The game plan for stroke recovery

Watching elite, Olympic-level athletes accept gold, silver or bronze medals, it’s easy to overlook the teams of specialists who have contributed to their winning performances — coaches, doctors, nutritionists and other specialists who have guided these superbly tuned bodies to their optimum levels of achievement. And like these athletes, people who have had a stroke need expert help if they’re to achieve peak performances in the acts of daily living.

Stroke survivors first meet their teams in the emergency room, when doctors, nurses and technicians work together to diagnose and stabilize their conditions in an effort to limit damage from stroke.

Physiotherapists join them as soon as the patient’s condition permits, usually on the first day. They work at preventing complications such as pneumonia, encouraging patients to become mobile as soon as possible. This may include passive exercise, where the affected limbs are moved by the physiotherapist if the stroke damage has been severe. A core multidisciplinary team moves in to assess the patient’s needs. As well as doctors, nurses and physiotherapists, the group can include a speech pathologist, social worker, and an occupatial therapist.

“From the assessment, we determine what the client’s needs are and what we think is realistic for us to work on and to accomplish.” says Dr. Maria Hujbrejcts, senior physiotherapist and coordinator of evaluation at Baycrest Centre for Geriatric Care in Toronto, and a former member of the Stroke Recovery Committee of the Heart and Stroke Foundation.

Family support is an important source of strength for stroke survivors. In fact, family, friends and caregivers become an essential part of the team. They’re the people who will be most involved as rehabilitation continues over months and even years. (In Canada today, there are some 300,000 stroke survivors.)

More than half of those who survive a stroke are left with some form of disability. Some can return home after the acute care phase, usually because their stroke damage was less severe. If necessary, they’ll receive home care or continue therapy on an outpatient basis. Others go on to rehabilitation centres like Baycrest where the average stay following a stroke is 50 days. There again, a whole team is involved with the client.

“Individual team members will meet frequently with the client,” says Hujbrejcts, “but as a whole team, we normally do it once during the client’s stay.”

This allows clients and their family members to discuss the plans for rehabilitation with the experts and sort out any concerns they may have.

Each professional involved in the client’s recovery uses standardized outcome measurements, developed to help assess a client’s condition. As well as helping chart progress, these are also useful in setting specific goals for a client, such as transferring to a wheelchair with the aid of only one person.

Eventually, the client will go home but may need supportive home care services. (Home care is increasingly in demand and unfortunately may not be adequate in many parts of the country.) Others will require placement in a nursing or retirement home.

Hujbrejcts is enthusiastic about the many new devices designed to aid people with disabilities when they return home. “There has been so much new development — so many changes within the last couple of years,” she notes. There’s no one, perfect, device that’s universally helpful, but clients and their caregivers should be able to find something that makes some part of their daily existence easier.