Can every stroke patient be rehabilitated?
NORMAN Neurological Rehabilitation Centre
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Whether rehabilitation is possible, and its type and intensity, is determined by the patient’s health and the time that has passed since the stroke. Immediately after a stroke, while the patient is on the neurology ward, it is the doctor who decides whether to begin rehabilitation. In the acute phase after a stroke, family members cannot intervene in the treatment process. At this stage, all you can do is trust the treating doctor, who makes decisions based on the patient’s current condition. This is because, in the acute phase after a stroke, there is a direct threat to life.
Not every patient can be rehabilitated immediately after admission to hospital. This is due to the direct threat to life and the need to stabilise vital functions. It usually takes anywhere from a few to several days before the first attempts to stand the patient up, which mark the beginning of the later work on gait and balance disorders. In some cases, when the patient is in a coma or is only partly responsive, this time may be longer.
In most cases, rehabilitation is possible around one to two weeks after a stroke. This is decided by the treating doctor, who issues a referral to a rehabilitation ward. It also happens that, for various reasons, a patient does not receive such a referral. Feedback from patients and their families shows that a common reason for refusing a rehabilitation referral is that the patient is said not to cooperate or not to have good prospects. Unfortunately, in many cases people with great potential to regain function are ruled out at the very start of their rehabilitation journey. It is important to remember that the absence of a state-funded rehabilitation referral, or words along the lines of “nothing more can be done here, please look for a nursing and care facility”, do not eliminate the chances of regaining at least some function.
Every patient has rehabilitation potential
Every patient has a certain degree of rehabilitation potential. Greater or smaller, but it is there. What matters is making the most of that potential. Whether a patient has good prospects and what the chances of regaining function are can only begin to be assessed once stroke rehabilitation has started and the patient’s response to the therapeutic approach has been verified.
Not every therapeutic approach is correct, and not every one is right for a given patient. That is why it is worth seeking out different places, centres, methods and neurological rehabilitation programmes — ideally ones dedicated to a specific condition and suited to rehabilitating the patient at their particular stage of illness. Not every facility is equipped to admit a bedbound patient with a tracheostomy tube who is fed enterally, because of a lack of staff able to care for such a patient. Another option is for the patient to stay together with a close relative acting as a carer. This possibility is most often reserved for private medical care.
Being discharged from hospital means that the patient no longer needs to be under constant medical supervision. Regular follow-up appointments with the treating doctor are usually required. This opens up the possibility of taking part in rehabilitation stays without constant medical supervision. Of course, this is a challenge for the patient’s family, especially if the patient has a urinary catheter, a tracheostomy tube or a tube for enteral feeding.
Sometimes the results of rehabilitation are spectacular within a relatively short time after a stroke. At other times they take far longer to work towards, and how long rehabilitation after a stroke takes is determined by many individual factors. In very extreme cases the results are minimal or absent altogether. It is worth seeking out a rehabilitation path that is right for the particular patient. This is difficult — emotionally, in terms of time and financially — but not impossible. We urge you to fight by every possible means for neurological rehabilitation dedicated to stroke patients: rehabilitation that is intensive, yet tailored to the patient’s needs and capabilities.
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Do comorbidities affect stroke rehabilitation?
Coexisting conditions can significantly limit standing up, physical stamina and the choice of exercises after a stroke, so therapy must take account of a full medical history and carefully measured levels of exertion.
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The next step
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We are here to answer any questions you may have about the rehabilitation process.
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