Many Techniques and Disciplines Contribute to Stroke Rehabilitation

How well a patient recovers from a stroke is dependent on many factors. Minimizing damage to the brain as much as possible during the stroke will make rehabilitation faster and easier. Important progress has been made in developing and prescribing clot-dissolving medications. When used properly in the first few hours of a stroke, they can help prevent damage to the brain.

During a stroke, brain tissue is damaged by blood clots (in an ischemic stroke) and/or internal bleeding (in a hemorrhagic stroke). However, we believe that the area of the brain around a zone of injury is salvageable and may repair itself to a certain extent. In addition, other areas of the brain may learn and replace functions previously performed by the injured tissue. Rehabilitation may enhance this recovery.

In Physical Medicine & Rehabilitation, we serve two roles in trying to put each patient in the best position to recover. We use neurofacilitation techniques to help enhance and facilitate the brain and body's recovery. For example, language skills may be relearned, or motor control of a weak arm or leg may be improved. And we help patients compensate for deficits, such as partial paralysis. The latter role includes equipment such as a walker or ankle brace or one-arm techniques for getting dressed so that patients may work around disabilities brought on by the stroke.

In the past, rehabilitation was delayed after a stroke, often for weeks, as health care providers waited and monitored the patient's condition. Today, we believe that the sooner rehabilitation begins, the better chance for a rapid and more complete recovery. We may begin rehabilitation even while a patient is still in intensive care during the so-called "acute" phase.

Neurofacilitation is largely dependent on the expertise of the therapist. New technologies are being used to assist the therapist. These include electrical stimulation of limbs to help the brain relearn diminished motor skills. To aid in retraining the brain, a stroke patient may practice walking while suspended from a harness, which is a safer method of beginning weight-bearing exercises.

Medications and Therapists

Some stimulants, such as Ritalin, are used to improve cognitive functions by activating brain areas that are suppressed after the stroke, or to stimulate brain areas that would normally be activated by the brain area damaged by the stroke. Certain stimulants can help the brain focus on a task and may help the brain recover faster or more fully. Sedatives, on the other hand, including anti-psychotic drugs (e.g. Valium, Xanax and Haldol), may interfere with stroke recovery.

Other medications may be given to prevent secondary conditions, such as pneumonia or blood clots in the lungs or legs. Two-thirds of stroke patients develop depression and may be successfully treated with anti-depressants. Depression is sometimes difficult to diagnose in stroke patients because they may have difficulty communicating.

During the rehabilitation process, physical therapists help patients with mobility issues, such as walking, climbing stairs and keeping their balance. Occupational therapists teach daily living activities, such as feeding oneself, getting dressed, grooming and using the toilet. And speech therapists help with language skills, as well as swallowing and cognitive issues. Rehab nurses care for patients and may teach family members how to care for loved ones affected by a stroke. Recreational therapists help stimulate damaged brain areas with music or play therapy. And social workers link stroke victims and their families with counseling, information and community resources. Attacking stroke deficits with a variety of techniques and disciplines helps patients recover as quickly and fully as possible.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.