Stroke rehabilitation professionals

When someone has a stroke, you can aid in his recovery not just by supporting him emotionally and physically but by helping to choose and coordinate the stroke rehabilitation team. Here are six ways to do it.

1. Get to know the team members

A stroke survivor will have a team of specialists dedicated to his rehabilitation. His team may include some or all of the following members:

• You. Of all the members of his team, as the caregiver, you're the one who probably understands him best. Depending on how much time you can devote to his rehabilitation, your role may range from providing support to coordinating meetings between other team members. At the very least, your care and support can be one of the most positive factors in his rehabilitation.
• Case manager. A good case manager is an invaluable resource. This person serves as the liaison between you and other members of the rehabilitation team and helps you deal with the patient's insurance company. The case manager should also be able to help you find support groups, information about finances, and legal assistance if necessary. Most often, the hospital assigns a social worker to manage the case, but these people are notoriously overworked. If you can't get the help you need from the hospital social worker, you may want to consider hiring an independent care manager. Ask the social worker for a referral, and be sure to check the care manager's references.
• Lead physician. A patient's doctor is responsible for managing his care and rehabilitation. In the hospital, the lead physician may be a neurologist or an internist. Once a stroke survivor is discharged, he may be referred to a physiatrist, a doctor who specializes in rehabilitation. In either case, this person will arrange medical care, manage medication, and oversee the other therapists.
• Rehabilitation nurses. In the hospital and rehabilitation center, nurses will tend to a stroke survivor's everyday medical needs and personal hygiene. They can teach you how to care for him at home, showing you how to avoid pressure sores, transfer him in and out of bed, deal with incontinence, and help him avoid another stroke.
• Physical therapist. The physical therapist will focus on his motor functions: strength, endurance, walking or wheelchair use, balance, and coordination. Once a stroke survivor returns home, the physical therapist may design an exercise program he can follow between sessions.
• Occupational therapist. Like the physical therapist, the occupational therapist will help with a stroke survivor's motor functions, but the emphasis is on normal daily routines. Known as "activities of daily living," these include personal hygiene, getting dressed, using the toilet -- any activity that's part of a person's normal day. For example, if the person you're caring for has lost his left visual field, the occupational therapist will work on teaching him to scan for objects on the left side. The occupational therapist can also recommend home modifications and assistive devices that may enable him to live more independently.
• Speech therapist. If a stroke survivor has any language deficits, a speech therapist can help him relearn how to speak or teach him to communicate in other ways. This therapist can also help him work on his cognitive abilities (such as problem solving, decision making, and social skills). Finally, she can help him overcome swallowing difficulties.
• Clinical dietitian. Along with swallowing problems, stroke survivors may have incontinence and excessive weight loss. A dietitian will address his specific nutritional needs and can recommend a low-sodium, heart-healthy diet to help prevent future strokes.
• Rehabilitation counselor. A rehabilitation counselor focuses on the emotional aftermath of a stroke, as well as issues that arise during rehabilitation. This counselor will address any depression, anxiety, or behavioral problems. The counselor should also work with you and family members, offering strategies for helping the stroke survivor and even suggestions for managing your own stress.