Rehabilitation is when you work on the things that have changed since your stroke. It helps you get stronger so you can do daily activities as independently as possible. Rehabilitation is called ‘rehab’ for short.
Stroke is a life-changing event. It affects everyone differently.
Your healthcare team will:
- do a detailed assessment to understand how you have been affected by stroke
- set realistic goals for you and monitor your progress
You may also wish to take some time to re-evaluate what’s important to you.
You CAN learn to live well after stroke with the help of rehabilitation. You may even develop new skills.
When and where will rehab take place?
Your healthcare team will begin your rehab as soon you are well enough.
Your rehab will usually start in hospital, for example, on the ward, in the physiotherapy gym or in other healthcare team departments.
You may have an early supported discharge to a rehab hospital, or you may continue your rehab at home or in a local rehab centre.
Some people also need specialist rehabilitation in the National Rehabilitation Hospital in Dun Laoghaire, Dublin.
In areas where there is no access to early supported discharge teams, you should be looked after by the health services in your community.
Your healthcare team will advise you on what the best pathway is for you. Get information about what services are available for you.
My healthcare team and how they help
Stroke can happen very suddenly, and your recovery can be slow. Whether your rehabilitation happens in a hospital setting or at home, you will have a multidisciplinary healthcare team looking after different aspects of your recovery. A typical stroke rehabilitation healthcare team looks like this:
Consultant doctor
This is the doctor who will oversee your care. They may be:
- a stroke physician (a doctor specialising in stroke),
- a geriatrician (a doctor specialising in the health of older people), or
- a neurologist (a doctor specialising in illnesses related to the brain, spinal cord and nerves).
They will have a team of junior doctors helping them.
Hospital nurses
A team of nurses will care for you in hospital.
They are the link between you, your consultant and the rest of your healthcare team.
They help to plan your care, encourage you to practise your exercises and help you with your daily activities.
Nurses will also help to plan your discharge with you, your family, carers and your healthcare team.
The Clinical Nurse Manager (CNM) is responsible for supervising nursing staff on your ward.
Stroke care clinical nurse specialist or advanced nurse practitioner
A stroke care clinical nurse specialist will help match your needs with members of the stroke team while you are in hospital.
They will explain to you about the type of stroke you’ve had.
They will identify your risk factors for stroke and give you advice on how to prevent another stroke.
Like stroke care clinical nurse specialists, advanced nurse practitioners have lots of experience and have undergone extensive training.
Public health nurse
The public health nurse looks after your needs when you leave hospital.
They will visit you at home and make sure you have the right care and support.
Physiotherapist
The physiotherapist will help you with your physical recovery after stroke – the way you sit, stand, walk and exercise.
They will help you with your movement and muscle strength, sensation, coordination and fitness.
Occupational therapist (OT)
An occupational therapist (OT) will work with you to help you become as independent as possible in your daily life.
The OT may also visit your home to see what alterations or equipment you might need.
Speech and language therapist (SLT)
The SLT will assess, diagnose and treat any difficulties you may have with speech, language, voice and swallowing.
Dietitian
If you are at risk of losing too much weight or you are having trouble swallowing, a dietitian will develop a nutrition care plan to help you meet your nutrition and hydration needs.
This is important if you need a feeding tube or the thickness or texture of your foods and fluids need to be changed to make them easier and safer to swallow.
Medical social worker
A medical social worker will give you and your family useful information about benefits, entitlements, employment, housing and HSE and voluntary services that are available.
They will organise meetings with you and your family to discuss any anxieties you or your family may have.
They will also plan your discharge with your team and provide advice and support to your carer.
Psychologist
A psychologist will work with you to help you make sense of the changes a stroke can bring to your life.
They may conduct tests to work out your needs and make a plan to support you.
You and your family and friends are also very important members of the team
What does rehab involve?
In rehab, you’ll do a lot of exercises. You’ll practise tasks over and over with guidance from your team.
Your team will make sure you’re aiming for the right number of repetitions and that the task is at the right level of difficulty for you. This repetition process will help your brain adapt and build new pathways.
Your team will also tell you how much time you need to spend on each exercise without getting fatigued. Many people spend about 45 minutes on each exercise 5 days a week, but this may vary from person to person based on their needs.
How much will I improve?
It’s difficult to say, but the majority of people show some improvement.
Your recovery will depend on:
- the area of the brain that was injured
- how much of it was injured
- how your rehabilitation is going
Not knowing how much you will improve can be frustrating, but every stroke is different and your recovery will be unique to you.
Focus on your rehabilitation as soon as possible. The fastest recovery takes place in the days and weeks after stroke but can continue for years.
It’s important to work on overall recovery. This means working on your:
- speech
- mobility
- thinking skills, which help with attention, memory, planning and organising
- emotional skills so you are able to cope with anxiety, sadness or fatigue
How can I get the most out of rehabilitation?
- Ask questions: If you don’t understand what you’re doing or why, ask your team. They are there to help you.
- Set realistic goals: Ask yourself what you think you can achieve and then break these goals down into smaller steps.
- Practice makes perfect: Practise the tasks that the therapists have shown you. Doing all your exercises regularly will help you improve your physical, thinking and emotional skills. All these areas are important to work on.
- Involve your family and friends: Spend time with them. They can help with your exercises.
- Take your time: Rehab is hard work. Take breaks when you need to. Make sure you’re getting enough rest. Be kind to yourself as you work through your rehab.
- Celebrate: Progress is not easy. Sometimes you may feel like you are going backwards. Keep a written or video diary to remind you of all the progress you’re making. Remember, recovery isn’t always linear.
- Connect with other stroke survivors: This can show you what’s possible if you keep working at it.
Call Irish Heart Foundation Nurse Support Line on 01 668 5001 or Email [email protected] to connect with other stroke survivors.
Don’t give up. We all have down days and when you have a stroke, these down days are even worse. If you can’t do your rehabilitation today, you WILL be able to do it tomorrow. Set goals. Let the professionals guide you. They aren’t pushing you for their own benefit, they are pushing you so you get better. People tend to forget that.
Discharge from hospital
When you are ready, your healthcare team will talk to you about leaving hospital. Together you can put together a discharge plan for yourself. A discharge plan relies on good communication between you, your family and your team. Talk to your team about your needs.
Your discharge plan will make sure:
- you get the right health care and services after leaving hospital
- you stay safe and well
Your occupational therapist will advise you on what changes and equipment you may need in your home. For example, you may need to install shower chairs or raised toilet seats in your bathroom. And you may need to add handrails or ramps in your house.
After you leave hospital…
- You will be looked after by your GP and a public health nurse.
- You may need more rehabilitation after you go home. If you do, your healthcare team will be there for you.
Early Supported Discharge
You may be allowed to leave hospital early and be under the care of a team who will help you with your rehabilitation at home. This is called Early Supported Discharge (ESD). However, this service is only available in a handful of hospitals and areas.
When I left the hospital, it emotionally hit me. I’m not sure that I’m fully back to where I was before my stroke with certain things like my vocabulary but other than that I feel I have made a full recovery.
Community support
Organisations in the community can help you settle into your life after stroke. Talk to your healthcare team to work out what community supports are available in your area.
The Irish Heart Foundation run stroke support groups, which often meet once a month. It’s a good place to come together to meet other stroke survivors and discuss common issues.
Contact our Nurse Support Line on 01 668 5001 for information on stroke groups in your area.
Support in your home
You might need to get extra help around the house or with your personal care. You may be eligible for HSE’s home support service. Talk to your healthcare team about it.
Your GP or public health nurse can give you information on services available in your area, such as home help, care assistants or Meals on Wheels.
If you need more care, your medical social worker can help you consider other types of caring arrangements such as sheltered accommodation, residential care in a nursing home or 24-hour nursing care.
I really encourage people to attend the free talks – from learning about rehabilitation to speech and language therapy, there are lots of really helpful topics that can make a difference to your recovery.
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