Alison Lichy, P. T., D.P. T., N.C.S.
Do patients regress? Undoubtedly
they do, but there are many reasons,
and it’s important to know why so
you can address the cause.
First of all, if you feel like you
have regressed, a medical issue needs to be ruled out. This
regression could be another stroke, a medication issue,
depression or simply the lack of challenging or appropriate
activity. Many things can cause a person to regress.
Immediate regression following inpatient rehabilitation
is often expected. This can occur because the rehab
facility is a different environment from your home. It can
take time to assimilate to your home environment and
routine. In preparation to returning home, communicate
with your therapists about your home environment in
order to set specific goals important to you and the
challenges you will face at home.
Job #1 of therapy is preparing survivors to be as
independent as possible in their home environment. For
example, walking in the clinic on a hard surface may go
well. However, if you have carpets at home with thick
padding and there are obstacles, coping with this should
be your goal for therapy and the task you are practicing.
Getting patients and family members to set specific goals
for their home environment and roles is crucial to progress.
Sometimes survivors feel that they’re regressing when
in reality they have progressed. This occurs when you
are participating in new or more activities with increased
challenges. This is great! This is also a good reason to go
back to outpatient rehabilitation to set new goals to help
you succeed in your desired activities.
Because of the age of most stroke survivors, you might
be fighting the battle with aging. Is the regression you
feel a year or two post-stroke the result of getting older or
is it the stroke or is it a combination? Either way, aging is
not a reason to accept regression. This can be treated with
therapy and exercise.
Another reason progress halts is that caregivers
provided too much assistance. The caregiver has good
intentions, but if the survivor does not participate in
their daily routine or take on family roles, the survivor
is unlikely to make progress at home. The best thing for
loved ones to do is support survivors in doing as much
as they can for themselves so when they have to do
something for themselves, they can.
Regression often occurs because patients compensate
with their less affected side. Clients say, “I used to be able
to do this with my hand when I was in therapy.” This is
because in therapy the focus was on using the affected
hand, but when at home, to do something faster, they use the
unaffected arm instead. As a result, the affected arm is not
being challenged at home as much as it was during therapy.
Therapists send survivors home with appropriate
exercises. It is important to do the exercises to the best
of your ability, and if they are not perfect, that’s okay.
Activity helps prevent regression. The best thing is for
family members to encourage survivors to do as much
as they can do on their own and provide assistance when
appropriate. But by all means, keep doing the exercises,
and when they get easy or you get bored, go back to
outpatient therapy and get new ones.
If you feel like you’ve regressed, then you definitely
have a reason to return to therapy, and it is appropriate
for your insurance to cover your therapy. Your reasons for
returning to therapy should be specific, such as “I can’t
do a specific task in my home environment that I need
in order to be independent,” or “I was able to perform a
task previously and can no longer perform this task,” or
“I have had a fall.” These reasons qualify you for return
to therapy. Also, being specific with your personal goals
helps the therapist set the plan of care and ensures you
are getting the most out of your therapy visits.
Job #1 of therapy is
preparing survivors to be
as independent as possible
in their home environment.