Choosing your stroke rehab team.


In yesterday’s column, I began to describe the rehabilitation (“rehab”) treatment that often follows a stroke and explained why it is necessary for your husband’s recovery. Today, I’ll describe rehab institutions and members of the rehab health professional team.

If your husband’s doctor expects he’ll be able to make rapid gains, he likely will be transferred to a rehabilitation hospital. To benefit from this type of program, he must be able to engage in three or more hours of physical, occupational and speech therapy per day, five days a week. Stays in a rehab hospital typically are shorter than those in a skilled nursing facility.

But a skilled nursing facility may be a better option for someone who was weakened by health problems even before the stroke, and doesn’t have the strength to engage in rehab activities as often as expected in a rehab hospital.

At the end of this post, I’ve put a list of questions to ask when choosing a rehab facility. I hope they will help you in your discussions with your husband’s doctor.

As for the team of rehab professionals you and your husband will meet, in yesterday’s column I mentioned the case manager who works with you and your husband’s doctor to arrange transfer from the acute-care hospital to the rehab institution. Here are the other members of the team, and how they can help someone to recover from a stroke:

  • A physiatrist is a physician who specializes in physical medicine and rehabilitation. A physiatrist often supervises a team of nurses and therapists to come up with a rehabilitation plan and evaluate whether it is working.
  • A rehabilitation nurse will help your husband with taking medication on the right schedule, bathing, using the bathroom, and getting himself in and out of a wheelchair. He or she also will help explain things to relatives, friends and other caregivers.
  • A physical therapist evaluates and treats disorders relating to movement, balance and coordination, and will help your husband regain strength and range of motion in his legs.
  • An occupational therapist helps a stroke patient learn basic activities such as eating, bathing, dressing and writing. He or she will help your husband learn techniques to compensate for a disability, such as learning to use adaptive equipment.
  • A speech-language pathologist will help your husband improve his capacity to speak and understand speech.
  • A recreational therapist will help your husband resume leisure activities that he enjoyed before his stroke. For example, a recreational therapist will help your husband find ways to play cards, read books or cook with special equipment, if that is required.
  • A music therapist uses rhythm and music to help a person improve coordination and strength. Music therapists also work with speech therapists: Some stroke patients recover speech more rapidly if they sing the words than if they just speak the words.

Rehab institutions and health professionals should be able to help your husband recover some or all of the abilities that were lost following the stroke.

Choosing a rehabilitation program

You need to weigh a number of important factors when choosing a rehabilitation program. Guidelines published by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services suggest that you ask the following questions:

  • If you are considering an outpatient program, is there someone at home who can provide care when you are at home? Is transportation available?
  • Does the program provide the services you need, such as speech therapy, or physical or occupational therapy?
  • Does the program match your abilities, or is it too demanding or too easy?
  • Does the program have a good reputation in the community?
  • Is the program certified by the Commission on Accreditation of Rehabilitation Facilities or the Joint Commission?
  • Does the staff include registered physical and occupational therapists and physiatrists?
  • If the program is residential, can relatives and friends visit easily?
  • Are patients and relatives actively involved in rehabilitation decisions?
  • What portion of the cost is covered by Medicare or private medical insurance?