When Therapy Begins After a Stroke and Who Is Involved
When Does It Begin?Rehabilitation begins in the acute-care hospital after the patient's medical condition stabilizes, often within 24 to 48 hours after the stroke. The first steps involve promoting independent movement because many patients are paralyzed or seriously weakened. Patients are prompted to change positions frequently while lying in bed and to engage in passive or active range-of-motion exercises to strengthen their stroke-impaired limbs. Passive range-of-motion exercises are those in which the therapist actively helps the patient move a limb repeatedly, whereas active exercises are performed by the patient with no physical assistance from the therapist. Patients progress from sitting up and transferring between the bed and a chair to standing, bearing their own weight, and walking, with or without assistance.
Nurses and therapists help patients perform progressively more complex and demanding tasks, such as bathing, dressing, and using a toilet, and they encourage patients to begin using their stroke-impaired limbs while engaging in those tasks. Beginning to reacquire the ability to carry out these basic activities of daily living represents the first stage in a stroke survivor's return to functional independence.
Professionals involved with rehabilitation after a stroke include:
- Rehabilitation nurses
- Physical therapists
- Occupational therapists
- Recreational therapists
- Speech-language therapists
- Vocational therapists
- Mental health professionals.
Physicians have the primary responsibility for managing and coordinating the long-term care of stroke survivors, including recommending which rehabilitation programs will best address individual needs. Physicians are also responsible for caring for the stroke survivor's general health and providing guidance aimed at preventing a second stroke, such as: