CVA After Discharge: Outpatient Services

Outpatient services emphasize continued development of skills after the patient has completed acute rehabilitation in the hospital. The patient's physician and treatment team will recommend a discharge plan that may include individual therapies, specialty programs and/or clinics. The goal is to help the patient continue to progress and maintain maximum independence.

Services provided on an outpatient basis include:

Therapies
Occupational therapy
Speech therapy
Physical therapy
Therapeutic recreation
Neuropsychology

Adapted Driving Education
For many of our patients, the goal of maximum independence includes learning to drive. A licensed therapist, who is also a certified driving instructor, can provide testing, individualized instruction, simulator training and behind-the-wheel training in a modified car or van. The instructor will recommend adaptive devices for the patient's vehicle and will follow the patient through getting his license.

Aquatics
Aquatic therapy is often a component of the interdisciplinary treatment plan. There are three separate pools of varying size and temperature, each providing a specific therapeutic purpose, including relaxing of muscles and reduction of spasticity, gait training and range of motion, and strengthening and endurance building. Patients who complete their outpatient aquatic therapy program are invited to participate in the Community Aquatics Program, if they are able to perform aquatic exercises independently and safely. The goal of this program is to help maintain functional gains achieved during formal therapy.

Balance/Vestibular Clinic
Following a stroke, patients may have problems with balance and are therefore at increased risk for falling and dizziness. Therapeutic goals for the patient include improving postural stability and balance, increasing independence for walking, and reducing dizziness to make carrying out daily living activities easier. The program also educates patients on risk factors for falls, environmental modifications and compensation strategies.

Communication Disorders Program
Speech and hearing assessments are conducted to determine therapy needs as well as the need for palatal lifts or surgical interventions to help improve the communication abilities of patients. An augmentative communication specialist is also available to evaluate the patient if assistive technology is needed.

Community Exercise Program
After completing a formal therapy program, patients are given the opportunity to participate in supervised exercise programs to help maintain independence and functioning. The "Fit 'N Fun" program is designed for seniors and is an hour class provided three times per week for a nominal fee. Activities focus on maintaining strength, range of motion and balance.

Day Neuro Rehab Program
Therapeutic activities are provided for approximately five to six hours, Monday through Friday. The goal of the program is to help participants gain improvements in cognitive, communication, physical and social deficits for return to a more independent, higher quality and more satisfying community life. Participants are individually evaluated to determine what difficulties they are experiencing, what activities are most important to them and what therapy activities are most appropriate to help address these needs.

Treatment plans are developed by a multidisciplinary team of clinicians including occupational, physical, and speech therapists, therapeutic recreation specialists, and neuropsychologists/ psychologists, in conjunction with the patient and family/caregiver. Medical management is available by a physiatrist and social work is provided to help the family/caregiver access community services, if needed. The family/caregiver is also provided suggestions for activities to incorporate within the home setting to encourage the patient's progress.

Dysphagia Management
Patients with swallowing difficulties are evaluated to determine the cause of the problem and to determine treatment options. These services include dysphagiagrams (modified barium swallow studies), FEES (fiberoptic endoscopic evaluation of swallowing) and DPNS (deep pharyngael neuromuscular stimulation) and are coordinated by speech therapy and radiology.

Vision Rehabilitation Clinic
This clinic is conducted by an optometrist, who specializes in neurology and low vision and is assisted by an occupational therapist trained in visual impairments associated with injury to the brain. Then a treatment plan is established. If needed, referral to a neuro-ophthalmologist or retinal specialist is available.

Neuropsychological Evaluation
This evaluation provides a thorough assessment of cognitive/perceptual skills such as reasoning, problem solving, memory, insight, attention and comprehension. The results of the evaluation reveal a patient's cognitive strengths and weaknesses and provide important information about the patient's ability to resume activities such as driving, working and returning to school. The test results are then used to determine if treatment intervention is required, and if required, to set realistic outcome goals for the treatment.

Orthotics Clinic
A team including a physiatrist, an orthotist and a physical therapist evaluate the patient's needs and make recommendations for the design and construction of the orthotic (brace). Orthotics include positioning splints, muscle tone inhibitory casts, serial casting and ankle-foot orthoses. The purpose of these devices is to help the patient improve gait, stability and balance, prevent deformities, increase range of motion, improve endurance and decrease muscle tone.

Real Life Rehab
This program is delivered in the patient's home and community by a specialized team of physical, occupational and speech therapists. In addition to traditional therapy services, the team focuses on helping families/caregivers establish a structured environment and routine schedule that is appropriate for the patient in the home setting. The program also provides a transition between inpatient rehabilitation and traditional outpatient services.

Return To Work Services
Pre-vocational testing and job skills training are provided to patients who are able to return to the work force. An occupational therapist works with the patient and the employer to discuss needed modifications in job tasks and work-site accommodations to help the patient return to his previous job. If it is determined that new job skills training is required, referral for vocational rehabilitation services can be made.

Spasticity Management Clinic
After a stroke, persons can experience increased muscle tone and spasticity, which means that straightening an arm or leg can be difficult. Spasticity can affect functioning in everyday living activities, and make independence more challenging.

In the Spasticity Management Clinic, a physiatrist, physical and occupational therapists, orthotists and nurses, team together to provide a comprehensive evaluation and treatment plan that incorporates advances in medication and treatment options for spasticity. Goals of treatment include decreasing muscle tone of the affected muscles, improving range of motion, improving joint positioning and more.

Treatment options include, but are not limited to:

• Physical and occupational therapies to help improve overall functioning
• Orthotics to provide splinting and bracing which can help improve positioning and decrease muscle tone
• Oral medications which can help reduce spasticity
• Injections of botulinum toxin (Botox), which can control specific muscle spasticity

Wheelchair Seating and Positioning Clinic
Patients who have posture problems and decreased trunk muscle control are evaluated by a physical therapist to determine a seating system for their specific needs. The systems range from a simple linear wheelchair to a power chair with contoured support or one with adaptive equipment. Patients benefit from the proper seating system through correction of uneven weight distribution, resulting in decreased risk of contracture or pressure sores, reduction of abnormal muscle tone, improved respiratory function and swallowing and improved balance and functioning.