Stroke and Post Rehabilitation Stroke

Stroke and Post Rehabilitation stroke can be a severely debilitation experience for many people, but some studies have shown that, timely diagnosed and administered, there are a wide range of rehabilitation regimens available that can mitigate and even avoid some of the more pronounced consequences.

To this end, this paper provides an overview of the importance of rehabilitation to stroke victims and what post rehabilitation techniques have been found effective, followed by a discussion of what healthcare providers in general and nursing practitioners in particular can do to facilitate such rehabilitation regimens. A summary of the research and important findings are provided in the conclusion.

Review and Discussion The rapidly aging population in the United States has experienced an increasing incidence of strokes in recent years (Ashih, Duncan, Lai, Matchar, Parmiagiani, & Samsa, 2004), and today, strokes are a major health problem in the United States and worldwide (Antai-Otong, 2004). Because strokes can occur without giving any type of warning, though, it is difficult to determine who is at risk (Goff, 2000).

The American Heart Association reports that approximately 600,000 Americans experience a first stroke or recurring strokes every year, making strokes the third-leading cause of death (about 160,000 annually) in the United States, ranking only behind heart disease and cancer (Goff, 2000). According to this author, "A majority of stroke victims who survive have some form of permanent disability, and the American Stroke Association estimates that stroke rehabilitation is a $45.3 billion business" (Goff, 2000, p. 30).

While the risk of having a stroke more than doubles each decade after people reach age 55 years, strokes also affect younger people, even in children as the result of complications from other conditions (Goff, 2000). Researchers are still investigating genetic links and vitamin B deficiencies as potential sources of the higher incidences of stroke in younger people (Goff, 2000). The need for timely and aggressive rehabilitation interventions for stroke patients is well documented with defined and measurable metrics that can be used to assess efficacy.

For example, in their study, "Successful experiences with clinical pathways in rehabilitation," Haley, Quigley, Smith and Strugar (1998) report that, "The purposes of rehabilitation are to prevent complications, restore abilities, and facilitate community transitions. Each aspect of the rehabilitation mission is potentially measurable through program evaluation measures" (p. 29). Some examples of rehabilitation program components that are amenable to on-going evaluation include: (a) access to rehabilitation services, (b) functional outcomes, (d) patient satisfaction, and (d) discharge planning (Haley et al., 1998).

Furthermore, time is of the essence is developing and administering rehabilitation services for stroke patients: "It is more important than ever for people -- particularly those in high-risk groups -- to get immediate help if they suspect they are having or have had a stroke. New drug therapies have worked very well on stroke patients, but they must be administered within three hours of the attack" (Goff, 2000, p. 30).

Although it is difficult to identify potential stroke victims in advance, patients can recognize a stroke by the symptoms which may present as a weakness (especially on one side; trouble communicating; vision problems; sudden, severe headaches; and problems with coordination). No matter what type of stroke symptom is experienced, though, Goff emphasizes that, "It is very important to recognize the symptoms and call your doctor. Every minute counts" (2000, p. 30).

Likewise, according to Ashih and her colleagues, stroke victims have a "window" of opportunity within which rehabilitation services are considered most effective: "Recovery from stroke is typically rapid during the first 30 days post-stroke, than slows and reaches a plateau within 3-6 months" (p. 273).

From a nursing perspective, the health and wellness of stroke patients undergoing rehabilitation treatment can be considered on several levels that involve the patient, the community, and the systems that control the interactions within the social and physical environments; therefore, healthcare providers in general and nurses in particular are in an excellent position to promote health and wellness activities at each of these levels, a result that is supported by previous studies (Hart, Rintala, & Fuhrer, 1996).

To help address these multi-level dimensions of the rehabilitation for stroke patients, Haley and his associates (1998) note that there has been an increased emphasis in recent years on delivering rehabilitation services to stroke patients using a collaborative approach among all healthcare providers. This approach to rehabilitation has been preferred due to the typical level of complexity of patient care needs, with many patients having medical, social, psychological and economic issues (Haley et al., 1998).

To be effective, though, these authors emphasize that such team approaches to healthcare delivery require communication, collaboration, and coordination required in order to avoid fragmented care that does not address the unique needs of the rehabilitation patient: "Rehabilitation professionals must collaborate and coordinate the intensity of rehabilitation care to efficiently and effectively influence and achieve maximum patient and family outcomes" (Haley et al., 1998, p. 29). This is particularly important for stroke victims that still have children at home.

According to Dowdy, Kiev, Lathrop and Winkle (1997), "Sudden disability of a parent brought on by stroke or other life-threatening illnesses can have a devastating effect on a child at any age. Families are frequently ill-equipped to deal with the questions and concerns that children have regarding the nature of the illness and course of recovery" (p. 22).

In this regard, nurses are in an excellent position to both help coordinate the delivery of rehabilitation services as well as to help educate stroke patients, their caregivers, family members and community at large concerning the ongoing need for timely rehabilitation interventions and what effect the stroke may have on the family unit.

According to Dillon and Sternas (1997), "Due to the multifaceted changes occurring within the health care system, it is essential that nurses continue to expand their care beyond that of restoration of health to include that of health promotion and health maintenance through education" (p. 1). These are especially important considerations once stroke victims return to their homes.

Because every patient is unique, Fischer (1999) emphasizes that the healthcare implications for stroke patients are varied, and nurses must to remain knowledgeable about changes in Medicare and managed care systems in order to ensure that homebound stroke patients receive the rehabilitation services they require.

In this regard, Antai-Otong emphasizes that many stroke patients are at an increased risk of developing depressive symptoms that can adversely affect their rehabilitation progress, but these symptoms are treatable: "Stroke is a risk factor for depression and requires early recognition and treatment with antidepressants, combined with other interventions to enhance the rehabilitation process and facilitate an optimal level of functional recovery and coping skills" (p.