Introduction
A stroke is a condition that requires immediate medical attention. There are mainly two types of stroke; hemorrhagic and ischemic stroke. A hemorrhagic stroke happens when a ruptured blood vessel bleeds into the brain; on the other hand, an ischemic stroke occurs due to a clot dislodging blood vessels, thus restricting blood flow to the brain. Ischemic stroke is the most common stroke type. Stroke is one of the most important causes of disability, and the amount of disability produced due to stroke depends on the extent of brain damage.
Rehabilitation helps the affected person relearn the skills that were affected due to brain damage. Stroke rehabilitation also aims to prevent other medical conditions like pneumonia, injuries due to falls, and urinary tract infections.
Neurorehabilitation programs consist of well-directed, focused, and repetitive practice. These programs are customized, and the patients are made to practice those skills impaired due to brain damage. These include a lack of coordination, gait problems, visual problems, speech problems, and problems with understanding.
What Are the Factors That Affect the Result of Stroke Rehabilitation?
The outcome of stroke rehabilitation is affected by the following factors:
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The younger the age, the faster and greater the degree of recovery.
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The extent and severity of brain damage.
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The rehabilitation program's intensity.
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Societal and familial support.
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Changes in the home environment (like grab bars) help the affected individual be independent and increase one’s safety at home.
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The sooner the rehabilitation program is implemented, the greater the chance of regaining skills.
What Are the Nursing Management Steps for Stroke Patients Before Rehabilitation?
After the stroke, nursing management focuses on starting rehabilitation to cope with deficits.
Nursing Assessment:
A neurologic flow sheet is maintained during the acute phase that asses the following:
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Change in consciousness level.
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Speaking ability.
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Neck stiffness.
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Pupil size.
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Color of the extremities and the face.
The following function assessments are made in the post-acute phase:
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Mental status assessment.
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Swallowing ability, skin integrity, nutritional status, hydration status, activity intolerance, etc.
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Sensation and perception.
Based on the above assessments, the following nursing diagnosis is made:
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Acute pain.
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Deficit self-care.
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Impaired physical mobility.
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Impaired verbal communication.
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Disturbed thought process.
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Impaired urinary elimination.
What Are the Nurse Care Plan and Goals?
The nursing care plans and goals for the affected and their families are:
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Sel-care achievement.
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Improving mobility.
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Improve sexual function.
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Improve thought process.
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Continence of bladder and bowel.
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Relief from sensory deprivation.
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Prevention of aspiration.
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Restoring family functioning.
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Avoiding complications.
The nursing interventions for stroke patients are:
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Proper patient positioning is necessary to prevent contractures and relieve pressure.
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The affected arm should be elevated to prevent swelling.
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Splints are applied at night to prevent flexion of the affected limb.
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A pillow is placed on the axilla to prevent adduction of the affected shoulder.
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The affected is taught to maintain balance in sitting and standing positions, and after achieving standing balance, walking is started.
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Exercises are done to prevent venous stasis.
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The patient’s voiding pattern is analyzed, and a bedpan is given per the schedule.
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Frequent skin assessments are done to look for signs of skin breakdown.
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A full range of motion is provided to the affected person at least four times daily to maintain joint mobility.
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Once the affected person sits up, personal hygiene measures are encouraged.
Who Are the Ones Who Take Part in Stroke Rehabilitation?
The neurorehabilitation team involves the following people:
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Rehabilitation Nurse:
A rehabilitation nurse provides information on the medication schedule, which includes how to care for the skin and bladder, and gives special attention and care to those with diabetes. They help the patient regain lost skills and become more independent.
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Physician:
The doctors involved in stroke rehabilitation include neurologists, family physicians, geriatricians (specialists for treating the elderly), and physiatrists (specialists in rehabilitation and medicine).
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Occupational Therapists:
Occupational Therapists help the affected become more independent by developing motor skills.
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Speech and Language Therapist:
Speech and Language Therapists help develop social and communication skills and improve swallowing ability.
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Vocational Therapists:
Vocational Therapists help identify vocational strengths and assist in finding jobs.
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Physical Therapist:
The physical therapist helps correct problems with balance, coordination, and movement. It also helps with muscle strengthening.
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Psychologists:
Psychologists help to improve the mental health of the affected and their cognitive skills.
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Social Worker:
A social worker helps with financial decisions and planning care after the patient is discharged from the rehabilitation center.
What Are the Places at Which a Person Receives Stroke Rehabilitation?
The various rehabilitation programs for stroke patients include the following:
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Outpatient Rehabilitation Program:
Outpatient rehabilitation programs are carried out in outpatient centers, which are part of hospitals and have full access to the physicians and therapists involved in a rehabilitation program. The affected individuals spend a significant period daily or three times weekly at the center to attend therapy sessions.
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Inpatient Rehabilitation Program:
Inpatient rehabilitation programs are carried out in hospital settings or independent inpatient treatment centers. In this program, the patient stays in the facility for a few weeks and attends the sessions. It provides benefits like full-time physician supervision, access to specialized equipment, and access to various therapists.
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Skilled Nursing Centers:
Skilled nursing centers provide greater attention to rehabilitation when compared to traditional nursing residential care. But full-time access to physician supervision as in inpatient care is not available, and fewer physician visits are conducted.
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Home-Based Rehabilitation Program:
A home-based rehabilitation program provides more flexibility and makes the program more customized to individual needs. They are best indicated in cases where the patient requires only one type of rehabilitation therapist.
What Are the Different Rehabilitation Programs Carried Out?
Rehabilitation is an important part of stroke recovery. The areas covered under stroke rehabilitation include the following:
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Physiotherapy:
Physiotherapy is an important part of stroke rehabilitation and helps the affected relearn motor skills like standing, sitting, walking, lying, and switching positions. Exercises and training sessions help restore balance, movement, and coordination.
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Speech Therapy:
Speech therapy helps the affected person learn another method of communication, relearn language, and improve social skills. These are especially useful in those cases where the affected person has a problem understanding speech and words but has normal cognition.
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Occupational Therapy:
The occupational therapist will ask one to modify the work and home environment to make the life of the affected more independent.
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Vocational Therapy:
Vocational therapy helps one recognize the skills and find new work if needed.
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Psychiatric Therapy:
A stroke can lead to disabilities like depression, anxiety, stress, and emotional imbalance. Psychiatric therapy for the affected and their families can help improve mental health.
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Nuerolutions Upper Extremity Rehabilitation:
Nuerolutions upper extremity rehabilitation for patients with hand disabilities (patients above 18 years) and undergoing stroke rehabilitation increases their range of motion. Non-invasive electroencephalography electrodes are used to detect brain activity.
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Vagus Nerve Stimulation System:
Vagus Nerve Stimulation System is used in stroke rehabilitation for patients with impaired upper limb and extremity motor defects.
What Are the Ways to Prevent Another Stroke?
Prevention is an important part of stroke rehabilitation. The preventive measures mainly involve treating the risk conditions, which include the following:
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Hypertension Management:
Hypertension is a significant risk factor for stroke. Controlling blood pressure under a physician's guidance will help prevent stroke.
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Diabetes Management:
Diabetes can cause destructive changes in the blood vessels and increase the severity of brain damage in stroke cases. Hence, controlling diabetes helps reduce the risk of stroke.
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Quit Smoking:
Smoking is a risk factor for stroke as it increases the chance of forming a blood clot.
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Regular Exercise and Maintenance of Weight:
Obesity is a significant risk factor for stroke, diabetes, and hypertension. Regular exercise and weight maintenance reduce the risk of stroke.
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Management of High Cholesterol Levels:
High cholesterol levels can lead to a condition called atherosclerosis in which fatty deposits block the blood vessels, and thus increasing the chance of stroke. Hence, management of the same can reduce the risk of stroke.
Conclusion
Stroke rehabilitation is an important part of stroke recovery. It is carried out by a multidisciplinary team consisting of a physician, rehabilitation nurse, occupational therapist, physiotherapist, vocational therapist, speech therapist, psychologist, and social worker. Prevention is also an important part of stroke rehabilitation.
