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Stroke Rehabilitation

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At the UPMC Rehabilitation Institute, we address a wide range of problems associated with stroke, including:

  • Cognitive difficulties, such as thinking and memory
  • Swallowing
  • Language
  • Balance and walking
  • Daily living activities, such as bathing and eating

The integrated patient team will work with you during rehab to help improve:

  • Communications and swallowing problems
  • Mobility
  • Physical function
  • Skills for daily living

The goal of treatment is to allow you to return to your community.

Testing for Swallowing Disorders

Someone who has had a stroke may have swallowing disorders.

The speech-language pathologist:

  • Will work with you see if you have such a disorder
  • Can do the evaluation at your bedside
  • May recommend you have an instrumental swallowing test

The two main types of instrumental swallowing tests are:

  • Modified barium swallow studies
  • Fiberoptic endoscopic examinations 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 you swallow it.

What to expect

You will sit in a wheelchair or a specialized chair and then swallow foods with different consistencies; these can include:

  • Barium liquids
  • Barium pudding
  • A small piece of cookie with barium

The speech-language pathologist and the radiologist watch to see where the food goes when you swallow.

If food goes into the esophagus, this is normal. If food goes into the airway, this is abnormal.

  • If the food goes into the airway, the speech-language pathologist will make note if you cough. It is called a “silent aspiration” if you do not cough. Both types of aspiration can lead to aspiration pneumonia.
  • The speech-language pathologist will make a recommendation to your doctor about the most appropriate diet.
  • If the test shows that you should not take food or liquid by mouth, you may need a nasogastric tube or a percutaneous endoscopic gastrostomy (PEG) tube until you can safely swallow.

Fiberoptic endoscopic examination of swallowing

This test is a minimally invasive way to find out what happens before and after you swallow. A doctor and a speech-language pathologist perform the test.

What to expect

  • The doctor first uses a topical anesthetic and a decongestant inside your 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 you small amounts of food – which has food coloring in it – for you to swallow. The food coloring makes it easier to see any food or liquid and helps determine whether you can safely swallow food and liquid.
  • After testing, the doctor and a speech-language pathologist will discuss an appropriate diet for you.
  • If the test shows that you cannot safely swallow, they will talk to your referring physician about beginning an alternative form of nutrition and hydration.

Supplementary treatment and services

At the UPMC Rehabilitation Institute, we create treatment plans for each individual patient.

Supplemental treatments and services, as your rehabilitation progresses, may include:

Family Involvement in the Rehabilitation Process

Family and caregivers who are involved in rehabilitation from the first day of admission and participate in training are better prepared to take 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, physical, and speech therapy sessions.
  • Spend time with the nurses to understand medication schedules.
  • Encourage and help your loved one practice new skills he or she learned in therapy.
  • Visit the patient and do the things he or she enjoys, such as:
    • Relaxing
    • Listening to the radio
    • Playing cards
  • Participate in activities and meals.
  • Learn what the patient can do alone, and what he or she needs help doing.
  • Ask the doctors, nurses, and therapists questions.
  • Eat well, get enough rest, and take breaks from caregiving as needed.

Read more on UPMC HealthBeat

Want to learn more about rehabilitation after a stroke? Check out Road to Recovery: Forms of Rehab After Stroke on UPMC HealthBeat!