Rehabilitation principles

Rehab Principles - Get Moving, Brain!

• Core Goal: Harness neuroplasticity-the brain's ability to rewire. Early and intensive therapy is key.
• Multidisciplinary Team: Physical Therapy (PT) for motor function, Occupational Therapy (OT) for Activities of Daily Living (ADLs), and Speech-Language Pathology (SLP) for communication/swallowing.
• Key Principles: Task-specific, repetitive, high-intensity, and goal-oriented training to prevent "learned non-use."

⭐ Critical Window: The most significant motor recovery typically occurs within the first 3-6 months post-stroke, emphasizing the urgency of early, intensive rehabilitation.

The Rehab Team - Meet the Crew

• Physiatrist (Rehab Physician): Team leader; creates the overall rehab plan.
• Physical Therapist (PT):
  • Focus: Gross motor skills (walking, balance, transfers).
• Occupational Therapist (OT):
  • Focus: Fine motor skills & Activities of Daily Living (ADLs).
  • Tasks: Dressing, eating, bathing, adaptive equipment.
  • 📌 Mnemonic: OT = Occupations of daily living.
• Speech-Language Pathologist (SLP):
  • Manages aphasia (language) and dysphagia (swallowing).
• Social Worker/Case Manager:
  • Coordinates discharge planning, insurance, and community resources.

⭐ The SLP's swallow evaluation is critical. Aspiration pneumonia from unrecognized dysphagia is a major cause of post-stroke mortality.

Deficit Management - Fixing the Glitches

• Core Principle: Neuroplasticity

  • Brain's ability to reorganize by forming new neural connections.
  • Harness through repetitive, task-specific practice.

• Motor Deficits (Hemiparesis/Hemiplegia)

  • Physical Therapy (PT): Focus on gait, balance, strength, and mobility.
  • Occupational Therapy (OT): Activities of Daily Living (ADLs) retraining (e.g., dressing, eating).
  • Constraint-Induced Movement Therapy (CIMT): Restrain unaffected limb to force use of the affected limb.

• Speech & Language (Aphasia)

  • Speech-Language Pathologist (SLP) consult is key.
  • 📌 BEAM Mnemonic: Broca's Expressive Aphasia (Broken speech), Motor; Wernicke's Receptive Aphasia (Word salad), Sensory.

• Cognitive & Perceptual

  • Neglect Syndrome: (Usually right parietal lobe) Patient ignores one side of space. Address with visual scanning exercises.
  • Apraxia: Inability to perform learned movements on command.

⭐ High-Yield Fact: Post-stroke depression is common (~33% of survivors) and can significantly impede rehabilitation progress. Screen and treat aggressively.

Complication Prevention - Dodging Dangers

• VTE Prophylaxis:
  • Early mobilization is crucial.
  • Pharmacologic prevention (LMWH/heparin) for non-ambulatory patients.
• Aspiration Pneumonia:
  • Perform a bedside swallow screen before any oral intake.
  • Consult speech therapy for diet modification.
• Pressure Ulcers:
  • Reposition patient every 2 hours.
  • Utilize pressure-reducing mattresses.
• Contractures:
  • Initiate passive and active range-of-motion exercises.
  • Apply splints in functional positions.

⭐ In immobile stroke patients, deep vein thrombosis (DVT) prophylaxis is a priority and should be started immediately unless active hemorrhage is present.

High-Yield Points - ⚡ Biggest Takeaways

• Early and intensive mobilization is crucial to prevent complications and improve functional outcomes.
• Task-specific training, like Constraint-Induced Movement Therapy (CIMT), promotes neuroplasticity.
• Manage spasticity with physical modalities, botulinum toxin, or baclofen to improve motor function.
• Speech and language therapy is essential for aphasia; address both expressive and receptive deficits.
• For hemispatial neglect, encourage visual scanning exercises and environmental modifications.
• Screen for and treat post-stroke depression as it significantly impacts recovery.