Tag Archive for: Stroke Recovery

American Stroke Association Recommends In-Patient Rehab For Stroke Recovery

Over 750,000 people suffer a stroke each year in the United States, and quality physical therapy and rehabilitation are vital after the stroke to manage residual disability. Studies show that in-patient rehabilitation facilities are more effective in treating patients recovering from strokes.

In May, the American Heart Association (AHA) and the American Stroke Association (ASA) released guidelines for rehabilitation after a stroke. The ASA strongly recommends that patients receive treatment at an in-patient rehabilitation facility (IRF) whenever possible. Treatment in an IRF produces enhanced functional outcomes with a shorter length of stay than treatment at other facilities, such as a nursing home.

Why are in-patient facilities more beneficial to stroke patients? The AHA and ASA agree that there are a variety of reasons:

Extensive Rehab

A patient in an IRF receives at least three hours a day of rehabilitation from physical, occupational, and speech therapists. Nurses are available around the clock, and doctors usually visit on a daily basis. Being treated by a team approach also helps the patient understand the importance of their rehabilitation during the early recovery period from their stroke. Also, patients benefit most from the comprehensive, goal-oriented rehabilitation programs that IRFs provide.

The fact that stroke patients have better overall outcomes and rehabilitation success in IRFs than in other facilities has been proven in studies for at least a decade. A 2006 study showed that IRF patients at the six-month mark of recovery had fewer ADL (activities of daily living) difficulties than patients treated in other facilities, as well as better functional improvements overall. Additionally, patients who suffered severe motor disabilities experienced better overall recovery and function through treatment in an in-patient facility.

Newest Technology and Equipment

IRFs often have access to the latest technology and equipment used in stroke recovery therapy. An example of new technology includes constraint-induced movement therapy, which is a way of forcing intensive skilled use of upper limbs that have been weakened by a stroke.

Aftercare

IRF staff members are trained to assist both the stroke patient and his or her caregivers in developing a structured program for when the patient returns home.

  •   This includes education about making changes in the home so that it’s safer, such as minimizing fall risks.
  •   Education and training on how to safely use assistive devices such as walkers, wheelchair, and canes.
  •   An individually-tailored exercise program so patients can safely continue their cardiovascular and overall fitness after their formal rehabilitation is complete.

The bottom line, experts say, is that a patient recovering from a stroke can fulfill their potential through a coordinated effort between a diverse team of professionals – such as that found at an in-patient rehabilitation facility – as well as the patient, their family, and caregivers.

A Day in the Life of a Speech-Language Pathologist

It can be difficult to fully describe the role of a Speech-language Pathologist, as the rehabilitative work they do throughout their days is extremely varied and complex. In order to give our readers a more accurate idea of what an SLP does, we asked one to tell us a little more about her patient work here at an Ernest Health Hospital, as well as walk us through her activities throughout the day.

EH: Can you share with us what a typical day looks like for you?

SLP: I get to work around 7 or 7:30 a.m. to help patients with using their safe swallow strategies during breakfast.

We have a short staff meeting at 8:00 to quickly discuss appointments, discharge plans, medical complications, etc. I treat patients from 8:30 to 12. I personally have more energy in the morning, so I try to see my patients then and save documentation for the afternoon

I document daily/weekly progress notes during lunch and begin therapy again at 1:00. I have 2-3 sessions in the afternoon, and then I need to write daily/weekly notes. Part of my role in the afternoon is to look at the patients we will have in the evening and which therapists will be coming in for the evening shift and get the patients signed out to a therapist accordingly.

Some of the things that I have to think about as I’m evaluating patients is: Are the patients sticking to their diet? Are they ready for advancement? How are they handling the diet?

EH: What does the majority of your work involve at Ernest Health, and how would you describe the majority of the patients you work with?

SLP: I provide individual sessions and group therapy sessions two days a week. The majority of my patients have cognitive impairments that limit their ability to make safe decisions.

Stroke and head injury are the majority of the causes.

EH: What treatments/therapies do you use to work with your patients at Ernest Health?

SLP: For dysphagia (swallowing issues): I use myofascial release therapy and e-stim (electrical stimulation) modalities.

Myofascial release therapy is a treatment for patients with dysphagia that aims to loosen up muscles in the cervical area to allow for more contraction in swallowing.

E-stim modalities are used for neuromuscular re-education, which is a technique used to help the patient contract the muscles used in swallowing to teach the patient what it should feel like. E-stim machines can be used for a variety of purposes, though, and all depends on the settings (pain management, muscle contractions, etc.).

One of our SLP’s main focuses is keeping the patient safe by educating them and family members on things like locking the wheelchair and using the call light for help. In addition to these practices, she also does her best to find fun and fresh ways to help retrain patients to their former levels of functionality. Using music therapy and technology like iPad games, for instance, allows the patient to learn in a way that feels less like work and more like recreation.

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Her empathy for the patients, dedication, and caring personality are shining examples of the qualities that Ernest Health values in its team members.

EH: Why did you choose Speech-Language Pathology as a career?

SLP: I chose to be an SLP because I wanted a career that would make a positive impact on someone’s life.

My first semester in undergrad, I, by chance, saw a class schedule with a class about Communication Disorders.  I decided to take it and knew from the beginning this was what I wanted to do with my life.

EH: What hobbies or interests do you have?

SLP: I teach fitness classes before and/or after work. My alarm usually goes off at 4:30 so I can fit in my hobbies. My husband and I enjoy traveling, skiing, and fly fishing together.

Speech-Language Pathology’s Role in Stroke Recovery

Stroke recovery is a complex process that varies from one patient to the next. Because of this, speech-language pathologists play an important role in a stroke patient’s rehabilitation. Last week, we discussed how a speech-language pathologist could help a stroke survivor regain their ability to read. However, with one fourth of stroke patients suffering from language impairments, an SLP usually plays a sizable role in most stroke patient’s recovery. Here are a few of the responsibilities you can expect them to take part in during the recovery process.

They make a plan.

Because every stroke is different, and every patient is different, it is only natural that every recovery plan is different as well. Speech-language pathologists work with their inter-professional team but also work with a patient’s case history and their family to come up with a plan that will work for every individual patient. Creating a successful rehabilitation plan requires an SLP to know the patient medically and personally. A speech-language pathologist’s close involvement throughout the treatment allows them to alter the rehabilitation plan if necessary.

They help patients relearn how to communicate.

Depending on which area of the brain is affected by the stroke, patients may either have difficulty communicating their thoughts through words or writing, or have difficulty understanding spoken or written language. Either way, an SLP’s education equips them with the ability to help both of these conditions. They use different techniques and exercises to help patients circumvent their disabilities such as making symbol cue cards or simply repeating phrases with their patient. All of this is done with the end goal of helping the patient relearn their communication skills or learn new methods of communicating. 

They help patients with self-awareness.

Although speech and language are in the title, speech-language pathologists help with much more than that. SLPs also help stroke patients regain their self-awareness. This can mean anything from helping a patient learn that they don’t swallow all of their food during meals, to learning how to comb their hair. A speech-language pathologist may set up different daily challenges such as basic cleaning, to personal grooming to help a patient recover their self-awareness. These skills will help a stroke survivor’s day to day life become less frustrating as their recovery goes on. 

The extensive duties of a speech-language pathologist in stroke recovery differ with each patient, but for every patient they make an incredible difference. We are committed to bringing the best care to our patients, and because of that, we appreciate the speech-language pathologist on staff!

 

What Aphasia Looks Like, and What to do About it

Last week we learned about a patient who had Aphasia, and what it was like for him and his family. Each patient is different when it comes to rehabilitation, but every patient can benefit from a family member that is aware of their condition. Aphasia Awareness Month is the perfect time to learn more about this condition. When a patient experiences damage to the parts of the brain where language occurs, we call this “aphasia.” Aphasia can cause a person to lose their abilities to process language, be it in expression or comprehension.  Most often, the left side of the brain is the one responsible for aphasia and causes the affected person to encounter difficulties with speech and comprehension.

Many of our aphasia patients are stroke survivors. Although things like brain tumors and traumatic brain injury can also be responsible, stroke is most-often the culprit for the language struggles that we help our patients work through.

Common symptoms of aphasia:

Patients with aphasia often display issues with both comprehension and expression.

When most of the problems lie in the comprehension or reception of language, this is often classified as “Wernicke’s Aphasia.” While a sufferer can sometimes pick up on the melody or cadence of a sentence (determining if it’s a command or question, for example), they might have problems understanding the specific words that are being said. Since a person’s vocabulary is housed in the left side of the brain, understanding of words can sometimes be affected, as well as the concept of stringing words together to form a full thought.

When the issues mostly lie in the survivor’s ability to express themselves, it usually falls under the category of “Broca’s Aphasia.” In this case, the symptoms are more outwardly visible, as the patient struggles greatly with speech and the construction of sentences. Aphasia, in this case, can present itself in a variety of ways. Sometimes a patient will create something that sounds like a sentence, but is comprised of gibberish-like words. Other times, they might be able to get out enough words to get an idea across, but leave out small connecting words like “the” or “and.” When all areas of language are hindered, it is referred to as “global aphasia.”

Support

The range of symptoms that can occur during aphasia is wide and varied, but the factor that stays constant is a need of support. Through the support of family members, friends, and rehabilitative therapists, a person suffering from aphasia has a better chance of getting back on the road to understanding and function.

What can you do?

The word “aphasia” can be intimidating. While it is definitely a serious condition, it is one that can be worked with and, to some degrees, overcome.

Recognize… that aphasia has not affected the patient’s intelligence. It has altered their ability to communicate and understand language, but their personality, memories, and knowledge remains. Remembering that the same person you’ve always known resides behind this communication disorder can be grounding and encouraging.

Take the time… to learn your suffering family member’s struggles and specific communicative needs. After a period of routine, you’ll be able to discern how to understand and communicate with your loved one, bringing a sense of comfort and progress to the both of you.

Create… an environment that is conducive to focus and treatment. When a person has difficulty understanding the simplest of words, even the simplest of distractions can be a deterrent to progress. Eliminate extra sounds and excessive visual stimulations, so that your loved one can focus on the task at hand. Simplifying your questions to yes/no and slowing down your rate of speech can encourage success.

Explore… different methods of therapy. Sometimes drawing, writing, and even the encouragement of socialization can stimulate progress in a stroke survivor’s language. It is important to keep communication with your loved one’s therapist open so that you can learn about techniques that may be specifically helpful to your situation.

We understand that recovery is a process that can take its toll on not only the patient but their support systems as well. To alleviate some of the pressure, we encourage you to seek help from rehabilitative professionals, Speech-language pathologists being an ideal option, to make this process as successful as possible.

 

Aphasia Awareness Month

June is National Aphasia Awareness Month, and, because aphasia is something the team here at Corpus Christi Rehabilitation Hospital encounters frequently, we feel very strongly about spreading awareness of this condition.

Aphasia is a neurological condition that is acquired. This means that something, often a stroke, inflicts damage to the brain and causes normal functions to be interrupted or altered. In the case of aphasia, the damage occurs in the parts of the brain that are responsible for language. A patient suffering from aphasia will often have a difficult time reading and writing. Understanding and communicating with others can also be affected, and presents some very frustrating circumstances for both the patient and the caregiver. One thing to note is that while communication is affected, the intelligence and coherence of the patient is not necessarily altered. The American Psychological Association phrases it well:

“However, it is important to make a distinction between language and intelligence. Aphasia does not affect the intelligence of the person with the disorder, but they cannot use language to communicate what they know.”

This is a fundamental piece of information that we understand and want the rest of the world to understand as well. We’ve had the opportunity to speak with Lisa Driver, the wife of a former Ernest Health patient, about their experience with aphasia rehabilitation at our facility, and it’s clear that she was well aware of this fact, too:

“He was still my Glen; he was still in there.  I knew he wasn’t gone, but he couldn’t get across the things he wanted to say.  I can’t imagine not being able to get people to understand what you’re trying (to say).”

Lisa was fully aware of the disconnect between Glen’s thoughts and his ability to communicate them. When discussing his frustration in therapy, she explained,

“He hated using the communication board, spelling things out, or using pictures. He wanted just to talk. The pictures were not what he wanted. He could not find the performed sentence or picture that matched what he had in his head.”

We use our interdisciplinary approach to care to provide a comprehensive experience that is efficient and complete. By assigning a team of specialists in different rehabilitation disciplines, we can ensure that a patient’s stay is quick and efficient, but also thoroughly attended to, so that no stones are left unturned.

Because of the frustrating disconnect between intention and actual communication, we know how important it is to be compassionate. The team here recognizes its responsibility to both the emotional and physical care of our patients.

When asked about their experiences over the four-month stay that the Drivers had with us, Lisa replied,

“The environment from day one… the administrative staff, nurses, therapists, cafeteria people, dieticians, housekeeping. They would not just come in and take out trash and mop.  They would visit with us, ask how he was doing, share about things in his life. We were there four months.  We would get excited when we would have a nurse rotate back to us.”

Aphasia is a frustrating and devastating condition that we see on a regular basis, and we feel that it deserves as much awareness as it can get. For more information, resources, and support for aphasia patients and their families, please visit the National Aphasia Association’s website.

If you or someone you know is struggling with aphasia, or if you’re simply exploring your options, please contact us. We can promise expertise, empathy, and compassion that can be heard in the testimonials of those who have worked with us previously.

Caregiver’s Guide to Brain Injury Rehabilitation

The goal of rehabilitation is to help your loved one live and function as independently as possible. Rehabilitation helps the body heal and assists the brain in relearning processes so that an individual recovers as quickly and efficiently as possible. Rehabilitation will also help the person with Brain Injuries learn new ways to do things if any previous abilities have been lost.

After your loved one’s initial life-saving treatment at the time of the injury, he or she will most likely start a rehabilitation program and will work with a team of specialists. The person with an injury and his or her family are the most important members of the rehabilitation team. Family members should be included in the rehabilitation and treatment as much as possible. Some of the other professionals who may be part of this team include:

  • Neurologists – doctors who are trained in the diagnosis and treatment of nervous system disorders, including diseases of the brain, spinal cord, nerves, and muscles.
  • Occupational, physical, speech and language therapists – therapists that help the person regain thinking skills, communication skills, physical abilities and behavioral skills.
  • Neuropsychologists – specialized psychologists who focus on thinking skills and behavior problems.
  • Vocational rehabilitation experts – employment coaches who help with regaining job skills.

Some of the different types of rehabilitation facilities include:

  • Acute rehabilitation – an intensive rehabilitation program.
  • Coma treatment centers – provide coma-specific medical care.
  • Transitional living programs – nonmedical residential programs that teach skills for community living.
  • Long-term care and supervised living programs – residential facilities that provide care and
  • rehabilitation to people with brain injuries who are not able to live independently.
  • Behavior management programs – typically community-based (i.e., not residential) programs that teach self-control and appropriate social behaviors.
  • Day treatment programs – provide rehabilitation during the day so the person can return home at night.

Recovering from a brain injury is a process and is individual to each person and family. One of the major impacts that stroke has on quality of life is the way that it affects a person’s emotions and relationships. There are hardships that immediately come to mind – communication problems, mobility limitations, cognitive impairment – but there are also complex social and emotional stressors that impact well-being. Stroke affects emotions, and in turn, relationships and social functioning among stroke victims and family, friends, and/or caregivers. It is important to remember that rehabilitation may last weeks or even years and that your loved one will benefit from the ability to receive rehabilitation services throughout this time. Appropriate programs and treatments will also change as your family member’s needs change. Choosing Ernest Health is a huge step forward on the road to recovery!

References:

www.biausa.org

www.caregiver.org