Stroke rehabilitation – How does it begin and help?
Assessment and treatment planning is vital, this should happen in the hospital soon after your stroke. The therapy will then be tailored to your specific needs depending on the level of weakness in your limbs. It may include:
- Practising to roll in bed, sit up, stand up, walk or use your hand and arm
- Exercises to improve your strength, sensation (ability to sense or feel things), coordination or fitness
- Using machines to help strengthen your muscles e.g. treadmill or an exercise bike. These will help reduce swelling and stiffness, reduce pain, give you information about how you are doing or provide support as you walk e.g. harness support system
- Stretching or supporting your muscles to reduce their stiffness or pain
- Teaching you how to safely walk with the help of certain aids e.g. frame or stick
- Choosing to limit the use of your good arm to encourage you to use the affected arm.
Starts small, then builds up.
The treatment may start by you trying to do small guided movements and practising simple tasks. As your strength is built up these movements will become larger and the physiotherapist will introduce more complicated exercises to encourage both sides of your body to work together. This will prevent you from overusing the side of your body that is unaffected by the stroke.
Family members and physiotherapist
Your family members may be involved in the treatment so they can help you with your exercises at home. The physiotherapist may also show your carer or family member safe ways to help you move in bed or to walk. The physiotherapist may give you an individual exercise programme to help your muscles work as well as possible.
Swallowing difficulties and help
Dysphagia is the medical term for difficulties swallowing. Difficulties swallowing are common in the first few days after stroke. You may find it hard to eat or drink. A swallow test is one of the first hospital assessments; initially it involves seeing if you can swallow a little bit of water without choking or coughing.
Due to brain damage caused by stroke, eating and drinking may be difficult, as the muscles of chewing and swallowing may be weakened especially in the early stages.
Feeding tube in the early stages
It is common to have a feeding tube in the early stages, to provide nutrition, fluids and medication until it is safe to eat and drink. These tubes can be placed either through the nose or through the abdomen. These tubes can be easily removed if and when the dysphagia resolves and you are taking an adequate diet. You may have an x-ray of your throat to see what your swallowing difficulties are and what types of food and drink are safe for you to eat.
Special swallowing therapy
The Speech and Language Therapist (SLT) will also provide special swallowing therapy and advice to help you eat and drink safely. The SLT will teach you how to sit correctly and proper eating methods to prevent food and drink from getting into your windpipe. In severe cases, a feeding tube will have to remain in order for you to get a nutritious diet.
Communication difficulties and help
After a stroke you may have problems communicating with others because you do not understand the words that they are saying, or because you cannot find the right words to express yourself fully.
Some people may completely lose the ability to speak, but can still understand what is being said to them. The ability to read and spell and write may also be affected. When a person has problems understanding and using words and sentences which affect his / her ability to communicate, this problem is called aphasia.
Some common difficulties / features of aphasia are:
- Mixing up yes and no
- Saying one word but meaning another e.g. saying brother instead of sister
- Getting stuck on a word or phrase over and over again
- Following only parts of a conversation
- Being easily distracted by noise
- Automatic swearing
- Slow responses, taking a bit more time to understand what is being said
- Words on the tip of the your tongue
- Speaking but not making much sense.
Slurred or difficult to understand speech
For others speech may become slurred and difficult to understand because the nerves and muscles of speech have been damaged. Sometimes one side of the face and tongue is paralysed or weak and can affect speech. This problem is called dysarthria.
Speech and language therapy can help you to recognise words or find other ways to communicate, like using gestures, word-and-picture charts, symbols and computers. The SLT will also show your family and friends ways of communicating with you which make it easier to get your message across.
Emotional problems and help
The two most common psychological conditions found in people after a stroke are:
- Depression – many people experience intense bouts of crying and feel hopeless and withdrawn from social activities
- Anxiety disorder – many people experience general feelings of fear and anxiety, often punctuated by intense, uncontrolled feelings of anxiety (anxiety attack).
These may be caused by the change in your life from the stroke or by the damage caused to your brain by the stroke itself. Feelings of anger, despair, frustration and grief are all normal for people who have had a stroke. Life changes that follow a stroke such as changes to relationships, work, finances and dealing with the loss of abilities and confidence can lead to anxiety and depression.
Do not suffer alone, ask for help and expertise.
If you are experiencing these problems, do not suffer alone. Both depression and anxiety can be treated using psychological therapies where you can learn to cope with and understand these feelings.
Contact your GP or medical social worker to get a referral to a clinical psychologist or psychiatrist for expert advice.
Nutrition and help with your weight
A dietitian will advise you to make sure you are getting the best nutrition to help you recover. The nutritionist or dietitian will make sure that your dietary needs are met by assessing your nutritional requirements, monitoring what food you eat and educating you on the type of food and drink more appropriate for your needs.
If you need a feeding tube, either because you have a swallowing problem or you’re not eating enough, the dietitian will instruct what feeding plan is most appropriate for your needs. She will monitor your nutritional status and adjust the plan as you improve.
Weight changes can happen after a stroke so it is important that you look after your diet when you leave hospital. A healthy balanced diet may help you prevent another stroke. If you have diabetes, high cholesterol or high blood pressure, remember to follow your diet plan.
Some practical tips for you to maintain a healthy stable weight are:
- Eat a balanced diet with a variety of foods
- Eat plenty of fibre-rich foods to prevent constipation
- Drink plenty of fluids
- View our article for tips and advice to Being a healthy weight
If you need more advice on your diet, ask your GP or hospital consultant to refer you to a dietitian.
Visual problems and therapy to help
Stroke may causedouble vision, blurred vision or partial blindness. Some people cannot see to the left or right and this causes difficulty with balance, co-ordination or recognising familiar things or people.
- Your physiotherapist and OT can help with movement and with exercises to compensate for, or cope with, areas of blindness.
- A psychologist will help you with problems with processing information like recognising things and people.
- An ophthalmologist or optician can recommend visual aids like glasses.
- An orthoptist can help with eye-movement problems and explain ways of coping with reading difficulties.
Bladder and bowel control advice
It is common for people to have difficulty controlling their bladder or bowel after a stroke. This is known as incontinence. For many people this control will come back over time.
- A nurse or continence advisor can show you exercises to improve your bladder retaining capacity, including pelvic floor exercises to strengthen muscles
- The physiotherapist can teach you exercises to improve your walking and on using a toilet or commode (a portable or small beside toilet)
- The OT will advise on how your house can be adapted and on what equipment would make it easier to use the toilet.
Occasionally, a tube (catheter) may need to be inserted to help drain the bladder. If this is needed, it should be done every now and then rather than inserted for long periods of time.
Dealing with day-to-day activities
The problems with movement, coordination and perception following a stroke can make it difficult to perform everyday tasks like washing, dressing, eating and going up stairs. The occupational therapist (OT) and physiotherapist work to help you become as independent as possible in your activities of daily life, leisure activities, working, driving and socialising to the best level possible.
How the Occupational Therapist can help you
If you have cognitive problems following your stroke such as, problems thinking, remembering and concentrating, the OT will work with you to improve these things. This may involve:
- Using memory aids like diaries and lists;
- Practising physical or mental skills through crafts and board games;
- Giving advice to your family members like keeping instructions short and reducing the amount of distractions when you are communicating.
You may find that you have difficulty with some day-to-day activities. By talking to your care team, you can find ways to make them easier.
Standing and walking – can be made easier with shoes which offer good support and rearranging the furniture in your home. Walking up and down stairs can be difficult, but fitting handrails or a stair lift can make it easier. Some may also need to use a stick, a walking frame or a wheelchair. If needed, an OT can advise you about the use of a wheelchair.
Getting out of chairs/bed – standing up from sitting in chairs or getting out of bed can be difficult. OTs can advise on the best types of chairs and mattresses. Your physiotherapist can show you the best transfer technique to help you move about.
Dressing – putting on and taking off clothes may be difficult. Simple procedures can make dressing easier, such as putting your weak arm or leg into clothes first and using shoehorns.
Feeding – sometimes using a knife and fork may be clumsy or awkward. Using utensils with thick handles can help, as can non-slip mats which prevent the plate from moving around the table.
Washing and grooming – again there are many simple tips an OT can give you which will may make it easier, such as using a free standing shower.
Going to the toilet – if your toilet is upstairs and you find it difficult to walk, you might use a commode or move your toilet downstairs. You might also need to have rails fitted in the bathroom. Talk to your public health nurse and your OT about what you could do.
Applying for a grant – Many of the adaptations to your home or the equipment you require can be purchased using a Housing Adaptation Grant. These grants are provided by your Local Authority. Ask your Social Worker about how you could apply for a grant.