include your primary care doctor as well as specialists in physical medicine and rehabilitation (physiatrists) and neurologists. They help guide your care and prevent complications. They also help you to gain and maintain healthy lifestyle behaviors to avoid another stroke.
  • Rehabilitation nurses specialize in caring for people with limitations to activities. They help incorporate skills learned in physical, occupational and speech therapy into your daily routines. They also can offer options for managing bowel and bladder complications of stroke.
  • Physical therapists help you relearn movements such as walking and keeping your balance.
  • Occupational therapists help you relearn functional hand and arm use for daily skills, such as bathing, tying your shoes or buttoning your shirt. They can also address safety issues in your home, and help with cognitive organizational tasks.

Other specialists focus on cognitive, emotional and vocational skills, including:

  • Speech and language pathologists help improve your language skills and ability to swallow. They may also teach you how to use compensation tools to address memory, thinking and communication problems.
  • Dietitians assist you with creating healthy menus, including heart-healthy, low-fat and low-salt foods.
  • Social workers help connect you to financial resources, as well as help you plan for new living arrangements, if necessary, and identify community resources.
  • Psychologists assess your thinking skills and help address your mental and emotional health concerns.
  • Therapeutic recreation specialists help you resume activities and roles you enjoyed before your stroke, including hobbies and community participation.
  • Vocational counselors help you address return-to-work issues if this is a goal. They can provide information about the Americans with Disabilities Act (ADA) to help with workplace accommodations, if needed.

What factors affect the outcome of stroke rehabilitation?

Because stroke recovery varies from person to person, it's hard to predict how many abilities you might recover and how soon. In general, successful stroke rehabilitation depends on:

  • Physical factors, including the severity of your stroke in terms of both cognitive and physical effects
  • Emotional factors, such as your motivation and mood, and your ability to stick with rehabilitation activities outside of therapy sessions
  • Social factors, such as the support of friends and family
  • Therapeutic factors, including an early start to your rehabilitation and the skill of your stroke rehabilitation team

Generally the rate of recovery is greatest in the acute and post-acute periods — weeks and months after a stroke. However, there is evidence that performance can improve well into the chronic phase, or years later.

Stroke rehabilitation takes time

Recovering from a stroke can be a long and sometimes frustrating experience. It's normal to face difficulties along the way. Dedication and willingness to work toward improvement will help you gain the most benefit.

June 11, 2014