ReJoycetherapy

After a stroke, home-based rehabilitation will be an important part of your path to recovery.

Here are some tips to maximize your recovery at home:

1. Getting active about your stroke care. After discharge from an acute care or rehabilitation facility, you may be inclined to let a caregiver take the reigns. It is vital to make sure you work with your caregiver and take an active stance on your health and rehab including: discussing your disabilities with your caregiver as soon as possible, acquiring the appropriate assistive devices, establishing a supervised exercise regimen (in accordance with your physician’s recommendations, of course).

2. Finding the right assistive devices. These include “reachers” (for dressing yourself if you have weakness in your arm or hand), large-handled cutlery to assist you with eating, analysis of your diet if you have trouble swallowing, canes and/or walkers to maximize your independence and mobility, an ankle-foot orthosis (AFO) or functional electrical stimulator (FES) for your leg if you suffer from foot-drop or for your hand to help with grasp and release. Your physician, therapist, caregiver and personal research will yield some very handy results to help you regain independence.

3. Recognizing and treating signs of depression quickly. Depression is common in people who have had a stroke, especially after the acute phase of stroke rehab has ended. If you develop signs of depression, make sure you let your caregiver and doctor know.

4. Getting involved in a rehabilitation program as soon as possible. Establishing a routine of exercise and rehabilitation early on will help you get motivated about your recovery. There are lots of options ranging from self-guided exercises with simple equipment to Internet-based stroke exercise therapy, in some cases with clinical supervision. All are available to you at varying costs. The sooner you get involved, the sooner you can accelerate your recovery. It is important to note that, even if you had a stroke several years ago, supervised movement rehabilitation may help you.

5. Getting social. Many people living with stroke complain of feeling isolated due to poor mobility. Telerehabilitation is a great way of reducing this feeling of isolation. It allows you regularly to speak with a therapist while you engage in home-based rehabilitation. Other options include support groups, online social networking, family visits and assistive devices that allow you to regain mobility.

6. Being consistent. Recovering from stroke is hard work, but it is rewarding. Try scheduling your rehabilitation into 6-week blocks and be consistent! After every 6-week block, determine how much you’ve improved (some stroke rehabilitation systems will let you track your progress) and plan your next 6-week block based on your experience.

7. Exercising at home. Stroke survivors in the past received health services, including therapy in a rehabilitation facility for up to 3 months. Healthcare systems can now only afford to provide this for 2 to 3 weeks. This increases the attractiveness of home-based rehabilitation alternatives.
Home-based stroke therapy offers major advantages, such as the elimination of travel to a clinic, frequent rehabilitation sessions, a more familiar and relaxed environment, and heightened family awareness.  The disadvantage is that hands-on contact between client and therapist is missing. Fortunately, recent advances in home-based telerehabilitation provides an exciting solution. Direct contact between client and therapist is restored and in fact it can be greatly increased in frequency, maximizing the effectiveness of the therapy. Telerehabilitation allows clients and therapists to communicate using an audio/video link over the Internet. Furthermore, specially designed exercise devices installed in the participant’s home allow the therapist not only to supervise standardized exercises but also to control the difficulty of the exercises and get precise data on how the participant is improving. This eliminates the need for the therapist to travel to the client’s home (which can take up to 8% of their day, according to a study conducted by Forster and Young in 1990). Additionally, it reduces isolation of clients from their therapists and therapists from their multi-disciplinary team in the clinic.

8. Is home-based rehabilitation effective? A scientific group in New Zealand (Baskett et al.) published results of a study in 1999 indicating that clients engaged in home-based therapy improved as much as those engaged in outpatient-based therapy. There was no significant advantage to outpatient therapy. Home-based recovery has the further advantage of improving caregiver confidence and reducing the social isolation of the patient, likely improving psychosocial well being.

9. What does home-based stroke therapy consist of? Home-based stroke rehab can be directed either by a therapist or by the client. In the case of physical rehabilitation, clients undertake a daily exercise regimen with a focus on recovering movement in their affected limb. In addition to verbal advice from clinicians, written descriptions of preferred exercises to improve tasks of daily living and improve mobility.are sometimes made available.

Several medical devices are also available to help complement home-based stroke exercise and recovery. These include FES (Functional Electrical Stimulation) devices available for the arm, hand and leg. These FES devices provide trains of electrical pulses that activate the nerves and muscles in a client’s affected limb. Most of these devices have exercise modes that patients can use to reduce stiffness and spasticity.  Some can be used to augment a patient’s ability during normal daily activities - this type is typically called a neuroprosthetic.

Specialized at-home exercise devices are available commercially for at-home stroke recovery. These range from simple rubber meshes for hand grasp and release, to sophisticated (and expensive) bicycles with FES components. Several telerehabilitation devices are available for at-home stroke rehabilitation - try a Google search for “stroke telerehabilitation” to find a list of these providers.
Home-based stroke rehabilitation is tremendously valuable to both patients and society in general. It saves time, cost, and can yield very positive results.