Rehabilitation
Rehabilitation After Stroke
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Rehabilitation can help people who have had a stroke or other brain injury regain some or all of their functional abilities. Although rehabilitation helps people recover lost function, the extent of functional recovery depends heavily on the brain's natural repairing of the damaged area. Most of this natural healing process occurs during the first 6 months after injury but may continue for as long as 2 years. The amount and rate of natural healing cannot be predicted with certainty. Because of this unpredictability, and to prevent other disabilities (such as muscle contractures) and depression, rehabilitation is begun as soon as the person is medically stable.
What part of the brain was injured affects what functions are lost. A detailed evaluation of the person, including psychologic testing, helps the rehabilitation team identify the type and severity of damage. The members of the rehabilitation team then assess which lost functions may benefit from rehabilitation therapy and create a program addressing the person's specific needs. The success of rehabilitation depends on the person's general condition, range of motion, muscle strength, bowel and bladder function, functional ability before the brain injury, social situation, learning ability, motivation, coping skills, and ability to participate in a rehabilitation program.
The damaged areas of the brain after stroke are limited to where the blocked or bleeding arteries are located in the brain. Thus, the area damaged and the symptoms of stroke are relatively well defined. The extent of brain damage due to a traumatic brain injury depends on the severity and direction of force and what part of the brain was injured. The brain can also be injured during surgery performed to remove a brain tumor. The extent and location of the surgery determine what functional problems a person will have afterward.
Some people require joint movement to prevent or relieve contractures. Others need coordination exercises. Because stroke often causes one-sided paralysis, exercise of the unaffected arm or leg is usually encouraged. The person is expected to practice other activities as well, such as moving in bed, turning, changing position, and sitting up. Regaining the ability to get out of bed and to transfer to a chair or wheelchair safely and independently is important to a person's physical and mental health.
Rehabilitation therapists treat problems with walking, lack of coordination, spastic muscles, vision problems (including partial or complete blindness in one or both eyes), and speech problems with specific therapies. For example, an ambulation exercise program is begun for people who are having trouble walking; this program may include learning how to prevent falls. Heat or cold therapy may temporarily decrease spasticity in muscles and allow muscles to be stretched. People with one-sided blindness are given special training to avoid bumping into door frames or other obstacles. Fine motor coordination may be improved with occupational therapy.
Cognitive impairment can also occur with stroke and other brain injury, especially concussions. Cognitive impairment can include problems with orientation, attention and concentration, perception, comprehension, learning, organization of thought, problem solving, and memory. However, not every person has all of these symptoms.
Cognitive rehabilitation is a very slow process, has to be tailor-made to each person's situation, and requires one-on-one treatment. It encourages desirable behavior and discourages undesirable action through conditioning and repetition.