Rehabilitation in the home

This article was published in The West End Times October 8, 2011.

Imagine being told you are not eligible for rehabilitation. I last spoke about rehabilitation in the home for people with aphasia after a stroke. I have since heard from people whose family member suffer with this disability. There does not seem to be the necessary help for this long term need. I started looking at rehabilitation in general and what is so disturbing is that many people stay in long term facilities and don’t improve because they were “not eligible for rehabilitation.” What then is the option? You become a chronic patient with no where to go.

I am reminded of a family who several years ago were told that their mother was not eligible for rehab because she had lost all strength and could not balance herself sitting on the side of the bed. She wanted to go home and despite resistance from the hospital team the family arranged for her to do so. After many hours of nursing and home care, she started to regain strength. Eight months later she was walking with a walker and enjoying family vacations. We don’t know enough about what hard work, support and determination can do. All too often the chronic ward or facility is offered as the only choice. All too often family members are left tied in a chair to avoid falls, waiting for someone to talk to or for someone to look at them as they pass outstretched arms crying “Nurse, Nurse”.

Despite the high incidence of stroke, there are a limited number of studies examining post-stroke rehabilitation and recovery. Results from the largest randomized clinical trial to date regarding rehabilitation after stroke were published in the May 26th issue of the New England Journal of Medicine This study presents strong evidence to the importance of initiating physical therapy for stroke patients, with over half observing improvements within the year. This study also proves that physical therapy at home can be just as effective as more expensive, locomotor training solutions such as robot-assisted treadmill steppers. Also, not only was the home-based program found to be cheaper, it was accompanied by fewer risks. As hospitals continue to evaluate best practices on post-stroke care, physical therapy/rehab will have to be addressed.

Studies that have been done show that with fast diagnosis and treatment you can do better. The importance of rehabilitation after stroke cannot be overemphasized. These studies have shown that rehabilitation is responsible for most of the recovery experienced by patients after a stroke, and that without it, little or no improvement can be accomplished. Stroke rehabilitation should provide a targeted and organized plan to re-learn functions lost within the shortest period of time possible.

Your brain can continue to learn and re-learn new and old tasks for as long as you live. This is why it is so important to support rehabilitation at home. Not everyone will return to prior to the stroke condition. It depends on the severity and location of the stroke. Post-stroke physical rehabilitation interventions have been used to reduce pain and spasticity, as well as to increase range of motion (ROM), muscle force, mobility, walking ability, functional status, physical fitness, and quality of life. Post-stroke physical rehabilitation interventions are mostly noninvasive interventions that present very few adverse side effects and contraindications as compared with a large number of pharmacologic interventions. Given this, why can’t we provide assessments and treatment plans for people in their home? Why can’t the money spent to keep people in chronic care facilities be used to support those people who have had a stroke and their families in their homes?

If the same amount of money was used to provide home support for personal care and to reinforce exercise programs designed by the rehab team, people can do better. If we add to this plan remote visits from the physiotherapist and nurse to do their evaluation of the progress throughout the process, modifications to the plan can be made at very little expense to the system. Why can’t we????