Stroke Rehabilitation

No two stroke patients are alike. Patients may have a wide range of problems to be addressed in rehabilitation, including:

• cognitive problems, such as thinking and memory difficulties
• swallowing
• language
• balance and walking
• daily living activities, including bathing and eating

The integrated patient team will work with the stroke patient to overcome and treat these problems. Speech-language pathologists work with communication and swallowing, physical therapists focus on mobility and function, and occupational therapists work with the patient on recovering skills needed for everyday living.

The goal of treatment is to allow patients to return to their community.

Supplementary treatment and services

Treatment plans are created for each individual patient. Supplemental treatments can focus on individual needs as rehabilitation progresses. Those treatments and services may include:

• job-related goals and skills
• behavioral medicine to address stress and pain management
• rehabilitation technology and assistive technology
• orthotics
• education about home safety
• pre-driving evaluation

Testing for Swallowing Disorders

Someone who has had a stroke may have swallowing disorders. The speech-language pathologist will work with the patient to see if there is such a disorder. This evaluation can be done at the patient’s bedside; the speech-language pathologist also may recommend that an instrumental swallowing test be done.

The two main types of instrumental tests are a modified barium swallow study and a fiberoptic endoscopic examination of swallowing.

Modified barium swallow study:

This test x-rays the swallowing process. It is done with a speech-language pathologist and a radiologist. A moving x-ray watches the swallowing process and lets the clinicians see what happens to food as it is being swallowed.

The patient will sit in a wheelchair or a specialized chair. They will then swallow foods with different consistencies; these can include barium liquids, barium pudding, and a small piece of cookie with barium. The speech-language pathologist and the radiologist watch to see if the material goes into the esophagus, which is normal, or the airway, which is abnormal. If the patient coughs when that happens, that is recorded. It is called a “silent aspiration” if the patient does not cough. Both types of aspiration can lead to aspiration pneumonia.

The speech-language pathologist will make a recommendation to the physician about the most appropriate diet. Some times the test might show that the patient should not take food or liquid by mouth. A patient then may need a nasogastric tube or percutaneous endoscopic gastrostomy (PEG) tube until they can swallow safely.

Fiberoptic endoscopic examination of swallowing:

This test is a minimally invasive way to find out what happens before and after the patient swallows. A physician and a speech-language pathologist perform the test, which lets them see what happens to food before and after the patient swallows.

The physician first uses a topical anesthetic and a decongestant inside the patient’s nose so that an endoscope can be put into the nasal cavity and the back of the throat. The physician looks at the structures in the larynx, including the vocal folds. Clinicians then give small amounts of food – which has food coloring in it – to the patient to swallow. The food coloring makes it easier to see any food or liquid, and the physician and speech-language pathologist can make clinical judgments about whether the patient can swallow food and liquid safely.

After testing, the speech-language pathologist and the physician will discuss what the appropriate diet should be for the patient. The recommendation to begin an alternative form of nutrition and hydration will be discussed with the referring physician if the patient does not appear to be swallowing any items safely.

Family Involvement in the Rehabilitation Process

Family and caregivers who are involved in rehabilitation from the first day of admission and participate in training have better preparation in taking on the physical and emotional responsibilities of caregiving. Progress made in rehabilitation can be more effective if caregivers are trained in all aspects of patient care.

Family members can help in the following ways:

• attend occupational therapy, physical therapy, and speech-language pathologist sessions
• spend time with the nurses to understand medication schedules
• encourage and help the patient to practice new skills he or she has learned in therapy
• Visit the patient. Do the things they enjoy, like relaxing, listening to the radio, or playing cards.
• participate in activities and meals
• See what the patient can do alone, and what they need help doing. Avoid doing things for them if they can do it for themselves.
• ask the doctors, nurses, and therapists questions
• eat well and get enough rest; take breaks from caregiving as needed.