rehabilitation progression after stroke...•the patients with ich had greater functional impairment...
TRANSCRIPT
![Page 1: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/1.jpg)
Rehabilitation Progression after Stroke
Hospital Discharge and Beyond
Kyle A Smith MPT ATC CSRS
Owner
ORION Physical Therapy
Ischemic= 85
bull Thrombic
-35
bull Embolic
bull 30
Ischemic
bull Lacunar
bull 20
bull small (02 to 15 mm in diameter) noncortical infarcts caused by occlusion of a single penetrating branch of a large cerebral artery that arise at acute angles from the large arteries of the circle of Willis
Hemorrhagic= 15
bull Itracerebral (hypertensive) hemorrhage
bull 10
bull Subaaracnoid Hemorrhage (ruptured aneurysm)
bull 5
Outcomes
bull The patients with ICH had greater functional impairment than the cerebral infarction patients at admission but made greater gains Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity Initial severity of disability age and duration of therapy best predicted functional outcome after rehabilitation
Arch Phys Med Rehabil 2003 Jul84(7)968-72
Functional recovery following rehabilitation after hemorrhagic and ischemic stroke
Kelly PJ1 Furie KL Shafqat S Rallis N Chang Y Stein J
Bottom line Cerebral Hemorrhages tend to be associated with more edema which take longer to subside but which may in turn be associated with a more dramatic recovery
Neuroplasticity
bull Promote Neural reorganization
bull How do we make these connections
bull Use it or lose it
bull Use it and improve it
bull Specificity and Repetition matter
bull Intensity Time Salience
bull Age matters
Kleim amp Jones 2006
Is there evidence that Repetition based therapies change the brain Liepert et al 2001
bull Certain types of Estim
bull Mental Practice
bull Modified Constraint Induced Therapies
bull Certain Robotics
bull FMRi Studies show increased activity in the lesioned hemisphere with practice
bull Must avoid learned non use
Interventions that promote Neural Reorganization
bull Functional task training
bull Constraint induced movement therapy (Wolfe et al 2006)
bull Robot assisted therapy (Volpe et al 2008)
bull Repetitive task training (Page et al 2007)
bull Arm Ability training (Platz et al 2001)
bull Circuit training for the LE and UE
Objective Measures
bull We are all take part in the justification of length of stay
bull Objective measures provide evidence of patient progress toward goals
bull FIMS
bull Reach
bull Gait-Dynamic Gait Index Timed up and go(TUG)
bull Reach amp BERG( balance measure)
bull Mini Mental Montreal Cognitive Assessment(MOCA)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 2: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/2.jpg)
Ischemic= 85
bull Thrombic
-35
bull Embolic
bull 30
Ischemic
bull Lacunar
bull 20
bull small (02 to 15 mm in diameter) noncortical infarcts caused by occlusion of a single penetrating branch of a large cerebral artery that arise at acute angles from the large arteries of the circle of Willis
Hemorrhagic= 15
bull Itracerebral (hypertensive) hemorrhage
bull 10
bull Subaaracnoid Hemorrhage (ruptured aneurysm)
bull 5
Outcomes
bull The patients with ICH had greater functional impairment than the cerebral infarction patients at admission but made greater gains Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity Initial severity of disability age and duration of therapy best predicted functional outcome after rehabilitation
Arch Phys Med Rehabil 2003 Jul84(7)968-72
Functional recovery following rehabilitation after hemorrhagic and ischemic stroke
Kelly PJ1 Furie KL Shafqat S Rallis N Chang Y Stein J
Bottom line Cerebral Hemorrhages tend to be associated with more edema which take longer to subside but which may in turn be associated with a more dramatic recovery
Neuroplasticity
bull Promote Neural reorganization
bull How do we make these connections
bull Use it or lose it
bull Use it and improve it
bull Specificity and Repetition matter
bull Intensity Time Salience
bull Age matters
Kleim amp Jones 2006
Is there evidence that Repetition based therapies change the brain Liepert et al 2001
bull Certain types of Estim
bull Mental Practice
bull Modified Constraint Induced Therapies
bull Certain Robotics
bull FMRi Studies show increased activity in the lesioned hemisphere with practice
bull Must avoid learned non use
Interventions that promote Neural Reorganization
bull Functional task training
bull Constraint induced movement therapy (Wolfe et al 2006)
bull Robot assisted therapy (Volpe et al 2008)
bull Repetitive task training (Page et al 2007)
bull Arm Ability training (Platz et al 2001)
bull Circuit training for the LE and UE
Objective Measures
bull We are all take part in the justification of length of stay
bull Objective measures provide evidence of patient progress toward goals
bull FIMS
bull Reach
bull Gait-Dynamic Gait Index Timed up and go(TUG)
bull Reach amp BERG( balance measure)
bull Mini Mental Montreal Cognitive Assessment(MOCA)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 3: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/3.jpg)
Ischemic
bull Lacunar
bull 20
bull small (02 to 15 mm in diameter) noncortical infarcts caused by occlusion of a single penetrating branch of a large cerebral artery that arise at acute angles from the large arteries of the circle of Willis
Hemorrhagic= 15
bull Itracerebral (hypertensive) hemorrhage
bull 10
bull Subaaracnoid Hemorrhage (ruptured aneurysm)
bull 5
Outcomes
bull The patients with ICH had greater functional impairment than the cerebral infarction patients at admission but made greater gains Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity Initial severity of disability age and duration of therapy best predicted functional outcome after rehabilitation
Arch Phys Med Rehabil 2003 Jul84(7)968-72
Functional recovery following rehabilitation after hemorrhagic and ischemic stroke
Kelly PJ1 Furie KL Shafqat S Rallis N Chang Y Stein J
Bottom line Cerebral Hemorrhages tend to be associated with more edema which take longer to subside but which may in turn be associated with a more dramatic recovery
Neuroplasticity
bull Promote Neural reorganization
bull How do we make these connections
bull Use it or lose it
bull Use it and improve it
bull Specificity and Repetition matter
bull Intensity Time Salience
bull Age matters
Kleim amp Jones 2006
Is there evidence that Repetition based therapies change the brain Liepert et al 2001
bull Certain types of Estim
bull Mental Practice
bull Modified Constraint Induced Therapies
bull Certain Robotics
bull FMRi Studies show increased activity in the lesioned hemisphere with practice
bull Must avoid learned non use
Interventions that promote Neural Reorganization
bull Functional task training
bull Constraint induced movement therapy (Wolfe et al 2006)
bull Robot assisted therapy (Volpe et al 2008)
bull Repetitive task training (Page et al 2007)
bull Arm Ability training (Platz et al 2001)
bull Circuit training for the LE and UE
Objective Measures
bull We are all take part in the justification of length of stay
bull Objective measures provide evidence of patient progress toward goals
bull FIMS
bull Reach
bull Gait-Dynamic Gait Index Timed up and go(TUG)
bull Reach amp BERG( balance measure)
bull Mini Mental Montreal Cognitive Assessment(MOCA)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 4: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/4.jpg)
Hemorrhagic= 15
bull Itracerebral (hypertensive) hemorrhage
bull 10
bull Subaaracnoid Hemorrhage (ruptured aneurysm)
bull 5
Outcomes
bull The patients with ICH had greater functional impairment than the cerebral infarction patients at admission but made greater gains Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity Initial severity of disability age and duration of therapy best predicted functional outcome after rehabilitation
Arch Phys Med Rehabil 2003 Jul84(7)968-72
Functional recovery following rehabilitation after hemorrhagic and ischemic stroke
Kelly PJ1 Furie KL Shafqat S Rallis N Chang Y Stein J
Bottom line Cerebral Hemorrhages tend to be associated with more edema which take longer to subside but which may in turn be associated with a more dramatic recovery
Neuroplasticity
bull Promote Neural reorganization
bull How do we make these connections
bull Use it or lose it
bull Use it and improve it
bull Specificity and Repetition matter
bull Intensity Time Salience
bull Age matters
Kleim amp Jones 2006
Is there evidence that Repetition based therapies change the brain Liepert et al 2001
bull Certain types of Estim
bull Mental Practice
bull Modified Constraint Induced Therapies
bull Certain Robotics
bull FMRi Studies show increased activity in the lesioned hemisphere with practice
bull Must avoid learned non use
Interventions that promote Neural Reorganization
bull Functional task training
bull Constraint induced movement therapy (Wolfe et al 2006)
bull Robot assisted therapy (Volpe et al 2008)
bull Repetitive task training (Page et al 2007)
bull Arm Ability training (Platz et al 2001)
bull Circuit training for the LE and UE
Objective Measures
bull We are all take part in the justification of length of stay
bull Objective measures provide evidence of patient progress toward goals
bull FIMS
bull Reach
bull Gait-Dynamic Gait Index Timed up and go(TUG)
bull Reach amp BERG( balance measure)
bull Mini Mental Montreal Cognitive Assessment(MOCA)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 5: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/5.jpg)
Outcomes
bull The patients with ICH had greater functional impairment than the cerebral infarction patients at admission but made greater gains Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity Initial severity of disability age and duration of therapy best predicted functional outcome after rehabilitation
Arch Phys Med Rehabil 2003 Jul84(7)968-72
Functional recovery following rehabilitation after hemorrhagic and ischemic stroke
Kelly PJ1 Furie KL Shafqat S Rallis N Chang Y Stein J
Bottom line Cerebral Hemorrhages tend to be associated with more edema which take longer to subside but which may in turn be associated with a more dramatic recovery
Neuroplasticity
bull Promote Neural reorganization
bull How do we make these connections
bull Use it or lose it
bull Use it and improve it
bull Specificity and Repetition matter
bull Intensity Time Salience
bull Age matters
Kleim amp Jones 2006
Is there evidence that Repetition based therapies change the brain Liepert et al 2001
bull Certain types of Estim
bull Mental Practice
bull Modified Constraint Induced Therapies
bull Certain Robotics
bull FMRi Studies show increased activity in the lesioned hemisphere with practice
bull Must avoid learned non use
Interventions that promote Neural Reorganization
bull Functional task training
bull Constraint induced movement therapy (Wolfe et al 2006)
bull Robot assisted therapy (Volpe et al 2008)
bull Repetitive task training (Page et al 2007)
bull Arm Ability training (Platz et al 2001)
bull Circuit training for the LE and UE
Objective Measures
bull We are all take part in the justification of length of stay
bull Objective measures provide evidence of patient progress toward goals
bull FIMS
bull Reach
bull Gait-Dynamic Gait Index Timed up and go(TUG)
bull Reach amp BERG( balance measure)
bull Mini Mental Montreal Cognitive Assessment(MOCA)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 6: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/6.jpg)
Neuroplasticity
bull Promote Neural reorganization
bull How do we make these connections
bull Use it or lose it
bull Use it and improve it
bull Specificity and Repetition matter
bull Intensity Time Salience
bull Age matters
Kleim amp Jones 2006
Is there evidence that Repetition based therapies change the brain Liepert et al 2001
bull Certain types of Estim
bull Mental Practice
bull Modified Constraint Induced Therapies
bull Certain Robotics
bull FMRi Studies show increased activity in the lesioned hemisphere with practice
bull Must avoid learned non use
Interventions that promote Neural Reorganization
bull Functional task training
bull Constraint induced movement therapy (Wolfe et al 2006)
bull Robot assisted therapy (Volpe et al 2008)
bull Repetitive task training (Page et al 2007)
bull Arm Ability training (Platz et al 2001)
bull Circuit training for the LE and UE
Objective Measures
bull We are all take part in the justification of length of stay
bull Objective measures provide evidence of patient progress toward goals
bull FIMS
bull Reach
bull Gait-Dynamic Gait Index Timed up and go(TUG)
bull Reach amp BERG( balance measure)
bull Mini Mental Montreal Cognitive Assessment(MOCA)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 7: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/7.jpg)
Is there evidence that Repetition based therapies change the brain Liepert et al 2001
bull Certain types of Estim
bull Mental Practice
bull Modified Constraint Induced Therapies
bull Certain Robotics
bull FMRi Studies show increased activity in the lesioned hemisphere with practice
bull Must avoid learned non use
Interventions that promote Neural Reorganization
bull Functional task training
bull Constraint induced movement therapy (Wolfe et al 2006)
bull Robot assisted therapy (Volpe et al 2008)
bull Repetitive task training (Page et al 2007)
bull Arm Ability training (Platz et al 2001)
bull Circuit training for the LE and UE
Objective Measures
bull We are all take part in the justification of length of stay
bull Objective measures provide evidence of patient progress toward goals
bull FIMS
bull Reach
bull Gait-Dynamic Gait Index Timed up and go(TUG)
bull Reach amp BERG( balance measure)
bull Mini Mental Montreal Cognitive Assessment(MOCA)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 8: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/8.jpg)
Interventions that promote Neural Reorganization
bull Functional task training
bull Constraint induced movement therapy (Wolfe et al 2006)
bull Robot assisted therapy (Volpe et al 2008)
bull Repetitive task training (Page et al 2007)
bull Arm Ability training (Platz et al 2001)
bull Circuit training for the LE and UE
Objective Measures
bull We are all take part in the justification of length of stay
bull Objective measures provide evidence of patient progress toward goals
bull FIMS
bull Reach
bull Gait-Dynamic Gait Index Timed up and go(TUG)
bull Reach amp BERG( balance measure)
bull Mini Mental Montreal Cognitive Assessment(MOCA)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 9: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/9.jpg)
Objective Measures
bull We are all take part in the justification of length of stay
bull Objective measures provide evidence of patient progress toward goals
bull FIMS
bull Reach
bull Gait-Dynamic Gait Index Timed up and go(TUG)
bull Reach amp BERG( balance measure)
bull Mini Mental Montreal Cognitive Assessment(MOCA)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 10: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/10.jpg)
ER Stroke Center
Acute Care
Inpatient Rehab
Out Patient RehabHome Health
Community Programs
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 11: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/11.jpg)
ER Stroke Center
ICU Acute Care
Skilled Nursing
Inpatient Rehab
Outpatient Rehab
Home Health
Community Programs
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 12: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/12.jpg)
The Team approach
bull Every patient interaction is an opportunity
bull Rehab begins at day 1
bull Studies have shown a correlation between how early stroke rehabilitation is administered and improved functional outcome
bull Very intense therapy immediately post stroke may worsen outcomes as shown in animal studies
bull Much of early recovery is caused by resolution of edema around the infarct (Lo 1986)
bull Consistency is vital across disciplines
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 13: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/13.jpg)
Phases of Physical Therapy
bull Acute care
Neuro ICU-
bull Typically very limited PT
bull Focus on medically stabilizing the patient
Acute bull PT begins with basic functional mobility training
bull Bed mobility transfers balance training gait training
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 14: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/14.jpg)
Acute Physical Therapy
bull Focused on Basic functional mobility
Bed mobility- Rolling Scooting Bridging
Transfers- supine to sit sit to supine bed to wheelchair commode transfers Sit to stand
Balance training- Static sitting at the edge of the bed in midline
Increase sitting tolerance in WC Geri chair bed
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 15: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/15.jpg)
Hooklying
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 16: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/16.jpg)
Side lying to Sit
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 17: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/17.jpg)
Squat Pivot
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 18: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/18.jpg)
Acute Physical Therapy
Static standing Pt may require an assistive device
Progress to midline stance
Gait training- May require an assistive device-walker quad cane single point cane AFO
Progress- quality not quantity
Midline orientation
Acute PT BID until DC
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 19: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/19.jpg)
Rehab Goals
bull Maximize Function
bull Maximize Independence
bull Restore Quality of Life
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 20: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/20.jpg)
Phases of Physical Therapy
bull Rehab unit
bull Must be able to tolerate minimum of 3 hours per day of therapy Combined PT OT SLP Rec
bull Length of stay based on progress (theoretically)
bull Typically 1-3 weeks
bull Goal is to enable the patient to return home safely
bull If unable to reach basic goals Skilled nursing facility(SNF) or long term care may be appropriate
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 21: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/21.jpg)
In Patient Rehab
bull Admit to Rehab- 3 hour rule
bull Progress Functional mobility to enable Pt to return to home environment (ideal)
bull Home assessment prior to DC With Pt
bull DC when goals are metPt safe for household mobility
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 22: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/22.jpg)
Phases of Physical Therapy
bull Rehab DC planning
bull Care conference with family discussing options including ability of family members to care for patient at home safely
bull In home caregivers may be needed to assist the family if the patients functional level is too low
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 23: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/23.jpg)
Bath Bench amp 3 in 1 commode seat
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 24: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/24.jpg)
Ramp
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 25: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/25.jpg)
Home Health
bull Goal is for patient to achieve safe functional mobility in the home and to ambulate into and out of home
bull PT will address specific mobility obstacles in patients individual environment
bull Provide assistive device and equipment recommendations to achieve safe mobility inout and throughout home
bull Start to Address Community ambulation
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 26: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/26.jpg)
Home Health
bull Training family and caregivers to safely assist in patient transfers gait bathing toileting and home exercise program execution
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 27: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/27.jpg)
Out Patient Rehab
bull Patient is able to safely get in and out of their home as well as complete car transfers
bull The patient has the strength and endurance to complete the journey to the outpatient clinic all therapy sessions and safely return home
bull Physical Therapy continues to progress functional mobility and endurance to maximize patient independence
bull Community ambulator
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 28: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/28.jpg)
Out Patient Rehab
bull Frequency can range from 1-3xwk
bull Duration often determined by insurance
bull Outpatient visits may include multiple disciplines
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 29: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/29.jpg)
Community Programs
bull Patient can work on long term goals and maintenance
bull Programs often in group settings
bull Group leaders PT PTA Adaptive PE specialist Aids
bull Caregivers often welcome
Frequency 1-3xwk
Often Private pay
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 30: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/30.jpg)
Community Programs
bull Adaptive PE
bull West Valley College
bull Foothill College
bull De Anza College
bull Mission College
bull College of San Mateo
bull Evergreen College
Group Programs
REACH Skills plus YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 31: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/31.jpg)
Community Programs
Group Programs
REACH (wwwfoothilledualreachphp) Skills plus (wwwskillsplusus) YMCA
Recreation Programs
BORP-Bay Area Outreach and Recreation Program-adaptive cycling Fitness Center (BORPorg)
bull Disabled Sports USA Far West (wwwdsusafworg)
bull Stroke awareness foundation
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 32: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/32.jpg)
National Programs
bull Disabled Sports USA
bull National Sports Center for the Disabled
bull YMCA
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 33: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/33.jpg)
Long Term
bull It is well documented this patient population can continue to make progress years after onset
bull Neuroplasticity principles are present at any age any time after initial onset
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 34: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/34.jpg)
Lon
Long Term
As with all of us it is just as important for this population to practice good healthy
living habits and enjoy life
Video
Thank You
![Page 35: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/35.jpg)
Video
Thank You
![Page 36: Rehabilitation Progression after Stroke...•The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients](https://reader033.vdocument.in/reader033/viewer/2022060810/608e5db9e9716d794a77e625/html5/thumbnails/36.jpg)
Thank You