Physical Therapy at Home After Suffering a Stroke
Rehabilitation in the early period after diseases that cause brain damage such as stroke, traumatic brain injury, and brain tumor is necessary to reach maximum functionality. In an event such as a brain hemorrhage or a clot in the brain, physical therapy is started as soon as the patient is out of danger to life. After the vital functions stabilize, the intensive rehabilitation process can be applied in the physical therapy clinic as an inpatient or outpatient. The patient’s learning capacity, active participation, and condition are important in the success of physical therapy. The patient, who receives physical therapy for an average of 1-2 months, is then discharged, usually with a home exercise program, and is followed up with regular controls.
Why is Clinic Physical Therapy Time Limited?
In-clinic therapy after stroke may take 3-6 months in mild cases, while it may take one year or longer in severe cases. In severe cases, lifelong limitations may occur. Although the recovery period may be one year or longer, it is not possible or feasible for the patient to spend all this time in the physical therapy clinic.
Appropriate rehabilitation goals are determined for the patient, and these goals are tried to be achieved in 1-2 months with intensive physical therapy. A plateau phase, in which recovery slows down, can be reached 3-6 months after stroke. When the patient reaches the “plateau,” discharge is usually planned. This is partly because rehabilitation is an expensive and labor-intensive treatment. Limited resources are used most efficiently. In addition, health insurances cover rehabilitation up to a certain session. To extend the determined number of sessions, it is required to document objectively that the patient has improved with rehabilitation.
When the patient reaches the “plateau,” discharge is usually planned. This is partly because rehabilitation is an expensive and labor-intensive treatment. Limited resources are used in the most efficient way. In addition, health insurances cover rehabilitation up to a certain session. To extend the determined number of sessions, it is required to document objectively that the patient has improved with rehabilitation.
In an ideal world, every rehabilitation patient would be discharged from the in-clinic therapy, with full independence in activities of daily living and ready to rejoin society. However, this is not always possible. Hence, an at-home therapy program is recommended so that the recovery can continue.
At-home therapy programs are usually given to the patient one or two days before the end of the treatment in the physical therapy clinic or on the day of discharge. An at-home therapy program can also be prepared during the outpatient clinic examination controls. Usually, the physiotherapist practically teaches the movements in the exercise program to the patient and their family. These movements are often repetitions of the exercises done during the in-clinic therapy sessions.
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It’s fair to say that in practice, at-home therapy programs are rushed. In reality, during the recovery time following disorders like stroke and traumatic brain injury, a home exercise program stresses the individual’s responsibility for their own rehabilitation. Patients are generally discharged after reaching a plateau despite physical therapy. Giving the same movements utilized in physical therapy as a home program, on the other hand, may at best protect rather than strengthen the recovery.
A considerable portion of patients’ functional status does not change much after discharge from in-clinic therapy, and sometimes gains are reversed. It is essential to adhere to at-home therapy programs in order to maintain a person’s muscle strength and endurance. Even the most basic programs are valuable in this regard. However, achieving progress requires more elaborate programs with defined goals and updates.
For a more detailed, targeted, and flexible program, patients should not be afraid to ask their physiotherapist and doctor questions. Setting and tracking long-term goals helps to better manage the therapy process.
Reaching a plateau throughout a training process is common. And by repeating the same exercises, a plateau may not be overcome. Therefore, therapists and patients should be open to diversifying their exercise methods. Different techniques such as bilateral exercises, mirror therapy, music therapy, mental exercises, electrical stimulation can trigger neuroplasticity by stimulating the brain. In recent years, approaches such as telephone applications and video conversations have been tried to boost the impact of at-home therapy programs. For proper treatment, patients should consult their doctors and physiotherapists. Exercises that are done unintentionally might wear the body out or raise the danger of falling.
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Chronic stage stroke survivors achieved on average 2.96 times higher improvement