Physical rehabilitation in hospital
Rehabilitation of physical function after a stroke usually starts as soon as the person is medically stable. Going to the rehabilitation gym became a fundamental part of people’s day in hospital and most valued the regular time spent working with knowledgeable and enthusiastic physiotherapists and occupational therapists.
Was very impressed with the knowledge and attitude of physiotherapists he saw in hospital and…
A few people felt annoyed at the lack of or delay in getting physical therapy. They felt frustrated as they later found out the importance of regaining physical function as quickly as possible to ensure maximum recovery.
She was frustrated that her husband was not helped to walk after his stroke. He later had some…
Stella feels that her rehabilitation stopped too soon and that exercises should be provided to…
With the help of her husband, Susan was able to fast-track herself to rehab while in hospital.
He was given a choice of what to work on in physiotherapy and had mainly focussed on walking…
The type of therapy varied dependent on the part of the body affected and the extent of the impairment. Those who had paralysis or weakness in both a leg and arm usually focussed on each at different times of the day or sometimes alternate days. Some had focussed more on one limb than the other.
Upper limb function
Regaining movement in a paralysed arm was difficult and often complicated by lack of sensation. Some never regained function, others were left with weakness, or felt insecure about using their hand because of lack of feeling.
Some people found it helpful to concentrate very hard on moving their fingers and hand and even to talk through the actions they were trying to perform.
She regained movement in her hand by visualising playing the piano. Her physiotherapist was very…
Strength and movement was improved by using arm exercises sometimes with light weights or plasticine to improve hand grip. Tasks to regain dexterity included threading nuts onto bolts, lifting small objects into a dish or doing jigsaws. Whilst this could sometimes seem like child’s play most realised the importance of following the therapists’ instructions and working as hard as possible.
Worked with plasticine and Lego to improve hand function. Even though it was elementary she did…
Practiced putting bolts on nuts and picking up small objects to improve his dexterity. He was…
Therapy of the upper limb generally progressed on to practicing everyday tasks (see ‘Stroke recovery: daily activities‘).
Standing and walking
A major focus of rehabilitation was standing and walking. Those who had experienced a major paralysis of one side of the body often started this process by regaining sitting and then standing balance. A woman explained that she sat and then stood with a physiotherapist at either side in front of a mirror to help her find her central balance point.
The first time she stood was in front of a mirror with two physiotherapists either side to help…
Exercises were given to strengthen weakened leg muscles. This involved lifting the leg in a lying position sometimes with a weight attached. As balance improved some used a special board called a wobble board to improve their balance.
Even those who were unlikely to walk after their stroke were helped to stand as this can be useful in helping transfers from bed to chair or toilet and to allow standing to wash and shave. One man who had developed some spasms in his leg which were preventing him standing was being treated with botulinum toxin injections. He hoped that if they were relieved he would be able to work towards standing.
He recently started some botox injections to relieve a spasm in his leg and hopes that it may…
Most people were encouraged to stand and take a few steps early on. However, one woman had experienced different styles of physiotherapy, one where she was encouraged to walk quickly, and another where she did exercise to gain strength and only walked towards the end.
The first steps were often taken with the support of someone either side or in front and sometimes between parallel bars.
His first few steps supported by a physiotherapist between parallel bars were wonderful. As he…
Standing and taking the first steps was both exhilarating and for some very frightening because they felt they would fall. Many where surprised how quickly they tired after only standing or taking a few steps.
As people progressed, or if their walking was less severely impaired, they practiced walking with a zimmer frame or walking stick often one with three feet for extra stability.
Learning to use stairs was often a final step in rehabilitation. Many found the prospect frightening but with practice and special techniques were able to negotiate stairs confidently.
Was taught to use the analogy of putting her good leg first for going up to heaven and her bad…
Sticks and wheel chairs
Although many people regained mobility after their stroke some felt their balance was poor and found that a stick gave them confidence particularly over long distances. Whilst some thought a stick was useful in alerting others to their disability others did not use one because they felt it made them look old or disabled.
His stick gives him confidence for longer distances because he knows it is there if he stumbles.
A number of people had initially used a wheelchair to get about but were pleased to get back to walking. Others needed to use a wheelchair for getting around. Some disliked using a wheelchair because of the loss of independence, embarrassment and a feeling that people ignored them.
Wheelchairs were not always suitable for where people lived, because they could not get around the house or because they lived on a hill.
Powered wheelchairs and scooters gave some people the much needed independence. Although a few had been provided with one, others rented or had bought one themselves.
An electric wheelchair has been excellent because it has given him independence.
Braces and splints
Sometimes people were fitted with a special splint to straighten out their fingers. Many found these uncomfortable to wear particularly overnight and stopped using them. Others persisted with them because they could see the difference and felt it improved their chances of regaining movement.
A few experienced problems with poor gait due to a dropped weak foot and were given a support to wear which had helped although often this meant they had to wear larger shoes.
Setting goals, monitoring progress and practice
An important part of physical rehabilitation for many people was setting and working towards goals. Some were asked to set goals for their rehabilitation others were graded for their physical ability after the stroke and found it helpful to monitor how their grading improved.
In the rehabilitation gym mobility was graded from 0 to 5. He found it encouraging to look back…
Some found keeping a diary of their progress helpful. A man stressed how important it was to look back at your achievements and then think forward to the goals that you would like to achieve.
Records his progress in a diary and encourages other people to do the same.
Practice was seen as important and some used their spare time in hospital often to practice walking. This was not always encouraged because of problems with falls and a few felt that there should be more time to practice under supervision.
Many people continued to set themselves physical goals after leaving hospital which included walking longer distances with a dog, walking to the shops or using exercise bikes. A few people were helped to do this by a community therapy team. This did not always happen and one man felt that more support should be offered once you leave hospital.
Susan would use the nurses check-list by her bed as a goal-setting tool.
Set himself goals for walking the dog and gradually increased the distance. Having a dog has…
Some attended specific exercise classes or gyms for people who had a stroke and others found that the gym would provide a programme tailored to their disability. Some individuals felt that community exercise through local gyms and pools should be recommended by health staff during discharge planning. In some cases it was felt that health staff were unaware of programs in the community.