There are a range of rehabilitation types that can help after a stroke:

• Speech Therapy

• Occupational Therapy

• Physical Therapy

• Hydrotherapy

• Emotional Support and Psychotherapy

• Sexual Rehabilitation and Couples Therapy

• Neuropsychological Diagnosis and Treatment

• Speech–Language Pathology (Speech Therapy)

Aims of speech therapy:

1. Diagnosing the impairment
2. Rehabilitating motor skills of the damaged speech organs
3. Treating problems with swallowing
4. Treating difficulty speaking
5. Rehabilitating the language and communication of people with aphasia (impaired speech ability) and teaching them how to effectively use existing language capabilities
6. Training family members to help them communicate with the stroke patient. This training focuses on teaching the conditions and means by which they can speak with and understand the patient.

Eligibility for Speech Therapy

The medical services basket entitles stroke patients to the following treatments:

Acute care condition: The medical services basket theoretically sets a limit of 20 treatments. In practice, all HMOs provide the service for those in acute care directly following the event and up to two years after the event. These treatments are not limited in number and are provided according to medical need, subject to a written recommendation from a speech therapist to continue treatments beyond the quota.

Chronic condition: The medical services basket offers 12 integrated treatments per year, including a combination of physical therapy, occupational therapy and speech therapy, modified to the needs of each patient.

Questions for the Speech Therapist

1. What is the exact diagnosis of the condition?
2. What type of treatment and follow-up are necessary?
3. How can we help with communication?

Find more details about social/communication rehabilitation for people with aphasia at specialized rehabilitation centers in Tel Aviv and Jerusalem on the “Ahead Above and Beyond” (Merosh Ume’ever) website here.

Occupational Therapy

Aims of occupational therapy:

1. Diagnosing the functional impairment
2. Improving fine motor skills and coordination
3. Encouraging proper movement and repressing incorrect patterns
4. Achieving maximum independence in daily life
5. Increasing awareness in the side affected by hemispatial neglect and encouraging its use
6. Training the patient and caregivers in the proper positions for lying down, getting up and sitting
7. Training for correct handling
8. Training for exercising motor skills to improve strength and range of movement
9. Working on thinking processes, memory and concentration in damaged areas (cognitive therapy)
10. Practicing functionality based on the stage of the illness
11. Recommending housing changes and assistive devices to improve and facilitate daily function

Eligibility for Occupational Therapy

Acute care condition: The medical services basket sets a limit of 25 treatments per year, spread over two months. In practice, if the patient’s condition is acute/severe after the event (and even if not), the HMOs provide an unlimited number of occupational therapy treatments, according to medical need.

*The treatment may be performed individually or in groups, depending on the professional opinion. The total number of treatments are counted together as part of the limit covered by the basket.

Chronic condition:The medical services basket offers 12 integrated treatments per year, including physical therapy, occupational therapy and speech therapy, modified to the needs of each patient.

Questions for the Occupational Therapist

1. How are the assistive devices used?
2. Are there recommended exercises that can be done at home?
3. What modifications are required in the home? Who is eligible? How do we obtain equipment? When? Read more on the “Preparing the Home” page in the “Rehabilitation” section.
4. What are the recommendations regarding driving? To read more, go to the “Driving After a Stroke” page in the “Rehabilitation” section, and the “Mobility and Driving” page in the “Rights” section.
5. Make sure all instructions and recommendations are clearly stated in the hospital discharge letter.
6.  

Physical Therapy

Aims of physical therapy:

1. Diagnosing the functional impairment
2. Restoring as much independent physical function as possible to the patient
3. Improvement in mobility, balance and coordination
4. Independence in transitions and mobility
5. Reducing pain and improving stamina

There are many methods of physical therapy, modified for the physical condition of each patient. These include maintaining the correct position in the bed, correct posture when lying and standing, encouraging movement, increasing the range of motion, sensory stimulation, maintaining muscle strength and range of motion, and using mobility devices as needed. In addition to providing treatment to patients, the physical therapist also has the job of training the patient’s family members, with an focus on primary caregivers, and providing them tools to help the patient during hospitalization and at home and support the rehabilitation process.

Eligibility for Physical Therapy 

According to the medical services basket, stroke victims are entitled to several physical therapy treatments, detailed as follows:

Acute care condition:Unlimited number, according to the written recommendation of the rehabilitation doctor.

Chronic condition (after the rehabilitation process, when the patient is in a stable condition):

Limit of 12 treatments per year. The doctor may recommend extra treatments according to the medical condition. This limit covers 12 integrated treatments per year, including physical therapy, occupational therapy and speech therapy, modified to the needs of each patient. Additional deductible treatments might be covered by private or supplementary insurance at the HMOs.

• אתר כללית
• אתר מכבי
• אתר מאוחדת
• אתר לאומית

Waiting times for physical therapy in the community

• In an urgent situation (includes any case of stroke after acute care hospitalization or inpatient rehabilitation): up to three business days after the request to make an appointment.
• If there is a need for physical therapy at home in an urgent situation: within two business days.
• All other situations: up to 15 business days.
• Chronic condition for physical therapy at home: up to three weeks.
• If told that the waiting time is longer than stated, you can file a complaint to the HMO or the medical professions ombudsman at the Ministry of Health. Find more information on the “Right to Rehabilitation” and “Legal Assistance” pages in the “Rights” section.

Questions for the Physical Therapist

*These questions were adapted from the “Ahead Above and Beyond” (Merosh Ume’ever) website. Find additional important questions on the “Ahead Above and Beyond” (Merosh Ume’ever) website.

1. Have all the necessary adjustments been made to the assistive devices?
2. When and how should adjustments be made to equipment provided by the Ministry of Health (wheelchair, bed, etc.)?
3. Did I receive all the necessary instructions? E.g. regarding transitions from chair to bed and from sitting to standing; operating the wheelchair; getting into the car.
4. Are there rehabilitative gyms in my area of residence?
5. Which exercises can be performed at home? You can request demonstrations and pictures to be sent to your phone.

Hydrotherapy

Hydrotherapy is physical therapy performed in a specialized pool and aimed at improving the function of the skeletal, nervous and muscular systems.

The treatment focuses on facilitating the performance of movements, reducing spasms, encouraging relaxation, reducing edemas, relearning functions, resistance movement without equipment, improving cardiovascular fitness, and building self-confidence.

In general, hydrotherapy is not a substitute for physical therapy.

What hydrotherapy treatments are included in the medical services basket?

The medical services basket covers 12 integrated treatments per year, with no special supplement for hydrotherapy. Therefore, it is possible to substitute hours of hydrotherapy for hours of a different therapy, such as physical therapy.

Emotional Support and Psychotherapy

A stroke is a sudden event that disrupts the normal course of life for patients, their families and their close environment. The shock and confusion in the initial period following a stroke is huge. The more severe the stroke, the greater the stress, fear and sense of helplessness experienced by patients and their family members. This situation often creates crisis responses such as shock and anxiety about the future, which may be manifested in anger and aggressive behaviour toward surroundings, and can sometimes even lead to depression.

These are normal responses to the situation.

Each person starts with a different set of resources to face the crisis; therefore everyone should be allowed to take the time they need and have a space where they feel comfortable expressing their feelings.

Note that in certain cases, the feelings of depression and anxiety are the result of neurological damage caused by the stroke.

In any case, it is recommended to talk to a professional, preferably a rehabilitative psychologist or psychiatrist, throughout the period of coping with a stroke. If someone in the patient’s close environment thinks the patient’s reaction or that of a certain family member is different from the norm in the family, and does not match their natural behavior, or that it lasts an abnormal amount of time, or is more extreme than expected, it is especially important to turn to a professional for help finding additional ways of coping with the new situation.

Referrals to professionals can be obtained from the insuring HMO, and patients can receive free therapy sessions with professionals who work at the HMO or have an agreement with the HMO (subsidized payment); in any case, there is no reason to go to a private practice.

According to HMO protocol, it is forbidden to limit the number of sessions against the recommendation of the professional therapist.

Before being discharged from the hospital (acute care hospitalization or rehabilitation), it is advisable to request that the discharge letter include a referral to psychological treatment, in order to receive a greater number of treatments from the HMO in as short a waiting time as possible.

Sexual Rehabilitation and Couples Therapy

Sexuality is an important and meaningful component of life. Beyond physical pleasure, sex helps strengthen a couple’s relationship and has been proven to be essential for maintaining and improving health and inspiring serenity and calm. After a stroke, patients might experience problems in sexual function for various reasons, sometimes due to feeling uncomfortable or ashamed, and sometimes as a result of functional failure. Disrupted sexuality can harm the couple’s relationship as they get back to routine and impact the quality of life of both patients and partners after the rehabilitation period.

Since in many cases disrupted sexual function is related to factors other than the damage of the nervous system, patients can turn to sexual health professionals for help developing a rehabilitation program that will eventually restore their ability to function sexually.

Factors that Contribute to Decreased Sexual Function After a Stroke

Depression and Anxiety

Not infrequently, coming home after a period of hospitalization and rehabilitation results in stress, anxiety and reduced independence. After a stroke, many patients are very afraid of having another stroke and suffer from low self-confidence due to brain damage and reduced independence, which can often result in depression.

• Disrupted Motor Function

One common characteristic of strokes is damaged motor function. Usually, paralysis occurs on one side of the body, which greatly limits patients’ movement and prevents them from performing simple tasks independently. In many cases, the weakness in the side of the body goes away with time; but until the situation is resolved, patients experience difficulty with mobility. The motor damage is also reflected in reduced fine motor skills and coordination. In these cases, it is hard for couples to have sex normally, and sexual desire can significantly decrease as a result.

• Medications

Patients are usually prescribed medications after a stroke, including medication for lowering blood pressure to prevent a recurring stroke. The medication prescribed to at-risk patients for lowering blood pressure causes decreased sexual function and may even be connected to impotence.

• Difficulties with Language and Communication

Many stroke patients suffer from communication disorders that manifest in difficulties with speech and understanding. These difficulties can impact the couple’s relationship and affect their level of attraction and desire to have sex.

Improving Sexual Function After a Stroke

There are several recommendations for improving sexual function after a stroke:

Improving interpersonal communication

Despite the difficulties, it is important for couples to work on good communication, which helps strengthen the relationship and brings the partners closer.

Consulting a doctor about changing medication

In many cases, it is possible to change some of the medications to reduce their effect on sexual function.

Consulting professionals who are experts in the field

Sexual consulting services are offered at rehabilitative hospitals, HMOs and private practices.

The following are details about specialist clinics within rehabilitative hospitals:

The Center for Sexual Health, Reuth TLV Rehabilitation Hospital: Most of these services are offered privately.

Director: Professor Rafi Heruti

Sderot HaHayil 2, Tel Aviv (Yad Eliyahu)

03-6383680 | 03-6893712

Sexual Rehabilitation Clinic, Sheba Medical Center (Tel HaShomer): These services may be funded by the HMOs (Form 17).

Director: Dr. Manuel Zwecker

Sheba Medical Center

03-5303842 | 03-5303718

Sexual Rehabilitation Clinic, Loewenstein Hospital: These services may be subsidized by your HMO (Form 17).

Director: Dr. Shmuel Shapira

Loewenstein Hospital, Fleischmann Building

09-7709104 | 09-7709034

Neuropsychological Diagnosis and Treatment

Stroke often affects the behavior, capabilities and faculties of patients. The process of neuropsychological diagnosis and treatment is an essential part of the rehabilitation process.

Neuropsychological Diagnosis

Neuropsychological diagnosis is performed by rehabilitative psychologists — neuropsychologists and can be used to specify the reason for the damage; help stroke patients identify their strengths and abilities; point out impaired abilities and behavioral problems caused by the stroke; and recommend possibilities for occupational rehabilitation. The diagnosis can be used to differentiate between psychiatric and neurological symptoms.

To maximize the effectiveness of the diagnosis, in most cases it should be performed at the stable, chronic stage of rehabilitation, a year or more after the stroke.

The diagnostic process includes several meetings, cognitive tests and personality tests. The opinion it provides is also based on medical findings and can be used to recommend suitable further rehabilitation.

Neuropsychological Treatment

Neuropsychological treatment is psychological treatment that incorporates tools from both neurology and psychology. Emotional and behavioral problems are examined through a neurological lens and of course with an understanding of the complexity of each person’s psychology. By addressing the consequences of the damage to function and behavior, it is possible to help patients process their experiences and to assist with the emotional, behavioral and cognitive aspects of coping with stroke.

The treatment is performed by a trained rehabilitation psychologist and intended for people with brain damage and neurological damage. During treatment, use is made of thought training techniques, cognitive behavioral therapy, and everyday coping tools.

To apply for neuropsychological treatment, contact your HMO and get a referral from your family doctor (sometimes Form 17 is also required). The services are provided at hospitals and private institutes and units, sometimes partially or fully subsidized by the HMOs. In some cases, family members can also receive training as part of the treatment.