Not enough rehab for stroke patients, report says - Ontario

You are going after the wrong problem. Rehab has only a 10% chance of getting you to full recovery and that has nothing to do with rehab, mostly luck of the location and size of infarct. Stop these  5 causes of neuronal cascade of death in the first week and there will be much less dead and damaged neurons. Cause and effect people, learn about it.
https://www.thestar.com/life/health_wellness/2011/06/21/not_enough_rehab_for_stroke_patients_report_says.html
Rehabilitation services for stroke victims in Ontario are sorely lacking, says a new report from the Institute for Clinical and Evaluative Sciences.

Ontario stroke patients get only a fraction of the rehabilitation they need, say the authors of a provincial evaluation report.

Discharged stroke patients receive an average of only 10 home visits from physiotherapists, occupational therapists and speech therapists when best practices say they should be getting 62 visits, said Dr. Mark Bayley, one of the authors of a report released this week by the Institute for Clinical Evaluative Sciences (ICES).

Moreover, 500 to 1,000 of those most severely disabled by strokes annually in Ontario aren’t getting any rehabilitation at all, he said.

“Unfortunately it is getting worse in that less and less (patients with) severe strokes are getting into rehab. That’s why we are concerned about this,” said Bayley, medical director of neuro-rehabilitation at the Toronto Rehabilitation Institute and chair of the Ontario Stroke Network’s stroke evaluation committee.

The 2011 Ontario Stroke Evaluation Report found that in the 60 days after being discharged from hospital after suffering strokes, patients typically received four home visits from physiotherapists, three from occupational therapists and three from speech language pathologists.

But best practices would dictate that patients should receive two visits a week from each of these health professionals for 12 weeks.

The report noted that community care access centres, which organize home-care services in the province, no longer send psychologists to stroke survivors’ homes even though the need is still there.

“It is concerning, given the prevalence of depression among stroke survivors, that CCAC-based psychology services were delivered across the province until 2007-08 but are no longer available,” the report stated.

According to ICES, most patients who receive in-patient rehabilitation services have suffered mild or moderate strokes.

“(This) suggests that a notable proportion of patients in the severe group did not have access to in-patient rehabilitation. This also suggests that patients with mild disability were going to in-patient rehabilitation due to the lack of outpatient services and/or pressure on in-patients rehabilitation to reduce length of stay,” the report said.

In recent years, hospitals have been closing outpatient rehabilitation clinics and reducing length of stays to save money.

“The first thing to go in the last 10 years has been outpatient rehab. It is very short-sighted,” Bayley charged.

Hospitals are then dedicating limited in-patient rehab resources to those who have suffered mild or moderate strokes while many of the most severely affected are needlessly sent off to live in long-term care facilities, explained Ruth Hall, an evaluation specialist with ICES. With rehabilitation, many of these individuals could have improved and returned home instead.

On a positive note, the report found that almost 90 per cent of stroke patients received neuro-imaging — normally CT scans — within 24 hours of arriving at hospitals in 2008-09, up from less than 50 per cent six years earlier.

“We have done remarkably well over the last 10 years in improving acute care for these patients but we could do more after the acute phase of the stroke is over to make sure that people are rehabilitated to their full capacity and absolutely reintegrated into their communities,” Hall said.