The importance of rehab after a stroke – a client story

Our client had his blood pressure checked at a GP appointment where it was found to be high, so – on the advice of his GP – he therefore undertook a series of home blood pressure readings on the advice of his GP.

Subsequent blood pressure readings showed his blood pressure to be high and in early May 2018 he presented a week’s worth of home blood pressure readings to his local surgery. Unfortunately, it appears that the surgery scanned the document into their clinical system but then did not forward it on to a clinician. As a result, our client received no contact from the surgery about what these readings showed.

It was in October 2018 that our client then suffered a severe intracerebral haemorrhage, his wife finding him collapsed on the floor. His wife had him rushed to hospital in a critical condition, where they admitted him to the acute stroke unit for a week. Once discharged, where the hospital staff noted he had high blood pressure on admission, he was taken to a community hospital for rehabilitation.

Our client’s experience of rehabilitation

Our client was the youngest of all of the patients in the community rehab by far, the others being very frail and elderly and him only in his early fifties. He only had two physiotherapy sessions per week, one of which was a group physiotherapy session with the elderly patients, who had very different needs.

Due to this disparity between himself and the other patients, and how unsuitable the rehab was as a result, our client got more and more frustrated and down as the days went on.

Our client, prior to his stroke, had been very fit. However, now, as he was not moving much at all, his muscles were beginning to waste away. His days would usually consist of being moved from the bed into a wheelchair and then back again, but when he was stronger he could just about manage to wheel himself to his sink and pull himself up onto it for a change of scenery and some exercise.

As the weeks went by, our client and his family realised that he was not going to get any better being in the hospital so began to consider other options, including whether he would be better off at home. However, speaking to a consultant to find out how much longer our client was likely to be in hospital, his wife found that the medical team did not know.

We asked our client his thoughts on the rehab he received in the community hospital:

“The rehab I got in hospital was at best sporadic and because I had spent approximately half the week sitting or lying, the half hour or 49 minutes were mostly taken trying to get my limbs at least ready to do something. I can't blame the nurses and doctors, physios, OTs or anyone; they were doing the best they could.

I don’t know if my prognosis would have changed had I had intense rehab at this stage, but it certainly didn’t help me by not having any (I barely had any in hospital).”

Fortunately, our client’s wife consulted an occupational therapist (OT). The OT was supportive, explained that early discharge was an option, and detailed what they needed to do from a practical point of view, including the equipment they would need at home. This adaptation required a reconfiguration of the downstairs rooms to accommodate a hospital bed as well as other supportive equipment.

Once this had been done, our client was able to return home where physiotherapists, speech and language therapists and OTs visited him for six weeks. This helped him to progress much quicker and allowed him to be a part of his family again.

Thanks to our client’s determination and the support of dedicated specialists, within a week he was walking upstairs with a stick and a handrail, allowing him to sleep upstairs and making space for his children’s playroom again.

Our client looks back on this time:

“We weren’t aware that we could really early discharge and off the back of this would be such an intense rehab programme for the allowed six weeks. So my proper rehab started when I got out of hospital. Because I had left early, I was entitled to early discharge care. This meant I had six weeks of intensive physiotherapy, Occupational therapy, speech and language. In an average week I would have about eight sessions lasting about an hour each.

I suppose I was not prepared for such a rigorous time training but it was just what I needed.

It encouraged me to try different things and as such I managed to get rid of most of my health equipment like bed and cricket [a supportive aid to help with getting out of bed].

Then after six weeks it stopped. I was lost for a while going down to one or possibly a physiotherapist and an occupational therapist in a week. I started to push myself with walking and going upstairs - things like that which helped

I would have liked an opportunity to keep the physiotherapy as I found it highly beneficial but I wasn't offered any additional services at a charge or anyone like that. I think that was an opportunity missed.”

The impact of the stroke

As a result of his stroke, our client is paralysed down one side of his body, has very slurred speech and needs lots of assistance with daily life. Initially he could not drive either, but is now able to (in a specially adapted car). However, he is still unable to work and is dependent on his wife.

The changes to our client’s life have been huge. Prior to the stroke he had always been fit, healthy and very active – even going to the gym three to four times a week – and enjoyed walking and taking his children swimming. This active lifestyle is now no longer possible.

However, testament to his resilience, our client looks back on the impact of his stroke and rehabilitation with a sense of pragmatism:

“I am now coming up to two years post stroke and I look back and think about those early days. It was highly advantageous to me leaving hospital early. It was brilliant to have the freedom to try moving around safely. It was excellent to have such first class service in the team delivering my care.

In hindsight I made the right choice to leave hospital early. If I were to make any changes to those early days at home, it would be to buy in some additional physiotherapy or occupational therapy like I was having. But just to have that one change is not bad. All in all I am happy with my progress.”

Finding the right support for you

Our client’s story demonstrates the value of finding the right support following a stroke, not only for an improved prognosis but also to help patients feel they are making progress and not that their care is stalled.

One organisation that does a lot to help people in the initial stags after stroke, and one that our client and his family was in contact with, is the Stroke Association. This charity offers a helpline and a whole host of information on finding the right support after stroke, and we would certainly recommend that anyone who has struggled – or is currently struggling – with early rehab like our client gets in touch with them.