|
Rehabilitation
in the home
This article was
published in The West End
Times October 8, 2011.
Imagine being told you are not
eligible for rehabilitation. I last spoke about rehabilitation in the
home for
people with aphasia after a stroke. I have since heard from people
whose family
member suffer with this disability. There does not seem to be the
necessary
help for this long term need. I started looking at rehabilitation in
general
and what is so disturbing is that many people stay in long term
facilities and
don’t improve because they were “not eligible for
rehabilitation.” What then is
the option? You become a chronic patient with no where to go.
I am reminded of a family who
several years ago were told that their mother was not eligible for
rehab
because she had lost all strength and could not balance herself sitting
on the
side of the bed. She wanted to go home and despite resistance from the
hospital
team the family arranged for her to do so. After many hours of nursing
and home
care, she started to regain strength. Eight months later she was
walking with a
walker and enjoying family vacations. We don’t know enough about
what hard
work, support and determination can do. All too often the chronic ward
or
facility is offered as the only choice. All too often family members
are left
tied in a chair to avoid falls, waiting for someone to talk to or for
someone
to look at them as they pass outstretched arms crying “Nurse,
Nurse”.
Despite
the high incidence of stroke, there are a
limited number of studies examining post-stroke rehabilitation and
recovery.
Results from the largest randomized clinical trial to date regarding
rehabilitation after stroke were published in the May 26th issue of the
New
England Journal of Medicine This study presents strong evidence to the
importance of initiating physical therapy for stroke patients, with
over half
observing improvements within the year. This study also proves that physical
therapy at home can be just as effective as more expensive, locomotor
training
solutions such as robot-assisted treadmill steppers. Also, not only was
the
home-based program found to be cheaper, it was accompanied by fewer
risks. As
hospitals continue to evaluate best practices on post-stroke care,
physical
therapy/rehab will have to be addressed.
Studies that have been done show that with fast
diagnosis and treatment you can do better. The
importance of rehabilitation
after stroke cannot be overemphasized. These studies have shown that
rehabilitation is responsible for most of the recovery experienced by
patients
after a stroke, and that without it, little or no improvement can be
accomplished.
Stroke rehabilitation should provide a targeted and organized plan to
re-learn
functions lost within the shortest period of time possible.
Your brain can continue to learn
and re-learn new and old tasks for as long as you live. This is why it
is so important to support rehabilitation at home. Not everyone will
return to prior to the
stroke condition. It depends on the severity and location of the
stroke.
Post-stroke physical rehabilitation interventions have been used to
reduce pain
and spasticity, as well as to increase range of motion (ROM), muscle
force,
mobility, walking ability, functional status, physical fitness, and
quality of
life. Post-stroke physical rehabilitation interventions are mostly
noninvasive
interventions that present very few adverse side effects and
contraindications
as compared with a large number of pharmacologic interventions. Given
this, why
can’t we provide assessments and treatment plans for people in
their home? Why
can’t the money spent to keep people in chronic care facilities
be used to
support those people who have had a stroke and their families in their
homes?
If the same amount of money was
used to provide home support for personal care and to reinforce
exercise
programs designed by the rehab team, people can do better. If we add to
this
plan remote visits from the physiotherapist and nurse to do their
evaluation of
the progress throughout the process, modifications to the plan can be
made at
very little expense to the system. Why can’t we????
Thoughts,
comments, suggestions are always
welcome.
Contact me at donna@ashcanada.com
Health Access, Home and Nursing care
514-695-3131
|
