joys of stroke rehab

Ah… stroke rehab. My most recent placement was mostly involving outpatient stroke rehab, and it was a bit of a roller coaster ride. It was in an international setting, and the patients were often 10 months, or even 2 years post stroke. The poor collusion between the physiotherapy department and the doctors there pretty much means that often stroke patients do not get referred for rehab until a long time after their stroke.
For anyone who has done any stroke rehab, you’d know that this can be really frustrating, as the early phase of rehab is so critical to a patient’s outcome. Not only this, but in the time that they are not being rehabbed, they are learning poor patterns of movement, and these are getting reinforced over and over. Its exactly this kind of thing that makes rehab of these patients so challenging, and frustrating.
There were a few patients that myself and the other student were assigned to treat regularly throughout the placement. Some of these patients were quite old, had had quite a delay between their stroke and receiving rehab, and often did not want to get better. Couple those factors with the language barrier and it made for a very interesting and frustrating clinical experience.
There were days when we’d work really really hard with a patient, and get absolutely no results. There were other days when we’d work really hard and we’d get a good result, and the next time the patient comes in for treatment the results are gone and they are back the way they were. One thing that was particularly frustrating was that some patients would only learn context specific activities. What I mean is that, say for example you are trying to retrain a patients gait, and the main problem they have is improper verticality, so naturally we would do a lot of work on the patients verticality in other positions, assuming that this would carry over to their gait. And often patients would really really improve a lot in their ability to do these verticality exercised in other positions, but once we try them in gait, its clear that there has been absolutely no carry over.
However, most of the patients did improve a little bit over the four week period that we treated them, even if the progress was very slow and a lot of hard work. Has anyone else experienced this?