National Stroke Awareness Month: What the Road to Recovery Looks Like
When Leslie had a stroke after delivering her third child, her family knew her rehabilitation would take all hands on deck. The recovery, which began at Burke Rehabilitation Hospital, would continue well past its doors, and her husband, parents and in-laws all banded together to not only take care of the children at home but to help Leslie recover to the best of her ability.
Leslie and her family are not alone. Every 40 seconds, someone in the United States has a stroke, and the condition is a leading cause of serious long-term disability. It reduces mobility in more than half of stroke survivors aged 65 and older. As May is National Stroke Awareness month, we talked to members of the Burke team about the most important elements of stroke rehabilitation and prevention.
Integrated Care Team
Stroke, says Dr. Jennie Valles, M.D., Burke Rehabilitation Hospital’s attending neurologist and Medical Director of Informatics, is like real estate. The size and location of the brain affected makes all the difference in the manner and severity of physical and cognitive deficits, and can include weakness or paralysis, speech loss, memory loss and vision impairment.
Recovery from stroke is highly individualized, and Burke gathers an integrated interdisciplinary team around the patient and their family. The team is led by a physician, who performs regular physical and neurological examinations, manages complications and medications, and guides the rehabilitation plan. The medical team, which also includes rehabilitation nurses, keeps an eye on secondary risk factors for another stroke, as well, including hypertension and diabetes
Burke’s renowned therapists—physical and occupational therapists, speech-language pathologists, and recreational therapists—work closely together, sharing information and adjusting the treatment plan based on the patient's progress and evolving needs. Psychologists play an important role for patients’ and family members’ wellbeing, and social workers help patients and families prepare to go home when the time comes. The entire team meets regularly to ensure a holistic and coordinated approach to recovery.
Dr. Valles still remembers how critical an integrated team was for a patient who came in following a mild stroke, was doing well in therapy over the course of a week, then started to decline. “He should have been getting stronger, not weaker—and it was the therapists who brought this to my attention,” said Dr. Valles. “Because the therapists work so closely with patients, they pick up on changes in someone's neurological presentation.” Dr. Valles referred him to the hospital, where they found a condition that needed immediate surgery. When he returned to Burke, his rehabilitation proceeded without incident.
Family Involvement and Education
Stroke can leave patients with significant physical and cognitive impairments, including difficulty with activities of daily living (ADLs) such as walking, dressing or bathing, as well as difficulty producing or understanding language and changes in personality. These changes and associated caregiving needs impact the whole family.
To prepare and support both patient and family, the Burke team shares insights and expertise on not just the therapies at hand now but also what to expect, how to measure success, and potential challenges. Leslie’s family members, for example, were at Burke every day learning and practicing how to help her with her ADLs and preparing for the next chapter.
“We are a means of education to help the patient and family prepare for what’s to come,” says Dr. Valles. “The doctors, nurses, therapists and social workers see patients like this on a regular basis and have a good idea about the struggles and obstacles they’re going to face while they’re here as well when they leave here.”
Social workers are a vital part of continuing education. Always planning ahead to avoid emergencies, social workers connect patients and family members to community services and resources they might need upon their return home, such as in-home health services or caregiving support groups.
Engage a Passion
A creative pursuit like music or art can go a long way in engaging a patient’s interests while also enhancing their rehabilitation. Burke’s Neurological Music Therapy program provides evidence-based interventions for patients recovering from stroke, including helping with speech through singing or with mobility through dance and movement. Burke also offers tools for rehabilitation through drawing and painting.
“Music elevates the mood, which can make the therapy more successful,” notes Dr. Valles. “When family members can engage their person in something they love, it adds to motivation—which is so important for the long run.”
Prevention Is Critical
Once you’ve had a stroke, you are at increased risk of another stroke. Prevention, too, is a vital part of recovery. Our teams recommend these key steps to stay ahead of stroke.
Manage your risk factors, including high blood pressure, a sedentary lifestyle, high cholesterol, and smoking, as well as diabetes and atrial fibrillation.
Make exercise a priority, focusing on physical activity as recommended by your care team.
Pay attention to what you’re eating, with a balanced diet that includes whole foods (unprocessed) and limits excessive salt, sugar and fats.
Stick to a regular sleep schedule. Here are some tips to get your 7 to 8 hours.
Take your medications properly, as prescribed, including refilling at the proper time.
Be socially active and engaged. “Social isolation can have really damaging effects on your health,” says Burke physical therapy assistant Daniel Leet, PTA, adding that group fitness classes can get you in shape and stay social.
Know the signs of stroke—and act fast. Remember the acronym B.E.F.A.S.T.:
- Balance – Sudden difficulty walking or balancing
- Eyes – Sudden change in vision
- Face – Facial droop
- Arm – Sudden weakness in one arm
- Speech – Sudden slurred speech or difficulty understanding speech
- Time – If you see any of these signs dial 911 immediately
One Step at a Time
Dr. Valles reminds patients and family members that stroke recovery, like most rehabilitation journeys, is a marathon, not a sprint. Much of the recovery occurs in the first three months, with additional gains possible over the next year or more. She encourages patients and families to set long-term goals, which, if appropriate, may include returning to work or getting out the in the community, but emphasizes the importance of shorter-term, more achievable goals, as well.
“It can be frustrating, but I encourage patients and families to not return to usual activities too quickly,” she says. “It’ll take longer than the next few weeks or months. Allow yourself to take it nice and slow—to take one step at a time.”
