The Role of Physical Therapists and Rehabilitation Nurses
Nurses specializing in stroke rehabilitation help survivors relearn how to carry out the basic activities of daily living. Rehabilitation nurses also educate survivors about routine healthcare, such as:
- How to follow a medication schedule
- How to care for the skin
- How to manage transfers between a bed and a wheelchair
- Special needs for people with diabetes.
These nurses also work with survivors to reduce risk factors that may lead to a second stroke, and provide training for caregivers.
Nurses are closely involved in helping stroke survivors manage personal care issues, such as bathing and controlling incontinence. Most stroke survivors regain their ability to maintain continence, often with the help of strategies learned during rehabilitation. These strategies include strengthening pelvic muscles through special exercises and following a timed voiding schedule. If problems with incontinence continue, nurses can help caregivers learn to insert and manage catheters and to take special hygienic measures to prevent other incontinence-related health problems from developing.
Physical therapists specialize in treating disabilities related to motor and sensory impairments. They are trained in all aspects of anatomy and physiology related to normal function, with an emphasis on movement. Physical therapists can:
- Assess the stroke survivor's strength, endurance, range of motion, gait abnormalities, and sensory deficits to design individualized rehabilitation programs aimed at regaining control over motor functions.
- Help survivors regain the use of stroke-impaired limbs, teach compensatory strategies to reduce the effect of remaining deficits, and establish ongoing exercise programs to help people retain their newly learned skills. Disabled people tend to avoid using impaired limbs, a behavior called learned non-use. However, the repetitive use of impaired limbs encourages brain plasticity and helps reduce disabilities.
- Encourage the use of impaired limbs. Selective sensory stimulation such as tapping or stroking, active and passive range-of-motion exercises, and temporary restraint of healthy limbs while practicing motor tasks.
- Use a new technology, transcutaneous electrical nerve stimulation (TENS), which encourages brain reorganization and recovery of function. TENS involves using a small probe that generates an electrical current to stimulate nerve activity in stroke-impaired limbs.
In general, physical therapy emphasizes practicing:
- Isolated movements
- Repeatedly changing from one kind of movement to another
- Rehearsing complex movements that require a great deal of coordination and balance, such as walking up or down stairs or moving safely between obstacles.
People who are too weak to bear their own weight can still practice repetitive movements during hydrotherapy (water provides sensory stimulation as well as weight support) or while being partially supported by a harness. A recent trend in physical therapy emphasizes the effectiveness of engaging in goal-directed activities, such as playing games, to promote coordination. Physical therapists frequently employ selective sensory stimulation to encourage use of impaired limbs and to help survivors regain awareness of stimuli on the neglected side of the body.