DEAR DOCTOR K:
My husband recently had a stroke. The doctors say he will need “rehab” after he is released, at a different type of hospital. Can you tell me what rehab is?
Your question requires a long answer. So I’m going to devote both today’s and tomorrow’s columns to that answer.
A stroke stops the blood supply to a part of the brain, and causes the death of brain cells in the area that no longer receives blood. The symptoms caused by a stroke are quite varied. Not only can strokes cause different types of symptoms, but the symptoms can also range from mild to severe. A patient’s symptoms depend on what part(s) of the brain a stroke has damaged, and how bad the damage is.
Unless a stroke causes very mild symptoms, a patient is hospitalized for some time in an acute-care hospital. After a patient’s condition is stabilized, a period of rehabilitation (“rehab”) begins.
About two-thirds of people who have a stroke need some form of rehab therapy. Rehab is designed to help the patient regain some or all of the abilities that were damaged by the stroke. It can address a wide range of issues. I don’t know what symptoms your husband’s stroke caused, so I don’t know what type of rehab he needs. For example, rehab could help your husband regain strength, learn how to walk again, improve his speech, restore his memory or help him adapt to a permanent disability.
Before he leaves the hospital, your husband’s medical team will assess his basic abilities: Can he swallow safely? Can he bathe and dress himself? Can he get around on his own? Based on the assessment, the hospital will recommend the level of post-hospital care that will be best for him.
If your husband doesn’t have significant medical needs, he may be able to return home directly from the hospital. If he has access to transportation, he may be able to receive treatment at an outpatient rehab center. The services at outpatient centers usually include physical therapy, occupational therapy and speech therapy, which I will describe tomorrow. Patients who can’t get to and from an outpatient facility may receive rehab services at home.
If your husband’s doctor thinks he needs to spend time in a rehab facility, the two of you will meet the first member of the rehab team: the case manager/discharge planner. This person coordinates the services you receive in the inpatient setting and works with the hospital and your health insurer to arrange for the appropriate continuing care after your discharge, whether it be to home-care services or a transfer to another inpatient level of care.
If the case manager and insurer think your husband needs to be transferred to a rehab institution, they will tell you the different facilities they recommend, and work with you to arrange to have your husband transferred to the chosen facility.
In tomorrow’s column, I’ll describe the different rehab institutions to which your husband may be transferred, and the members of the rehab team that he may meet.