What is rehabilitation?
The main goal of rehabilitation is for stroke survivors to attain the most optimal quality of life and live well after stroke. Rehabilitation is not a “cure” for the effects of stroke but helps individuals to achieve the best possible outcomes by re-learning pre-stroke skills or learning ways to compensate for the effects of the stroke.
Rehabilitation is needed for the physical, sensory, communication, cognitive, behavioural, and social issues that limit community participation for those with aphasia.
The first stage of rehabilitation starts in the acute or sub-acute care ward in hospital. Patients’ rehabilitation needs are assessed within 24-48 hours of admission to hospital and members from the multidisciplinary treating team will determine what services are appropriate.
Rehabilitation is patient-centred and goal focused. Each team member focuses on different therapy goals but all work together to meet patients’ needs. Initial therapy goals are often centred around patient safety and reacquiring the ability to carry out basic activities of daily living. For example, Speech Pathologists will undertake assessment of communication skills and swallowing. The outcomes of these assessments will determine what the rehabilitative needs are for the patient.
Best practice for aphasia rehabilitation
Best practice recommendations require all patients with aphasia and family/carers to be provided with information for options for treatment. Patients with aphasia should be offered intensive and individualised therapy to have meaningful impact on communication and quality of life.
Therapy goals should be developed in collaboration with the patient and family/carer and reassessed at regular intervals throughout therapy. Initial therapy goals will likely focus on the ability to communicate everyday needs and wants, with longer-term goals focusing on meaningful life participation.
While aphasia care is indicated early in acute stroke, it is lacking, with much of the therapy focus in the first stage of rehabilitation dominated by swallowing safety and management. Work undertaken by us is aiming to establish a pathway for acute stroke aphasia care. We aim to develop a multidisciplinary acute aphasia management pathway that are aligned to best practice statements.
Rehabilitation can transition from the acute hospital setting to rehabilitation units and beyond. The role of a Speech Pathologist is to continue to provide patient-centred, goal-oriented therapy that aims to improve functional communication and achieve optimal quality of life.
Transfer into a rehabilitation unit
Speech Pathologists continue to provide therapy services in a rehabilitation unit as part of a multidisciplinary team. They continue to provide intensive and individualised aphasia therapy. Current aphasia intervention in early recovery typically involves one-on-one and group therapy sessions. As aphasia affects the speed, ease, and effectiveness of communication, aphasia therapy will usually involve teaching alternative forms of communication using alternative and augmentative communication aids. Families and/or caregivers should be included in the rehabilitation process and include education and support regarding the causes and consequences of aphasia, as well as learning how to communicate with the person with aphasia through communication partner training.
Home-based or centre-based rehabilitation
After patients with aphasia are discharged, they may still have needs that require ongoing input from a Speech Pathologist. Community-based Speech Pathologists continue to work with people with aphasia on an intermittent basis, assessing progress and adjusting the treatment plan accordingly. This rehabilitation may occur in blocks of intensive therapy or intermittent weekly or fortnightly sessions. Aphasia therapy should continue to focus on improving quality of life and to improve functional communication.
Rehabilitation is an ongoing process to maintain and refine skills to live well after stroke. However, after the sub-acute phase of treatment (up to 3 months post stroke)services decline and are non-existent in some areas of Australia. The chances of further recovery continue beyond this sub-acute period, so new models of treatment are needed to maximise this. Our CRE is exploring innovative models of care at the sub-acute and community phases of care.