01 What are the features of a rehabilitation plan that will best help recovery?
I will contribute two features that had a strong impact on Rita’s stroke recovery. The first is that the patient* should be seen once weekly by professional therapists covering all appropriate therapies. The two obvious ones are a physiotherapist and an occupational therapist. A third likely one would be a speech therapist. These sessions should continue for 12 weeks minimum.
The second feature is that paid carers should spend a minimum of 3 hours each day for 5 days per week with the patient; although it would be better to increase this to 4 hours per day and 7 days per week if at all possible. The reason being that carers should contribute substantially to the quantity of therapy provided. This also continues for 12 weeks. During these 12 weeks there should, ideally, be no more than 3 different carers involved with the patient.
It is essential that the therapists and carers work together. Sessions should be timed such that at least one carer can watch every session of a therapist. At the end of each session the therapist gives the carer a list of appropriate exercises that the carers can then give to the patient every day until the next therapy session.
Typically, each day the carers should also take the patient for a short walk (if appropriate); keep the patient entertained by playing selected fun games and activities with them; and help the patient with Activities of Daily Living at an appropriate level for that patient. The aim is to keep the patient active, mentally or physically, for 2 to 3 hours every day of the week.
At the end of her first 12 weeks it was clear that Rita had made significant progress both physically and mentally towards recovery; she had become keen to continue. Setting up further 12-week sessions was easily justified. Conversely, had the UK health professionals been right in their assessment that Rita had no capacity to recover, it is likely that fact would have become clear too, with no progress having been made and Rita keen to avoid the hard work of rehabilitation and return to a life of leisurely dependence. Sensible decisions could thus be made at the end of 12-week periods without large sums of money having been spent.
*Throughout this website and the book Pushing the Boundaries the word “patient” is used as a brief way of saying “a severely disabled stroke survivor”.