Rehabilitation & Recovery

While many tests are being performed and the cause of your stroke is being determined, an occupational therapist, a physical therapist, and/or a speech therapist may be called in to assist with your rehabilitation. Rehabilitation is one of the most important phases of recovery for many stroke survivors. The goals are to build your strength, capability and confidence to you can continue your daily activities despite the effects of the stroke. Depending on your needs, therapists are available in many different settings. Rehabilitation usually starts in the hospital as soon as possible, but you may receive therapy at an inpatient rehabilitation facility, at home or in other settings.

Occupational therapy prepares you for the activities of daily living, like self-care, homemaking, leisure interests and work skills. Your occupational therapist may work with you on:

• Bathing
• Dressing
• Feeding/meals
• Managing household chores

The occupational therapist may also help you to relearn daily activities by:

• Increasing strength and coordination of the affected side of your body
• Determining if adaptive equipment would be helpful
• Teaching you how to do daily activities

Improving movement and increasing independence are the aim of physical therapy. Your physical therapist will see how you're able to move about in bed and in your room and do certain exercises. In order to help you regain motor skills like moving about, walking and using stairs, the physical therapist will:

• Help you practice basic tasks and progress to more complex tasks
• Use exercises to increase muscle strength and coordination
• Have you do activities to help with positioning and balance
• Help you get needed equipment such as a cane, walker or wheelchair

Your speech therapist (speech-language pathologist) will help in the recovery of the speech, language or thinking skills you may have lost as a result of a stroke.

He or she will check your speaking and thinking skills and design a treatment program using the findings. They might also teach family members how to help in the recovery process.

Areas that a speech therapists address include:

• Language: Understanding and using spoken and written language, including:
  • Listening and understanding
  • Speaking
  • Reading
  • Writing
• Oral-Motor Skills: Strength and control of muscles used for speaking and eating
• Voice: Maintaining normal pitch, volume, breath control, and vocal quality for speaking
• Swallowing: Controlling lip and tongue movements for swallowing and making diet changes for safer swallowing
• Cognition: Restoring thinking skills, including attention, memory, problem solving, and reasoning.

You may work with some of all of these Stroke Recovery Team members during your recovery:

• Doctor - Your doctor directs the care and prescribes treatments, medications, and tests. He or she explains care and treatment options and can answer your questions.
• Staff Nurse - The staff nurse focuses on your physical needs and care. He or she works closely with the doctor and other healthcare team members to provide any needed care.
• Stroke Coordinator - The stroke coordinator is a nurse who can provide information to help you understand what causes a stroke and help you reduce your risk factors. He or she can answer your questions about medications, the recovery process, and tests and treatments. The stroke coordinator meets with your doctor on your behalf, asks questions for you, and voices your concerns. She can explain your discharge instructions and help you choose the correct level of care and type of rehab you need.
• Rehab Nurse - If you are transferred to an inpatient rehab unit, you may also see a rehab nurse. The rehab nurse focuses on your physical needs and care. He or she also works with other team members to coordinate your rehab program.
• Physical Therapist - The physical therapist helps you to improve movement and increase independence in positioning yourself in bed, wheelchair mobility, transfers, walking and exercise.
• Occupational Therapist - Your occupational therapist helps you improve your skills with self-care, homemaking, leisure interests, and work tasks.
• Recreational Therapist - The recreational therapist uses recreation and leisure to help you make life more enjoyable as you recover.
• Speech Therapist - The speech therapist works with you to overcome any problems you have with swallowing, speaking, listening, reading or cognitive skills.
• Social Worker - Your social worker works with you and your support system on planning for discharge and making any needed arrangements.
• Dietitian - The dietitian teaches you and your family about healthy eating and special diets (low salt, low fat, low calorie, etc.)
• Neurologist - The neurologist specializes in the prevention, diagnosis, and treatment of stroke and other diseases of the brain and spinal cord.
• Neurophyschologist - The neuropsychologist assesses behavior and thinking ability and offers guidance to the team in setting treatment goals. He or she may also provide general counseling to assist with your adjustment during rehab.
• Chaplain - The chaplain is available to offer spiritual and emotional support as needed.

You'll have several discharge options once you're ready to leave the hospital. Choosing the best option for you will depend on how severe your stroke was, how able you are to do your normal activities, and your living arrangement prior to your stroke. Your insurance may also be a factor. Your therapists and other healthcare team members will be there to offer guidance, and your social worker or discharge planner will help you make the plans.

• Home - If you have had a mild stroke with no lasting deficits or a TIA, you will likely be discharged to home. If you have mild deficits that persist, you may be sent home with home health therapy or outpatient therapy. With home therapy, a therapist will travel to your home. With outpatient therapy, you'll go to a place of your choice to receive the therapy you need.
• Acute Rehabilitation Facility - Acute rehabilitation is an intensive, collaborative inpatient program that you'll stay in for a set length of time. You must be able to do three or more hours of therapy each day and you must need at least two types of therapy. There is an acute rehabilitation program at Mount Carmel West that is both CARF (Commission on Accreditation of Rehabilitation Facilities) accredited and stroke-certified. Mount Carmel has also partnered with HealthSouth® to construct a 60-bed hospital that will provide rehabilitative care to patients who have experienced stroke.
• Sub-Acute Rehabilitation/Skilled Nursing Facilities - These are both inpatient options where you'll be able to receive therapy while you progress to higher levels of function.
• Palliative Care - Your doctor may consult the Palliative Care Team to assist in your care. Palliative care is provided by a team of doctors and nurses who will work with your doctor to provide an extra layer of support. The team will focus on providing you with the relief from the symptoms, pain and stress of your illness with the goal of improving your quality of live.

After a stroke you're at a higher risk of falling. That's why your therapists will work with you on improving your movement and independence. Making your home safer is also important in preventing falls. This checklist will help you find and fix and hazards in your home.

• Floors:
  • Make sure there's a clear path through each room. Ask someone to move furniture so your path is clear.
  • Remove throw rugs or use double-sided tape or non-slip backing so rugs won't slip.
  • Pick up things that are on the floor. Always keep papers, magazines, books, blankets, towels, and other objects off the floor.
  • Coil or tape cords and wires next to the wall so you don't trip over them. Have an electrician put in extra outlets if needed.
• Stairs:
  • Pick up things on the stairs. Always keep papers, shoes, books, or other objects off the stairs.
  • Fix any loose or uneven steps.
  • Have a handyman or electrician put an overhead light and switch at the top and bottom of the stairs. It's helpful to get light switches that glow.
  • Have a friend or family member replace any burned-out light bulbs.
  • Repair loose or broken handrails. There should be handrails on both sides of every stairway, and they should be as long as the stairs.
  • Repair any carpet on the steps that's loose or torn. If carpet is not firmly attached to every step, remove it and attach non-slip rubber treads to the stairs.
• Kitchen:
  • Move items that you use often to lower shelves (about waist high).
  • Buy a steady step stool with a bar to hold onto. Never use a chair as a step stool.
• Bedrooms:
  • Place a lamp close to your bed where it's easy to reach.
  • Use a night-light so you can see where you're walking. Some night-lights can be placed on a timer.
• Bathrooms:
  • Put a non-slip rubber mat or self-stick strips on the floor of the tub or shower.
  • Have a grab bar installed inside the tub and next to the toilet.
  • Install raised toilet seats.
  • Get a tub bench for the tub or shower.
  • Install a hand-held shower head.
  • Use long-handled brushes, electric toothbrushes and electric razors.
  • Use washing mitts with pockets for soap.
• Other Injury-Related Prevention Tips:
  • Exercise regularly. Focus on increasing leg strength and improving balance.
  • Ask your doctor or pharmacist to review a list of your medications, including both prescription and over-the-counter, to check for and reduce side effects and interactions that may cause dizziness or drowsiness.
  • Have your vision checked at least once a year. Poor vision can increase your risk of falling.
  • Get up slowly after you sit or lie down.
  • Wear sturdy shoes with non-slip soles. Avoid slippers and running shoes with thick soles.
  • Improve the lighting in your home. Use brighter bulbs (at least 60 watts). Use lamps or frosted bulbs to reduce glare.
  • Use reflective tape at the top and bottom of the stairs so you can see them better.
  • Paint doorsills a different color to prevent tripping.
  • Keep emergency numbers in large print near each phone.
  • Put a phone near the floor in case you fall and can't get up.
  • Think about wearing an alarm device that will bring help in case you fall and can't get up.

It's very common for stroke patients to need some form of additional care after they leave the hospital. In some cases that's skilled nursing. In others, it's rehabilitation. But no matter the need, Mount Carmel makes getting the right care in the right facility incredibly easy, and the transitional incredibly smooth.

Through Mount Carmel ConNext, we can help you and your family connect with our preferred partner nursing facilities and rehabilitation centers.

High Standards

Mount Carmel ConNext has created and continuously updates a select network of skilled nursing and rehabilitation facilities with the goal of giving immediate access to better post-acute care.

To be part of the ConNext network, each facility must:

• Receive ongoing education and training from Mount Carmel experts
• Work collaboratively with our teams to continuously improve processes and care
• Review stroke signs and symptoms with each patient
• Maintain high levels of patient satisfaction
• Provide physical and occupational therapies 6 days a week
• Schedule appointments with family physician prior to discharge
• Maintain hospital-prescribed medications for secondary stroke prevention
• Submit required quality metrics