Post-Stroke Rehab for Balance § Coordination

[Stan's Girl]

My dad had a stroke on 7/6/04.  We were told it was likely in the brain stem & cerebellum & that it was likely not his first.  CAT scans were done BUT he has a defibrillator & pacemaker so MRI not feasible.  He was stabilized (also some CHF issues) arose & went to reahab (still acute care) for 3 weeks before returning home in wheel chair.  Balance & coordination were still not great.  He had another episode August 28 (stroke... seizure???) & was put back in hospital at which point it was discovered he was anemic - hemoglobin was 8 & he was transfused - GI testing done.  We noted some backsliding in rehab gains particularly in balance & coordination PLUS worsened spacticity in right (dominant) arm. He was sent back to same rehab & after 2 weeks they are releasing him.  We are not able to care for him at home until he regains the ground he lost - particularly his ability to help with transfers RE: balance issue.  He will be going into a skilled nursing unit in a nursing home for a few weeks,  What can be done PT or whatever to improve balance/coordination & spasticity in right arm?  Our goal is to get him home again knowing we will need some outside help with bathing, etc.
HELP!!!

[Vadim PT]

First of all sorry about misfortune your father had to go through.
In my experience a few things can and should be done about it. While your father in the SNF you and him must show a lot of will to go home vs. nursing home. Than you must be really involved in his care and make sure he gets appropriate PT/OT attention.
While he is not in the therapy he must be positioned appropriately in the bed or chair (it makes a huge difference). The proper positioning of stroke victims in the bed or chair you can look in the book “Steps to follow” by P. M. Davies. This book is written for professionals, but it is very straight forward. In mean while he must use an assistive devise for ambulation to insure safety and stability.
When he gets home, you may look for home health care agencies (HHCA), which may assist you with further rehab, if he qualifies.
After completion of HHR, you can find out if anyone in your area provides vestibular rehab, which may be beneficial for your father as well.
I hope this information is helpful.

[Stan's Girl]

Thanks for your feedback.  What is vestibular therapy?

[Vadim PT]

Vestibular therapy (vestibular rehab) is very specialized therapy that is provided by the therapist with special training. You can find detailed information is in the following article.


http://www.tchain.com/otoneurology/treatment/rehab.html


If you'll be looking for a therapist to do this, do not hesitate before you make an appointment to ask him if he is familiar with this type of rehab.

Let me know where your dad is currently residing - I may be able to help you to find a therapist.

[Stan's Girl]

Thanks.  I did also look up some info on the web about vestibular therapy - interesting.  My dad is in Reading, PA.

[Stan's Girl]

Thanks for you response.  In reference to therapy for balance/ccordination - we were told these are very difficult to rehab.  Can we expect improvement in these over time given proper therapy?  

Also, we have been given discrepant information regarding the critical nature of the first 3 months post-stroke in success of rehab - some say they mean that the natural healing that will occur is greatest in this period devoid of the rehab efforts - others say it means both the natural healing PLUS that this is the period when rehab has it's greatest impact?

Finally, when would any of the treatments you mention for the spasms be contraindicated?  My dad has 4 major issues 1.) weak heart..he has a defibrillator & issues with CHF (should he become stable enough cardiologist is talking about replacing current defibrillator with latest one which will improve current hear function by 30%)  2) he is on depakote for seizure control (although no definitive evidence exists that he has had any)  3) they are discussing putting him on coumadin (I'm not sure why this hasn't already been done & I do understand the risks vs. benefits  4) he was anemic - hemoglobin back up to 11.6 after being transfused (it was at 8)GI doctor saw nothing in his testing that he felt would have caused this - now needs to see Hemotologist.

Any feedback greatly appreciated.