Paul was in rehab for about 3 1/2 weeks. He was originally supposed to be there for 2 weeks, but because he was starting to show some improvement, they were able to extend his stay a little longer so that he could continue to get therapy on a daily basis.
Once your stroke survivor (SS) goes home, they will either receive in-home therapy or outpatient therapy, but in either case, it’s usually only a couple of times a week vs. the daily therapy for in-patient rehab. Note that daily therapy is 5 days a week, but they usually do a light form of therapy on one of the weekend days.
This is how it was done at our facility, your experience may be different based on your facility, insurance, state, etc. Paul’s therapy included speech, occupational, and physical therapy sessions.
What I learned about the difference in these 3 therapies:
Speech isn’t just speech. They do the swallow testing to check what types of food can be tolerated and they also do the cognitive therapy, memory, reading, comprehension, etc. So even if your SS doesn’t have very much trouble with speech, he may still receive speech therapy for these other issues.
Occupational therapy is not about the person’s occupation and helping them get back to that. Yes, obviously we all want our SS to return to as much of their activities as possible and if they can return to work, that’s fantastic. But occupational therapy is about working on the affected area, but also about teaching them how to do things for themselves in a new way.
The physical therapy focused on standing, taking steps, using a walker, etc.
Paul's stroke was on the left side of his brain. That means that physically, his impairments were on the right side of his body and he is right-handed. Part of the occupational therapy was teaching him how to dress, put on his shoes, bathing, personal care, toilet and bed transfers, etc. with only the use of one hand and arm.
I should explain here what I mean by toilet and bed transfers. Because my IS was in a wheelchair, they taught him how to transfer from the wheelchair to the toilet seat and from the wheelchair to the bed with the goal being that he was able to do those transfers on his own.
Reality? He still needed a little help with this when he came home, but I think it was more about the setup of our bathroom and bedroom. neither one was designed of course to be wheelchair friendly and the bathroom was particularly tight so it was difficult to get the wheelchair in the right position for the transfers.
Thankfully, he progressed fairly quickly to the walker and once we installed a grab bar in the bathroom that helped as well. We put it on the wall directly opposite of the toilet and he used this to help pull himself up.
If you want some information on how to set up the walker to work for someone with hand/arm paralysis, you can read about that here.
Now back to the therapy discussion.
They actually had an apartment set up in the therapy area complete with living room, kitchen, laundry area, bathroom and 2 bedrooms. part of his therapy was learning to maneuver around furniture in his wheelchair and how to take care of himself in his current state.
The occupational therapist was also the one that worked on his arm and hand to try to get motion back in those.
The physical therapy focused on strengthening his leg with the goal of being able to use the walker and get out of the wheelchair. The physical therapist also practiced car transfers with him – going from the wheelchair to the car seat and back to the wheelchair. Again, not because they were planning on him staying in the wheelchair, but to help him be mobile while working on getting out of the wheelchair.
At the end of that 3.5 weeks, he came home in the wheelchair but was using the walker during therapy sessions. When he left therapy he had not regained any use of his arm or hand yet. They determined he was mobile enough to go to outpatient therapy instead of having someone come to the house for therapy.
At first, you may think it’s easier to have someone come to the house, and no doubt it is, but it’s better for your stroke survivor (SS) if they can go to the therapy facility. They will have more equipment the therapists can use and will have more opportunities to try different things to progress the therapy. So if they are able to do outpatient therapy, you should take that option if at all possible even though it is not easy.
Getting your injured spouse (IS) in and out of the car, not to mention the wheelchair if you have to take it, is a royal pain. However, it’s worth it in the long run as you’ll most likely find that he progresses faster than if you do the at-home therapy.
It was both exciting and scary that he got to come home. I was now going to be responsible for his wellbeing. Talk about stress…
You can go here to read about the prep we did for Paul to come home from the rehab facility.
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