On admission to the William Randolph Hearst Foundation Stroke Rehabilitation Unit at the Rusk Institute, patients and family members are welcomed with an introduction to the program and the staff. Clinical assessments begin at the time of admission with nursing and physiatrists who specialize in stroke rehabilitation.
The other clinical departments usually complete their clinical assessments within 24 hours. This quick timeline enables the rehabilitation team to gather pertinent clinical information and create a comprehensive and interdisciplinary plan of care that is individualized to each patient’s unique rehabilitation needs.
Each stroke patient receives a daily schedule of therapies. Patients at the Rusk Institute receive therapy throughout the day. The types of therapy and amount of therapy vary according to each patient’s needs.
Patient/family education begins immediately with either 1:1 education provided by the rehabilitation staff or participation in stroke patient and family education groups. These educational sessions address a variety of topics including: signs and symptoms of a stroke; stroke risks factors; risk factor modifications related to diet, behaviors and physical activity; community and leisure resources; and psycho-social issues related to living with a stroke. Every patient that is admitted into the Rusk Inpatient Stroke Program receives a Rusk Stroke Education Resource Guide that includes information from the American Stroke Association and other sources.
As previously mentioned, the Rusk Clinical Team is composed of clinicians with advanced skills and knowledge that results in some unique stroke treatment programs. The following list highlights some of the specialty programs that benefit people who have had a stroke:
Vision Rehabilitation
Barrier Free Design Program
Computer Assistive Technology
Neuropsychological Program
Vestibular Therapy
Seating Clinic (manual and powered seating)
Body Weight Support Treadmill Training
Inpatient Occupational Therapy: An occupational therapist will be working with a patient who has had a stroke for a minimum of one hour per day. Occupational therapists are trained to help people regain their functional independence following a stroke. They will address difficulties caused by the stroke that impact the patient’s ability to perform activities of daily living such as dressing, bathing, and managing a household or a job.
The occupational therapist will assess and treat impairments including physical skills (i.e. strength, coordination, and balance); cognitive skills (i.e. memory, problem solving, sequencing and focusing on an activity) visual skills (i.e. scanning and depth perception); psychological skills (i.e. coping and managing frustration); and sensory skills (i.e. identifying different textures, temperatures and having a sense of space).
The patient and the occupational therapist will identify and prioritize the main areas that need to improve to increase functional independence. The occupational therapist can provide modification to make a person’s activities of daily living easier or possible through the use of adaptive equipment and home modifications, if indicated. Information is presented to patients and their families regarding stroke education and prevention. Family/caregiver training is provided when it is appropriate. The entire rehabilitation team works together towards the patient’s goals.
The occupational therapy department at Rusk offers regular staff education and specialized courses to keep the therapists current with stroke rehabilitation treatment approaches. There are clinical specialists in the areas of neuro-rehabilitation, vision rehabilitation, wheelchair seating and positioning, and barrier free design that address treatment, program development, and staff education. Research is currently being done in the occupational therapy department to assess the value of current treatment techniques.
Inpatient Physical Therapy: Once patients are admitted into the Rusk Institute Stroke Rehabilitation Program, they are evaluated by a physical therapist. Physical therapists on the Rusk Stroke Team are trained to work specifically with patients who had a stroke. Based upon that evaluation, a physical therapy treatment program is designed to meet each patient’s individual needs and goals.
Physical therapists work on restoring a person’s ability to move his/her body after having a stroke (i.e. sit up in bed, stand up, sit down, walk or climb stairs). Current research is used to support our physical therapy treatments. Multiple treatment techniques can be used to optimize a person’s return to functional mobility after experiencing a stroke. Some progressive treatments include body-weight support treadmill training for early ambulation training and the use of the Balance Master for balance re-training.
Physical therapists on the stroke team engage in frequent continuing education and departmental lectures to promote current and specialized treatments in working with patients who have had a stroke. A board certified specialist in neurologic physical therapy facilitates program development and patient care for the physical therapy stroke team.
The Nursing Staff of the Rusk Institute of Rehabilitation Medicine has a long history of providing specialized care to stroke patients. At Rusk, the Nursing Staff has excellent functional assessment skills and take a comprehensive/holistic approach to the care of the stroke patient and their families. With a significant number of Registered Nurses possessing certification in Rehabilitation Nursing ((CRRN) they demonstrate expertise in the management of incontinence, pressure ulcer prevention, medication administration as well as they carry out treatments and procedures associated with the management of pain.
In addition, the Nursing Staff functions collaboratively with the Interdisciplinary Team to coordinate patient and family education from admission to discharge. The goal of Rusk’s Nursing Staff is to facilitate meeting the patients self-care needs and to increase the level of independence while fostering problem-solving skills and maximizing abilities for re-entry into the community.
Preventitive care is always emphasized from the time of initial evaluation and throughout the rehabilitation process.