You or your loved one just had a stroke and you want to know how soon you should start rehabilitation. Is it possible you could cause more damage if you start too early? Here are the facts. For practical purposes, you can’t start too early. There are some animal and human studies that suggest that the first 24-48 hours after a stroke may be too early, but the reality is that most patients are either too sick or have too much going on to participate in exercise and rehabilitation at that time. After that point, it is time to get things going.

In an ideal world we would start rehabilitation in the intensive care unit. It’s important for acute care hospitals to realize this and have physical therapy, occupational therapy and speech therapy see the patient in the ICU. Some progressive hospitals will walk patients who are still on a ventilator.

What can you do in an intensive care unit or shortly after a stroke? You can start with simple things like range of motion exercises but, there are many other things that can start at the bedside. Learning to sit on the edge of the bed, regaining postural control, positioning and weight bearing of the affected upper extremity are all things that can start immediately. People frequently wait to involve speech therapy, but they too should be part of the initial rehabilitation team. We need to start with a cognitive evaluation. Is Mr. Smith different than he was before his stroke? We want to evaluate speech and swallowing to determine if he is safe to start eating? The speech therapist can start to work on paying attention, following directions and finding objects in a visual field. Many patients can get out of bed, stand and walk with an assistive device while they are still in the ICU.

Several years ago, I had a personal experience with my wife as a patient in an ICU for a prolonged period. Her intensivist was very progressive and believed in the therapeutic value of sunshine and fresh air. As she was improving, but still in the ICU, we went outside one on one with a nurse and a physical therapist to their garden to perform therapy. After a month in the ICU, the combination of sun, crisp clean air plus therapy was terrific.

There’s a lot you can do and the sooner the better. Patients who start rehab early have better outcomes and will reach a higher functional level. You don’t have to wait to go to the rehabilitation hospital to get a head start.

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