Following a stroke, about two-thirds of survivors receive some type of rehabilitation. This is a time of both hope and anxiety for stroke families: hope that the survivor will make a good recovery; anxiety or fear about what happens next and what to expect.
Of course, the first priority after stroke is stabilizing the patient. Once a hospitalized survivor is medically stable, they may be moved to inpatient rehab. Inpatient rehab is sometimes referred to as acute rehab and requires at least three hours of therapy a day. The goal of inpatient rehabilitation is to return patients safely to their home environment. The average stay is 15 days, although some patients may stay less and others may stay longer. Patients not able to meet the requirements of inpatient rehab may be discharged to a skilled nursing facility. After leaving inpatient rehab, survivors are typically discharged home.
“Once home, survivors may need ongoing therapy to continue to build their strength and return to the activities they pursued before the stroke,” said physical therapist Kim Brennan, administrative director of outpatient therapy and specialized services at Shirley Ryan AbilityLab in Chicago. In that case, survivors may be transitioned to outpatient rehab, either provided in an outpatient clinic or at home through a home healthcare agency. In outpatient therapy, survivors go into a rehab facility, which distinguishes it from home-based therapy. Prescriptions and insurance vary, but outpatient therapy is typically two or three hours, once or twice a week.
“Whether a patient is referred to inpatient or outpatient therapy depends on the level of medical care required,” said Brennan. “When a patient’s medical status can be managed and monitored without IVs, nursing care and the like, then the patient can be considered for outpatient rehabilitation.”
Outpatient or Home-based Therapy?
The decision of whether to use outpatient or home-based therapy depends on the survivor’s abilities. “If the patient demonstrates difficulty getting in and out of the home, he or she would be a better candidate for home health therapy until he or she is strong enough to regularly attend therapy in an outpatient clinic,” Brennan said. “Stairs can often be a barrier to transitioning out of the house for appointments or community events, and having a therapist come to the house to practice the stairs and negotiate the rest of the home environment can be helpful. Inpatient rehabilitation simulates these activities, but everyone’s home environment is unique and presents different challenges after stroke.”
“Whether a patient is referred to inpatient or outpatient therapy depends on the level of medical care required.” — Physical Therapist Kim BrennanHome therapy is not considered to be part of outpatient therapy; it is a separate level of care. Home health therapy is often recommended when a patient is homebound and may require continued nursing support for issues such as wound care, blood draws, etc., in addition to therapy care.
Bridging Levels of CareAt Shirley Ryan AbilityLab, they offer a program called Day Rehabilitation, which is a bridge from acute inpatient rehabilitation to outpatient therapy. “Day Rehabilitation provides patients with three-to-six hours of therapy three-to-five days per week with the primary goal of community reintegration,” Brennan said. “Upon discharge from this program, outpatient therapy may be considered if ongoing therapy is required.” Not all rehab hospitals have a program like this.
Types of Therapies in Outpatient FacilitiesOutpatient therapy may consist of occupational, physical and speech therapy. Recreational, art, and music therapy may also be offered during inpatient rehab or at a skilled nursing facility. Brennan says that they collaborate closely with their fitness center so that patients have the option to pursue a personalized exercise program with an exercise physiologist upon discharge.
Getting the Most Out of an Outpatient Therapy RxBrennan offered a few recommendations patients should consider for outpatient care:
Kenneth Mauck, MPT, MS , Manual Therapy Expert