Stroke Rehabilitation Should Be Personal

By Margaret Schmidt

A recent article in Provider Magazine reminds rehab teams that from start to finish, clinicians need to consistently communicate with and listen to all parties involved in the patient’s care.

From the outset, the patient and the multidisciplinary rehab team should take the opportunity to educate each other. Clinicians inform the patient and the patient’s family about the clinical implications of stroke, and the patient gets the chance to explain their goals and their life before their stroke.

“We need to learn a lot more than we usually do about the patient’s personality, life events, and coping skills before they had their stroke,” says David Smith, MD, CMD, president of Geriatric Consultants of Central Texas in Brownwood.

Therapists should capitalize on this chance get to know their patients and uncover their wishes at the beginning of treatment.

“I don’t think we spend enough time asking patients what they want,” says Mary Van de Kamp, MS, CCC, SLP, senior vice president of quality and care management at Kindred Healthcare, RehabCare’s parent company. “We don’t want to make promises we can’t keep, but we also don’t want to discourage aspirations.”

If the stated goal is independence, find out what independence means for that particular patient. Mary recalls a patient who loved to play basketball before his stroke. The physical therapist had doubts, but he worked with the patient to accommodate his goal of getting back in the game. In the end, staff was able to arrange for the patient to join a wheelchair basketball league.

Incorporating patients’ interests and hobbies in therapy can encourage the patient to take an active role in his or her recovery. Once the rehab team understands the patient, they are in a good position to design a care plan that will work.

The rehab team often has to adjust the plan of care as treatment progresses. Therapists must monitor mental health and determine if efforts to engage the patient are working. If the team is struggling to motivate an individual, the patient’s family can be consulted, says Katie O’Shea, PT, DPT, GCS, MBA and rehabilitation manager at PowerBack Rehabilitation in Vorhees, New Jersey. Delivering meaningful therapy requires thorough and ongoing communication with the patient, family and care team. It is important to involve the entire care team in these discussions. When therapists from each discipline are involved, problem solving is more efficient.

A top-notch plan of care also leverages the latest technology with the personal approach. For example, robotic devices can deliver specific repeated exercises to patients with severe weakness. Repeated noninvasive transcranial magnetic stimulation (nTMS) can deliver low or high stimulation to the brain’s hemispheres to assist with motor recovery and pain alleviation. Experts recommend that rehab teams take advantage of these advancements. “Strong departments have both good equipment and a comprehensive approach,” says Mary.
By Margaret Schmidt