Category Archives: Therapy

Occupational Therapy Programs

The following programs are offered to assist patients with occupational difficulties.

A Matter of Balance
Helps reduce the fear of falling and increase activity levels in older adults.
New Castle: (302) 255-9882
Kent & Sussex: (302) 515-3020

Safe Steps
Safe Steps was created to help seniors walk safely and confidently as they age. Most falls by seniors are due to balance, gait, and vision problems; medications; and issues in the home. Muscle weakness and health conditions that affect joints, feet, and legs may also contribute.
Wilmington Hospital
Gateway Building, 5th Floor
501 W. 14th Street
Wilmington, DE 19801
(302) 320-6475

Stroke Support Group Meetings

  • Stroke Education & Support Group
    Third Friday of Every Month, 12 – 1 p.m.

    Next Meeting: Nov. 16
    Christiana Care Rehabilitation Services

    Stroke survivors, their caregivers, family, friends and medical professionals are invited to attend our monthly meetings. At some meetings, outside speakers will focus on related health care topics and other important issues. At other meetings, a general support group is held.

  • Stroke Education & Support Group
    First Thursday of Every Month, 4 – 5:30 p.m.

    Next Meeting: Nov. 1
    Christiana Hospital campus

    Stroke survivors, their caregivers, family and friends are invited to attend our monthly meetings – a place where we gather to connect, share experiences, receive information and learn in a caring atmosphere.

  • Aphasia Education Group
    First Wednesday of Every Month, 10 – 11 a.m.

    Next Meeting: Nov. 7
    Christiana Hospital campus

    Aphasia is an acquired language disorder that can happen as a result of stroke or brain injury. We offer a support group for those affected by aphasia.

  • Rehabilitation Services Lecture Series
    Tuesday, Nov. 13, 6 – 7 p.m.

    Christiana Hospital campus
    “Stopping Foot Pain In Its Tracks.”

    Join us for a series of six lectures in our 2018 Rehabilitation Lecture Series. To learn more call 800-693-CARE (2273).

Stroke Rehabilitation

JOHN P. SCHOLZ, PT, PHD

PROFESSOR, DEPARTMENT OF PHYSICAL THERAPY,

UNIVERSITY OF DELAWARE

 

 

A brain attack or stroke can have a devastating effect on the patient as well as his/her family. Movement and, sometimes, cognitive functions that were once performed automatically now require great effort and new strategies, if they can be performed at all. The patient’s family is often torn between sympathy combined with the compulsion to do as much as possible for the patient and anger at the additional burden this tragedy brings to their own lives.

 

In the early stages following a stroke, the patient is often bewildered by the sudden loss of even the most basic functions. As initial recovery progresses, he/she becomes understandably torn between the expectation that full recovery is only a matter of time and the frequent reality that some functional deficit is likely inevitable. What can the patient expect from rehabilitation?

 

Immediately after the stroke, the focus of the medical staff is to medically stabilize the patient. At this stage, physical therapy (PT) consists largely of attempts to prevent the loss of joint motion that can occur due to tightening of muscles and ligaments that are not moved through their full available range. Early exercise also helps to minimize the loss of muscle strength that occurs with disuse of the limb. As soon as the patient’s medical condition has stabilized, however, aggressive therapy becomes an essential ingredient to promote the patient’s long-term recovery.

 

Rehabilitation:
Because of time limitations resulting from the rising cost of health care, initial rehabilitation often emphasizes teaching the patient to compensate for the loss of control of the extremities on the side affected by the stroke. Although recovery of function is of greatest importance following a stroke, it is important for clinicians not to be short sighted about the long-term implications’ of neglecting the patient’s most affected side. Failure to help the patient develop strategies that actively and appropriately incorporate the affected extremities into daily tasks often leads to a greater risk of falls and other accidents because the patient has no practice in controlling the impaired side of the body. Moreover, an aspect of rehabilitation that is often neglected is control of the trunk. The trunk is essential for postural stability in sitting and standing, serves as a base of support from which the arms and legs are able to work, and allows extension of the functional use of our extremities when objects are beyond our typical reach length. Thus, coordinated function of the trunk with the extremities is an essential aspect of rehabilitation that should not be neglected.

 

Although a course of inpatient rehabilitation is typically shorter today than in the past, most patients receive some form or continued therapy after discharge, either as an outpatient or with the guidance of a home health therapist. This additional therapy provides an important opportunity to address control issues of the trunk and the extremities affected by the stroke. Unfortunately, an important window of opportunity may have already closed by this time if early rehabilitation focused solely on learning compensations for the affected extremities. Thus, early treatment aimed at getting the patient functional enough for discharge must be tempered by an understanding of the need to foster use of the most affected side of the body as much as possible.

 

Guidelines for improving motor skill:
Several implications for rehabilitation come from recent studies of the brain’s ability to recover function after a lesion. Some important lessons follow:

 

  1. Begin practice as soon as possible following a stroke (i.e., once the patient is stable medically).
  2. Treatment should emphasize the practice of functional skills that incorporate use of affected extremities as much as possible.
  3. Treatment should challenge the patient’s abilities, within appropriate limits of other medical conditions/ contraindications and the need to ensure safety.
  4. Treatment should vary as many aspects of a task’s practice as possible (e.g., the size, shape, texture and weight of objects being manipulated) and should allow the patient opportunities to self-evaluate their performance so that they do not become dependent on outside assessment.
  5. Feedback is important for learning. Providing external feedback too frequently, however, can be detrimental to learning.
  6. Extensive practice is essential for recovery of function. The amount of practice available in most therapy sessions is not adequate to maximize functional recovery. Patients must engage in frequent and quality practice of skills outside of formal therapy if recovery is going to be optimal.

 

Newer Therapies for Stroke Rehabilitation:
In recent years, a number of therapeutic approaches have been introduced to help re-train movement function in persons following a stroke. Examples of more commonly used clinical approaches to rehabilitation include Constraint-Induced Movement Training (CIMT) and Body-weight supported treadmill training (BWSTT). CIMT, in particular, is based on point #6 above. Participants agree to keep their non-impaired upper extremity in a splint while intensively practicing functional tasks with their impaired extremity. Treatment is both intense and short-term, typically lasting 6-hours per day for about two weeks, although modified versions have been recently implemented in some clinics. CIMT was developed to improve arm function, although a variant of the approach also has been applied to train walking post-stroke.

 

BWSTT attempts to improve a patient’s confidence in bearing weight on the affected leg by providing partial body weight support while the patient walks on a treadmill. The support is maximal at first and then gradually decreased to no additional support over a number of treatment sessions. In addition, it is useful to increase the treadmill speed to help the patient gain confidence walking at faster speeds.

 

More recent experimental innovations introduced in recent years include Robotic Assisted Training (RAT), either applied to improve arm function or walking ability, Split-Belt Treadmill Training (SBTT) and Fast-FES Treadmill Training (FFTT) for walking. FFTT involves practice of walking at higher than normal speeds while functional electrical stimulation (FES) is applied to the ankle muscles to assist their contraction. SBTT attempts to help the subject learn to bear weight for equal time periods on both the impaired and non-impaired legs. RAT uses computer-controlled robots to assist or resist movement of the arm or leg while patients attempt to perform functional tasks. None of these approaches are in standard use clinically but have potential to improve function in persons post-stroke. Most insurance companies do not pay for these latter treatments because they are still considered experimental. However, variants of all three are currently under study at the University of Delaware Department of Physical Therapy and volunteers are currently being enrolled for trial therapy with them.

 

Some treatments like CIMT have been shown to be effective only in individuals with mild impairment of their hand function. Patients with more significant impairments of their arm and hand would not qualify for this therapeutic approach at the present time. Thus, while these and a number of related treatments not mentioned here provide hope for the stroke survivor, it is still too early to know how widely useful they will be.

 

Local Rehabilitation Studies:
As mentioned above, the Department of Physical Therapy at the University of Delaware is engaged in a number of ongoing research projects aimed at better understanding functional loses after a stroke and to develop improved treatment methods. For further information on how you can become involved in this research, please contact Ruby, our research scheduling coordinator, at (302) 831-0150 or UDPTResearch@udel.edu.

How Will This Stroke Change My Daily Life?

MARY CIECHANOWSKI, MSN, ACNS, BC, CCRN

TERESA ZACK, MSN, RN, NE-BC

 

When someone suffers a stroke a portion of the brain becomes damaged. Since the brain is the command center of the human body, a stroke can affect the signals coming from the brain. The brain controls all aspects of the person, from the physical to emotional aspects. Functions that can be affected by stroke can include reading, writing, walking, talking, thinking, and seeing as well as the memories we form and our moods. Having a stroke has the potential to affect and change any part of who we are and result in problems with intellectual abilities, emotions and personality, in addition to the physical disabilities.

 

Speech and Language:

Some stroke survivors can have problems with speech and language. This can make it difficult to communicate with others which can become very frustrating. After a stroke, one can have difficulty naming objects correctly, expressing themselves or even comprehending what others are saying. Some people may also experience problems in related skills such as math, reading or writing. This does not mean these skills are lost forever. Many times with speech and language therapy these skills can be relearned or alternate ways of communication are formed.

 

Memory:

Memory, especially short-term memory, can be affected by a stroke. One may not be able to retain what has just happened 5 minutes ago or one may not be able to retrieve memories from the past. Strokes can affect verbal memory, such as naming items on a shopping list or visual memory, such as recall for faces. A stroke can cause problems with recalling information, but that does not mean these skills cannot be re-learned.

 

Visio-perceptual Skills:

A stroke can affect one’s ability to pay attention to one side of one’s physical space or visual field. Even though there may not be problems with one’s eyesight, the visual field loss may cause a person to bump into walls while walking or trip on objects in the walking path. Sometimes this neglect of space can be so severe the person may deny that a body part even belongs to them or will not use one side of the body despite no actual loss of physical ability. There can also be difficulty with solving problems such as puzzles or drawing. If there is a problem with the visual system, a stroke can also cause problems with reading. Physical and occupational therapy are terrific sources to help compensate for one-sided neglect or eyesight issues.

 

Emotional functioning:

Patients can develop emotional problems after a stroke such as depression and mood swings. Depression often goes undiagnosed and untreated. Some of the symptoms of depression include: persistent sadness, anxiousness or “empty mood”, feelings of hopelessness, guilt, worthlessness, decreased energy, fatigue, difficulty concentrating, insomnia or excessive sleepiness, appetite changes, or thoughts of suicide. If these symptoms are present, seek an evaluation from a medical practitioner. Social workers, pastoral services, physicians, and other counseling services are available and offer insight and help with these symptoms.

 

Personality Changes:

Personality changes can also occur after stroke. Some common changes that may happen are doing things without thinking, social inappropriateness, impulsiveness, or a lack of interest in activities. Communication with loved ones is key – making sure everyone knows that these behaviors can occur after a stroke may make it easier to seek help if needed.

 

The most important thing to remember is that, although having a stroke may change many aspects of your daily life, these changes can be overcome in time.

Speech Therapy’s Role in Rehabilitation

JAMIE MANCE, SPEECH PATHOLOGIST

 

After a stroke, a person may experience language deficits and swallowing difficulties. Other impairments may include slurred speech, voice disorders and cognitive deficits. The severity of these may vary depending on the location and size of the damage caused by a stroke. A speech therapist (ST) is a health care professional who specializes in assessing and treating communication disorders and swallowing problems.

 

When a patient is medically stable and cleared by the physician, the rehabilitation process begins. Early intervention with a stroke patient is crucial to obtaining the greatest recovery potential from therapy services. A speech therapist is part of rehabilitation team which includes physical therapists (PT) and occupational therapists (OT). This team is responsible for helping the patient regain as much lost function as possible.

 

In an acute care setting, a speech and swallowing therapist is consulted by the physician when the patient exhibits difficulty with talking and/or eating meals. A speech and swallowing evaluation is completed. The result of this evaluation determines the strengths and weaknesses of the patient and guides the development of an individualized rehabilitation program. This plan may include compensation strategies and strengthening exercises to assist the patient to improve their communication and swallowing function.

 

An emphasis is applied to the family’s education so that there is continuity with therapy strategies and exercises. Handouts are given to patients so that they can continue with their therapy daily.

 

Therapy does not end when the patient is transferred to another facility or discharged home. Rehabilitation services are available in a rehab hospital, nursing home or extended care facility. Home care services provide a therapy setting in your own house. If the patient requires further therapy, then outpatient clinics will provide for their needs.

 

Terms commonly used in speech therapy:

Aphasia – A difficulty producing and processing language. One example is when the patient states, “I know what it is, but I can’t say it,” when trying to identify an object.

Apraxia – The inability to coordinate (planning, sequencing) the muscles involved in speech production.

Dysarthria – A weakness in the muscles involved in the speech mechanism. This is often described as having slurred speech.

Cognitive deficits – These impairments affect the ability of an individual to think and process information. This may include memory, sequencing and problem solving.

Dysphagia – A weakness in the muscles that are involved with swallowing.

Dysphonia – The inability to produce voiced sounds in speech.

Occupational Therapy for Stroke

SARAH EKBLADH, OTR

 

The primary goal of Occupation therapy (OT) in the treatment of patients who have had a stroke is to increase their independence with activities of daily living (ADL’s). In acute care, this would focus on assisting patients with the ability to dress and bathe themselves. Initially, this involves training patients in compensatory techniques to complete these activities as patients may have weakness on one side, balance deficits or visual deficits. Adapted equipment may also be issued for feeding or dressing if this increases independence.

 

OT also focuses on the use of the arms and hands. Since strokes often cause weakness or incoordination on one side of the body, treatment may include range of motion exercises, strengthening or coordination activities on the affected side. Additionally, OT may provide braces or splints for the affected limb to prevent contractures (if needed).

 

OT may also evaluate visual and perceptual skills as patients may have visual deficits after a stroke. These deficits may include not being able to see one side, “forgetting” about one side or double vision. Treatment includes re-training visual skills as well as compensating for deficits.

What Can I Expect From Physical Therapy

BECKY BROCKSON, P.T.

 

Physical therapy (PT) after a stroke aims to help the stroke survivor to regain skills that were lost when part of the brain is damaged. The degree of disability that follows a stroke depends upon which area of the brain is damaged. The physical therapist will usually focus on helping the patient in regaining strength, balance, coordination and the ability to move and walk. Physical therapy cannot “cure” or reverse the brain damage, which was caused by the stroke. Participation with an early physical therapy program can, however, help the patient to achieve the best level of recovery possible.

 

PT in the acute care hospital begins as soon as the patient is medically stable, often in the first or second day of admission. If stable, the patient will be assisted out of bed to a chair. Patients progress from sitting to standing, to transferring and walking with physical therapy. Exercises may involve teaching the stroke patient how to coordinate leg movements, how to regain balance, or walking with an assistive device. Physical therapy sessions may also include reviewing good safety practices or involving the patient’s family to teach them how to help assist the patient.

 

As the time for discharge from the acute care hospital approaches, the staff will work with the patient and family to decide which type of rehabilitation will be best suited for the patient. This depends on many factors: if the patient lives alone or how much help is available to the patient at home, how safe the patient is when moving or walking, and how much therapy and activity the patient is able to tolerate. The rehabilitation options after discharge include:

 

  • Outpatient therapy – usually 2-3 times per week
  • Home care therapy – this would involve a therapist corning to your house, usually 2-3 times per week
  • Sub-acute inpatient rehabilitation – this therapy is usually provided in a nursing home, 3-5 days per week, for approximately 1 hour per day, with a goal of the patient returning to home.
  • Acute inpatient rehabilitation – this therapy is usually provided in a rehabilitation hospital, 5-7 days per week, for approximately 3 hours per day.