Comprehensive Care Plan for Post-Paralysis Patients
A multidisciplinary rehabilitation team approach is essential for effective post-paralysis care, focusing on preventing complications, maximizing functional recovery, and improving quality of life through coordinated interventions across all care settings. 1, 2
Core Components of Post-Paralysis Care
1. Multidisciplinary Team Coordination
- Team should include physicians, nurses, physical therapists, occupational therapists, speech-language pathologists, dietitians, social workers, and psychologists 2
- Regular scheduled team meetings to discuss patient progress and adjust care plans
- Nurses serve as primary coordinators, providing 24/7 care and ensuring continuity across all interventions 1
2. Preventing Major Complications
Fall Prevention
- Implement comprehensive fall prevention program including:
- Regular fall risk assessment using validated tools
- Clear walking paths (avoid loose rugs, clutter)
- Adequate lighting (open curtains during day, night lights)
- Non-skid footwear and surfaces
- Assistance with transfers and toileting
- Slow, deliberate movements during transfers 1
Skin Integrity Management
- Regular skin assessment every shift and during position changes
- Use Braden scale to predict pressure ulcer development
- Reposition patient at least every 2 hours
- Keep skin clean and dry
- Use specialized mattresses and wheelchair cushions
- Minimize friction and pressure during transfers 1
Venous Thromboembolism Prevention
- Early mobilization when safe
- Pneumatic compression devices and compression stockings
- Consider anticoagulation (enoxaparin 40mg daily more effective than unfractionated heparin)
- Monitor for signs of bleeding if on anticoagulants 1
Spasticity Management
- Daily stretching of hemiplegic limbs
- Position hemiplegic shoulder in maximum external rotation for 30 minutes daily
- Consider resting ankle splints at night and during assisted standing
- Proper positioning and supportive devices to prevent shoulder subluxation 1
3. Functional Rehabilitation
Mobility Training
- Early, short, frequent exercise sessions
- Progressive mobility protocol based on patient tolerance
- Task-oriented therapy focusing on practical daily activities
- Train family members to assist with exercises 1
Activities of Daily Living (ADLs)
- Combine restorative and compensatory approaches
- Focus on self-care tasks (toileting, eating, washing, dressing)
- Gradually progress to instrumental ADLs (telephone use, shopping, finances, cooking)
- Nurses responsible for daily practice of techniques 1
4. Psychological Support
Depression Screening and Management
- Early depression screening (affects 1/3 of stroke survivors)
- Monitor for mood disorders including pseudobulbar affect (10-48% incidence)
- Consider pharmacological treatment (selective serotonin reuptake inhibitors)
- Provide cognitive-emotional therapy, psychotherapy, and support groups 1
Cognitive Support
- Assess for delirium using validated tools (4 Assessment Test or Confusion Assessment Method)
- Regulate sleep/wake cycles and day/night orientation
- Cognitive stimulation activities
- Consider family presence to promote orientation and security 1
5. Nutrition and Hydration
- Regular assessment of nutritional status and weight monitoring
- Swallowing evaluation before oral intake
- Consider enteral feeding if dysphagia present
- Monitor hydration status
- Educate family on proper feeding techniques 1
6. Discharge Planning and Transitions of Care
- Early assessment of discharge needs
- Clear communication between hospital and next level of care
- Scheduled follow-up appointments
- Connection to community resources and support groups
- Patient and family education on:
- Disease process and expected recovery
- Medication management
- Self-care techniques
- Home safety modifications
- Warning signs requiring medical attention 2
Special Considerations
End-of-Life and Palliative Care
- Comprehensive assessment of physical symptoms, emotional status, and unresolved issues
- Pain management following palliative care principles
- Support for family members and caregivers
- Consider hospice services when appropriate 1
Medication Management
- Ensure medications are assessed for appropriateness, effectiveness, and safety
- Consider comprehensive medication management to optimize regimens and reduce costs 3
- Develop shared medication treatment plans to support continuity of care 4
Implementation Strategies
- Develop standardized protocols and clinical pathways for consistent care
- Ensure staff receive appropriate training in post-paralysis management
- Establish support systems for follow-up after discharge
- Create community resource networks to support ongoing rehabilitation 2
- Use comprehensive care plans as communication tools across multiple care settings 5
By implementing this comprehensive care approach, healthcare providers can significantly improve outcomes for post-paralysis patients, reducing complications and enhancing quality of life through coordinated, evidence-based interventions.