Justine Mamone, P. T., D.P. T., N.C.S.
Kessler Institute for Rehabilitation
Saddle Brook, New Jersey
I think that the word regression is
difficult to define when referring to the
function of a stroke survivor. To me
the word has a negative connotation
when referring to function, and its
meaning, “to return to a former or less developed state,”
may not be appropriate when referring to these individuals.
For survivors who feel as though they have regressed, it
may be their perception of how they are doing now in a
more challenging home environment as compared to how
they were doing in a controlled rehab setting. There is no
denying, however, that a survivor may have encountered a
secondary complication such as a fall, pneumonia or even
a urinary tract infection following their stroke that may
impact their mobility and overall function.
Things may not have changed quantitatively. They may
not necessarily require more assistance to do things at
home than they did in rehab, but things may in fact be more
challenging or not as qualitatively satisfying. They may
feel that their walking is not quite as good as it was when
they were walking under a therapist’s supervision providing
them cuing and while walking on linoleum flooring with
minimal clutter or environmental distractors. Back at home
or in the community, they are challenged by walking on
different surfaces with shoes rather than hospital socks and
while in busy environments. They may then perceive that
they are not performing at that same level because there are
greater challenges surrounding them.
If you think of the level of intensity in an inpatient
rehab, a survivor is being seen for three hours a day, if not
more, with a skilled clinician to address the things that have
changed following their stroke. Once released, they are
going from three hours a day to potentially three hours a
week in an inpatient or home care setting. Big difference!
Our programs are designed to prepare survivors for
success at home, but there is a lot of emphasis placed on
the importance of keeping up with the exercises provided
to them and to maintain mobility on their own between
sessions. This may be difficult as many have caregivers or
family members who have returned to work, unavailable
to help perform some of these activities or supervise
them while on their feet. Without the same support and
in a more challenging environment, they may not have
the opportunity to progress as before. We try to provide
home exercise programs that are not overwhelming in the
number of exercises and making sure the exercises provided
are the right amount of challenge that can be completed
successfully and safely at home.
Another way to deal with this feeling of regression is
to tailor therapy to prepare the individual for the specific
challenges they may face in their own home. We do home
evaluation and have the patient come along if possible. This
allows the survivor, their family members and the therapy
team to gain a new perspective on what it is like for the
individual to be in a home environment with their new
impairments. Ultimately, this gives us the chance to practice
the skills required more precisely while in therapy.
Emotional, cognitive and social changes after a stroke
may also contribute to feelings of regression or plateau
in function. The presence of depression and decreased
motivation often seen following a stroke can greatly impact
a survivor’s drive to continue staying active and can lead
to some decline in function. They may also not have the
encouragement and support from a caregiver or family
member, which will also impact function in those who need
the additional support. Another contributor to post-rehab
decline in function is compensation, not challenging the
affected limbs and finding a way to complete activities with
greater ease. In rehab we emphasize the use of the affected
limbs as much as possible, but once at home it’s likely that
without the reinforcement a survivor will find ways that
may be more efficient and easier.
