Because hemiplegia affects muscles of the face, arm and leg on one side, it prevents patients from doing a variety of activities which range from walking to feeding themselves.
Therefore, the goals of the rehabilitation plan are very specific to each patient, and they must be agreed upon before the rehabilitation program is initiated. Even the side of the body affected by hemiplegia can influence the rehabilitation plan, as people with right-sided hemiplegia may also have difficulty with speech and language (aphasia). When this is the case, they also require a comprehensive plan of aphasia rehabilitation.
How Are Rehabilitation Goals Set for Each Patient?
Hemiplegic patients are referred to a rehabilitation physician who works along with physical and occupational therapists, rehabilitation nurses, speech pathologists and others to design a specific rehabilitation plan with clear goals based on each patient's needs.
Why Are Rehabilitation Goals Important?
Setting specific rehabilitation goals enable the physician and the patient to measure progress. It also focuses both the rehabilitation team and the patient on accomplishing clear goals both in the short and the long term, which makes the rehab experience much more effective. Needless to say, the goals set for each patient must be considered thoroughly and should be realistic.
Some goals are easy to measure, such as strength, but others are more difficult, such as grooming and feeding.
Here are some of the goals that rehabilitation specialists and patients should think about when implementing a plan of care.
The Overall Goal: IndependenceReaching independence is the most important goal for any stroke survivor. Independence can be reached once a person can perform all of his or her own activities of daily living. This is most often accomplished by hemiplegic patients who have preserved cognitive function.
Grooming GoalsDepending on the severity of a stroke, a person might need to relearn basic skills such as washing, cutting finger and toe nails, and getting dressed.
Some grooming goals might include activities such as learning how to pass the affected arm through a coat sleeve, or how to place a glove over the unaffected hand. Other such tasks include putting on a pair of pants, socks or shoes and taking them off, doing and undoing buttons, zipping and unzipping clothing, and using a comb.
Functional GoalsFunctional goals include re-learning how to do things such as rolling over in bed, getting up and balancing one's body in a steady standing position, and carrying objects from one place to another.
As a person gets closer to reaching independence, he might also set goals on activities such as using a key to open a door and dialing a phone number. For people who enjoy reading, an important goal may be to learn a good way of holding a book.
Feeding GoalsConsideration must be given to learning how to pick up and use utensils, as feeding oneself is a key aspect of independence. However, patients whose ability to chew or swallow was affected by a stroke usually require a separate plan of dysphagia therapy.
Strength GoalsIncreasing the strength/movement of the affected limbs is perhaps the most important goal of any rehabilitation plan. Any increase in strength, even if minor, has the potential to improve multiple goals delineated in the care plan. For example, increasing hand strength can allow someone to hold a toothbrush, spoon or key, all of which can have a very positive impact in a person's quality of life.
It is also important to improve strength in the non-hemiplegic side as this "good side" must be strengthened in order to compensate for the weakness of the hemiplegic one.
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Carolynn Patten, PhD, PT; Jan Lexell, MD, PhD; Heather E. Brown, MSPT; Weakness and strength training in persons with poststroke hemiplegia: Rationale, method, and efficacy; Journal of Rehabilitation Research and Development Volume 41, 293–312
Mary Ponte-Allan, Gordon Muir Giles; Goal Setting and Functional Outcomes in Rehabilitation; The American Journal of Occupational Therapy; 53 (6) 643-649