Development and Implementation of a New Model of Care for Patients With Stroke, Acute Hospital Rehabilitation Intensive SErvices

Abstract

The optimal timing and intensity of early rehabilitation remain uncertain. The literature has stated that too early high-intensity mobility within 24 hours can result in poor outcomes as compared with the 24-to 48-hour poststroke (Stroke 2012;43:238943: -94. Stroke 200435:1005-9). However, few studies have shown that mobilizing patients a few times per day can have positive results (Stroke 2004;35:1005-9. Cerebrovasc Dis 201029:352-60). In addition to mobility impairments, many patients after stroke have dysphagia, aphasia, and cognitive-linguistic deficits. To date, there is limited literature on early rehabilitation in these areas. Here, we describe a program of enhanced rehabilitation in the acute care hospital. In this enhanced model of care, our team delivers up to six sessions of therapy per day focused on the patient's deficits. A patient can receive up to two sessions of each discipline daily to include physical therapy, occupational therapy, and speech language pathology. The model emphasizes team collaboration between therapy disciplines, physiatry, nursing, and neurology accomplished through a daily therapy schedule, rehabilitation huddle, and direct communication before and after therapy sessions. With this model, we aim to enhance coordination of care resulting in improved patient satisfaction and, ultimately, recovery.

Feasibility of an Enhanced Therapy Model of Care for Hospitalized Stroke Patients

“…12 In addition, a midday team huddle, attended by therapists of all three disciplines and a physiatrist, is incorporated into the weekday schedule to promote cross-disciplinary discussion and to ensure that patient progress and barriers to therapy are addressed in real time. (Please refer to Langton-Frost et al 16 in this supplement. )…”

A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals

“…The main objectives of rehabilitation treatment and physical therapy interventions following a stroke are to enhance the patient's functional capabilities, foster self-reliance, and enhance their overall quality of life [19,20]. There are numerous types of interventions available that are customized to address the specific requirements of each patient [21][22][23].…”