Clinical practice. Rehabilitation after stroke

Abstract

A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech was limited to effortful answers of yes or no. He could not walk or use his right arm, and self-care tasks required maximal assistance. What advice would you offer him and his family regarding rehabilitation for his disabilities?

Figure 1. Algorithm for Placement for Rehabilitation Care after Stroke

Minimal assistance denotes physical help from another person that consists of no more than touching while the patient expends 75 percent of the effort (e.g., to walk, reach for an object, manage self-care); moderate assistance denotes physical help needed while the patient expends 50 to 75 percent of the effort; and maximal assistance denotes physical help needed while the patient expends less than 50 percent of the effort.