Just as the range of disability following stroke varies widely, so will rehabilitation needs. Rehabilitation begins in the hospital with an assessment of your needs and some basic therapy. The assessment is a survey of your impairments. Are you able to swallow? How is your speech? How is your understanding of language? Have you lost strength in an arm or leg? Has the stroke affected your memory? This assessment will determine what kind of rehabilitation is best for you and where you should go for it.
The type of health care professional who does the assessment varies from hospital to hospital. It may be a physician specializing in rehabilitation, a neurologist, a physical therapist, or a social worker who does case management. People with mild deficits can leave the hospital and get some short-term physical or occupational therapy at home or at an outpatient clinic if they need it. People who have trouble walking or sitting by themselves typically need more intensive therapy at a rehabilitation hospital or a skilled nursing facility. Speech and language therapy can be given either at a rehabilitation facility or at home, depending on the type and degree of impairment and the other deficits the patient has.
The recommendation you get rests to a large degree on the personal judgment of the health professional in charge at the hospital. Therefore, it's to your advantage to have a family member or friend learn about all of the types of rehabilitation therapy and the particular stroke deficits that each one can address to help ensure that you receive the right care. It's also worthwhile to research local facilities to find out what stroke rehabilitation services they offer. With a full range of knowledge, you (or whoever is advocating for you) will be in a strong position to evaluate the hospital's recommendation and decide whether it seems right. If it doesn't, you or your advocate should say why and see whether the hospital can revise its assessment.
More Answers from Natalia Rost, MD