They are not mutually exclusive. If the patient still has recovery potential, our PM&R physician recommends intensive rehabilitation — especially within the 3–6 month golden period after a stroke. When the underlying disease is progressive and cure is no longer the goal, palliative and hospice care take over, keeping comfort-focused mobility and positioning therapy in the plan so the patient stays as comfortable and dignified as possible.

• •Full medical assessment before recommending rehab, palliative or a combined plan
• •Gentle positioning, range-of-motion and pressure-sore prevention continue in hospice care
• •Swallowing and secretion management for comfort, not for performance goals
• •Family counselling and bereavement support throughout

Any prescription medication, including neuro-adjuncts such as Cerebrolysin, is reviewed by the attending physician within the goals of care. In palliative and end-of-life care the emphasis shifts to symptom relief — pain, breathlessness, secretions and anxiety — and treatments that no longer add comfort or benefit are discussed openly with the family before being adjusted.

Patients who still have recovery potential — for example a stroke within the last 3–6 months who can still participate in therapy — may continue it alongside training if the physician sees value. When the disease reaches its final stage, the patient can no longer take part in therapy, or no measurable functional change is seen, the medical team recommends reviewing and stopping it so care can focus on comfort rather than intravenous treatment.

It is avoided or used with caution in severe renal impairment, epilepsy, known hypersensitivity, and in patients with fluid overload or heart failure, since it is given as an intravenous infusion. Side effects are usually mild — dizziness, palpitations, flushing, agitation — and increase with rapid infusion. At Sanpiti it is administered only on the attending physician's order under 24-hour nursing observation, and the cost is itemised separately from the monthly room rate.