First off, a very warm and heartfelt welcome to our new subscribers! Thank you for joining the conversation. Also, a friendly reminder that you can continue the conversation on Facebook @ptsonmission. Go visit Facebook and "Like" the page to receive more updates and encouragement!
Second, I am super excited to welcome another friend and colleague to the blog today! Alyson O'banion is a PT with extensive experience with CVA rehab. Today, she is gracious enough to share three important keys that she and her team utilize to maximize the functional outcome of a patient who has suffered a CVA. I hope you enjoy it!
"I have been working with stroke patients for many years and have witnessed first hand the importance of interdisciplinary care for the success of rehab for patients who have had a CVA. CVA can be, and often is, a life altering condition that has significant impact on not only the patient but also the patient's family. According to the CDC, stroke is the leading cause of serious, long-term disability in the US and that is why an interdisciplinary approach to rehab is so important. So what is an interdisciplinary approach? It is using all forms of rehab specialists to provide a complete plan of care to maximize the function of a patient post CVA.
An interdisciplinary approach is crucial to assist in restoring cognitive function, ADL and iADL skills, and safe mobility/gait in order to return patients to the the highest level of independence. In our clinic, we often work to return the patient to the type of work the patient participated in prior to the CVA. But the bottom line is that we want to limit the need for care-giver assistance or any other additional burdens on other family members. Memory, attention and concentration, spatial awareness, executive function, driving, weaknesses in extremities, ability to dress, feed, toilet, grocery shop, handling finances, handling own medication, as well as negotiating stairs, may all be affected by a stroke, and only a skilled interdisciplinary team can address all of those needs. It should be noted that although PT, OT, and SLP are essential during the recovery process, the team would not be complete without the MD, social worker, nurse, dietitian, and neuropsychologist assisting in other areas of need for most patients. So how do we manage the diverse array of medical providers to ensure the most successful outcome? For me, it comes down to three key things.
Identify the Barriers to Learning. One key area for multidisciplinary care is for each therapist to know what the barriers to learning (cognition vs physical limitation) the patient may have in order to help assist in the performance of a task during a session. Meeting together to discuss barriers, as well as successful tips, can benefit each therapist and make the patient perform at the maximum potential during each session and to follow through with home reproduction of those same tasks.
Set Proper Expectations. Another key area is for the patient and caregiver/family to all have realistic expectations of the rehab process and also the expectations of the amount of dedicated time that is necessary to work on the interventions given by the therapists. The patient and family must be willing to spend many hours a day practicing the activities to stimulate neuroplasticity - the ability to learn skills through a new neural pathway. A minimum suggestion of practice is 60 hours to begin making the task more automatic. The patient and family must also understand that neuro-regeneration is a slow process, so reaching goals or making improvements can take much longer than the patient or family may realize. The interdisciplinary team will assist in the motivation and provide the repetition required to help that patient meet his or her goals but it is so important that the patient and family understand the rehab process will take time and effort. Setting the proper expectations will assist that process.
Communicate. This cannot be stated enough. As a patient moves through each rehab discipline, new observations will be made, new problems might be discovered and new successes will surface. All parties involved in each patient's rehab need to know all these new developments so that each therapist and modify the therapy session to maximize function. You must communicate frequently to each other throughout a rehab session. But we also hold rounding meetings every week to discuss all the patients we are currently seeing with all the other rehab specialists. These meetings are always fruitful to maintain high quality care.
I hope you found these three keys helpful to you especially if you work in the stroke rehabilitation world!"
Alyson O’Banion, DPT