When to start stroke rehabilitation and how to do it?
NORMAN Neurological Rehabilitation Centre
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Rehabilitation after a stroke should be started as soon as possible. For this process to begin, all vital signs must be stable. The decision to start rehabilitation is made by the doctor.
Introducing rehabilitation quickly helps to engage the patient more actively in their further recovery and has a positive effect on their motivation to keep working on themselves. One of the fundamental goals of early rehabilitation is also to prevent the complications that arise from keeping the patient immobile for too long.
- The development of abnormal movement patterns.
- Joint contractures.
- Respiratory and psychological problems arising from a sense of helplessness and feeling of no longer being of use.
In the initial phase after a stroke, we focus on basic functions. Patients often have trouble swallowing, and their respiratory capacity can be reduced. This is why, alongside standard rehabilitation, it is worth introducing swallowing and speech therapy early, led by a neurological speech and language therapist.
Swallowing problems can lead to malnutrition and weakening of the whole body, which prolongs the rehabilitation process and reduces its quality.
It is very important to change the patient’s position frequently, ideally every 2–3 hours. This limits the entrenching of abnormal movement patterns and helps to shape muscle tone, which is very important in the further course of rehabilitation.
To begin with, we teach the patient basic activities: sitting, standing up, rolling onto their side, dressing, personal hygiene and, finally, walking and keeping their balance from scratch. Early mobilisation into an upright position is very important, although the decision to begin it always rests with the doctor.
Patients who are mobilised upright early usually have fewer problems with abnormally increased muscle tone and with contractures at a later stage of recovery.
Principles that matter in the first stage of rehabilitation
- You should not pull on the paralysed limbs, because their muscles are very weak and additional stretching can lead to a dangerous partial dislocation of the joint.
- If possible, the patient should eat their meals sitting up rather than lying down or in a semi-seated position, as this makes swallowing easier.
- The patient should not use the hospital bedside pull-up bars, as they disrupt the correct working of the muscles and entrench poor movement habits.
- A paralysed upper limb should not hang passively, because its weight and the pull of gravity strain the shoulder, ligaments, nerves and muscles.
In the initial phase the patient should use a pressure-relieving mattress, but once they have learnt to change position it should be set aside, so as not to accustom the patient to staying in one position for a long time and not to deepen problems with perception and spatial orientation.
Respiratory rehabilitation is also important, as a way of preventing bronchitis and pneumonia. In the first stage, the patient’s back should be patted frequently to prevent secretions from building up. Changing position and mobilising the patient upright further support the prevention of respiratory complications.
After a stroke, every rehabilitation process runs differently. Much depends on the location and extent of the brain damage and on the time that passed between the onset of symptoms and medical intervention. We write more about what to look out for in the early stage of recovery in a separate article. The brain’s compensatory plasticity can sometimes bring very quick results, while in other cases it requires longer, systematic work.
The first year after a stroke is a crucial period, because this is when the patient forms the movement patterns they will use in their later functioning. This does not mean, however, that improvement stops after a year. Systematic rehabilitation — for example as part of intensive neurological rehabilitation stays — can bring benefits throughout life, although it is worth making the most of the greatest intensity of recovery right at the start. That is why, after a stroke, a patient should undergo rehabilitation 5–6 days a week in order to maximise the results of therapy.
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