What is rehabilitation?
The main goal of rehabilitation is for stroke survivors to attain the most optimal quality of life and live well after stroke. Rehabilitation is not a “cure” for the effects of stroke but helps individuals to achieve the best possible outcomes by re-learning pre-stroke skills or learning ways to compensate for the effects of the stroke.
Rehabilitation is needed for the physical, sensory, communication, cognitive, behavioural, and social issues that limit community participation for those with aphasia.
The first stage of rehabilitation starts in the acute or sub-acute care ward in hospital. Patients’ rehabilitation needs are assessed within 24-48 hours of admission to hospital and members from the multidisciplinary treating team will determine what services are appropriate.
Rehabilitation is patient-centred and goal focused. Each team member focuses on different therapy goals but all work together to meet patients’ needs. Initial therapy goals are often centred around patient safety and reacquiring the ability to carry out basic activities of daily living. For example, Speech Pathologists will undertake assessment of communication skills and swallowing. The outcomes of these assessments will determine what the rehabilitative needs are for the patient.
Best practice for aphasia rehabilitation
Best practice recommendations require all patients with aphasia and family/carers to be provided with information for options for treatment. Patients with aphasia should be offered intensive and individualised therapy to have meaningful impact on communication and quality of life.
Therapy goals should be developed in collaboration with the patient and family/carer and reassessed at regular intervals throughout therapy. Initial therapy goals will likely focus on the ability to communicate everyday needs and wants, with longer-term goals focusing on meaningful life participation.
While aphasia care is indicated early in acute stroke, it is lacking, with much of the therapy focus in the first stage of rehabilitation dominated by swallowing safety and management. Work undertaken by us is aiming to establish a pathway for acute stroke aphasia care. We aim to develop a multidisciplinary acute aphasia management pathway that are aligned to best practice statements.
Rehabilitation can transition from the acute hospital setting to rehabilitation units and beyond. The role of a Speech Pathologist is to continue to provide patient-centred, goal-oriented therapy that aims to improve functional communication and achieve optimal quality of life.