Rehabilitation Setting Selection and Indications

images (7)Knowing and using objective criteria in recommending a rehabilitation plan best suited for a patient is imperative. This effort to maximize functional outcome and independence and targeting expensive resources to patients who will benefit is a very important role for physiatrists and other rehabilitation specialists.

Acute, inpatient rehabilitation is the most intense and expensive rehabilitation setting in terms of hours of therapy provided each day. Comparison to subacute rehabilitation, typically provided in a skilled nursing facility, in terms of functional outcome, is discussed later in this article. However, the basic criteria for admission to acute rehabilitation are as follows:

Potential for significant functional improvement requiring at least 2 therapy disciplines in a reasonable period
Realistic and safe discharge plan with family support and housing that allows return to the community rather than to a skilled nursing facility or long-term care
Medical stability, willingness, and ability to participate in at least 3 hours of therapy/day
Inpatient, subacute rehabilitation is generally offered at a skilled nursing facility or long-term acute care hospital. Patients with more complex medical care such as mechanical ventilation or advanced wound care often undergo at least their initial rehabilitation at a long-term acute care hospital. Both skilled nursing facility and long-term acute care hospital therapy is generally, but not always, with fewer hours of therapy offered per week. Such facilities are not bound to a minimum hours of therapy per day.

Home health and outpatient therapy are provided to patients after they complete their inpatient therapy or for those who are less impaired after their stroke.

Frankly, there are very few indications for no therapy and evidence does suggest that earlier mobilization translates to better long-term patient outcome.

Ideally, rehabilitation should begin immediately after a patient is admitted for stroke, barring additional medical issues aside from the stroke itself

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