Stroke Rehabilitation

Stroke Rehabilitation helps people with impairments after a stroke to regain as much function and independence as possible in physical, cognitive, emotional, communicative and social domains. Rehabilitation interventions are a set of activities that begin early after the stroke occurs, once the stroke survivor is medically stable and can identify goals for rehabilitation and recovery.
Rehabilitation Services in CESN
Canadian Stroke Best Practice Recommendations: Stroke Rehabilitation Practice Guidelines
Ontario Stroke Evaluation Report 2016: A Focus on Stroke Rehabilitation
CESN Newsletters – Stroke Rehabilitation Best Practices Highlights

The Interprofessional Team includes physicians, nurses, physiotherapists (PTs), occupational therapists(OTs), speech-language pathologists(S-LPs), social workers, psychologists, recreational therapists, pharmacists, dietitians, and rehabilitation assistants. Core stroke rehabilitation therapies are OT, PT, and S-LP. The regulating colleges for these regulated health professionals in Ontario are:

Support Personnel – The regulated health profession for each of these therapies may supervise associated rehabilitation support personnel (Occupational Therapist Assistant, Physiotherapist Assistant, Communication Disorders Assistant). While supervising their associated support personnel, regulated health professionals may directly assign clinical tasks and related work to assist in the provision of the their therapy. Regulated health professionals must follow guidelines of their regulatory college when working with support personnel including:

  • have sufficient and ongoing direct contact with patients
  • be available on a regular basis to review, discuss and provide additional support
  • ensure informed consent has been received
  • ensure the support personnel has knowledge, skills and judgment to provide the intervention assigned
  • define his/her role as supervisor to the support personnel, patient, family and employer

Rehabilitation may begin as early as two days after the stroke event while still in acute care. For some, rehabilitation may continue in a hospital in-patient rehabilitation setting. Others may participate in rehabilitation in an outpatient setting, the community, or the home. Where the rehabilitation occurs depends on many factors including the severity of stroke, presence of rehabilitation goals, and availability of services.

The purpose of a Rehabilitation Assessment is:

  • to determine if speech-language therapy, occupational therapy, or physiotherapy is indicated
  • to determine if referral to another provider is indicated
  • to establish goals
  • to determine an intervention plan
  • to monitor and respond to client status during interventions
  • to reassess client status and needs as appropriate
  • to evaluate client outcomes and goal attainment

There are several components of Rehabilitation Service Delivery including:

Obtain Informed Consent –  The patient/client must be informed of the outcomes, benefits and risks associated with assessment and management services before these services are provided as specified by the Health Care Consent Act (S.O. 1996 c.2 Sched. A.). This discussion must be documented by the regulated health care professional.

Determination of Need – Identification of a patient/client who may require the services of a regulated health care professional may originate from a variety of persons (family members, caregivers, health care providers, physicians, or the individual themselves).

Screening / Assessment – Regulated health care professionals must take steps to minimize any risks associated with screening / assessment.

  • Screening (a pass or refer only test; refer if failed to appropriate rehabilitation professional for assessment)
  • Assessment of impairments to inform development of a therapeutic plan (including determination of readiness)

Management – Implement planned interventions:

  • compensatory techniques
  • rehabilitation technique
  • education
  • assist client to develop self-management skills
  • initiate the involvement of others (recommend the involvement of appropriate professionals when necessary and with consent)
  • modify intervention plan as indicated based upon ongoing re-assessment

Discharge Planning / Discharge Criteria – Discharge planning serves to direct intervention toward the ultimate goal of appropriate and timely discharge from the current service or transfer to another setting. Steps include:

  • develop a discharge or transition of care plan
  • prepare client for discharge or transition of care
  • make recommendations for discharge based on clinical findings including reasonable efforts to secure appropriate resources for the patient/client, especially if discharge occurs before the achievement of goals
  • ensure effective transfer of information at transition

Discharge from a regulated health professional’s service may occur because of:

  • discharge from the facility or service (e.g. discharged from the hospital or status changed to Alternative Level of Care)
  • achievement of goals or completion of a management plan
  • sustained lack of progress in therapy / patient/client has plateaued
  • consent for assessment or treatment is withdrawn
  • no further intervention is indicated based on assessment findings
  • the client/patient does not require the regulated health professional’s intervention
  • the patient/client is unavailable to the regulated health professional and reasonable efforts have been made

Disclaimer:  This information is not intended to replace practice guidelines provided by your professional college. Please refer to college for specifics for your profession.