We all know someone who has suffered a stroke. Strokes are clinically called Cerebral Vascular Accidents (CVAs) and there are two major types: Ischemic (most common at >80% of all strokes), when a blood clot prevents blood flow to an area of the brain affecting the center of control for the body. And Hemorrhagic (bleeding) strokes that happen when an artery leaks or ruptures usually due to high blood pressure. A third type of lesser intensity is called Transient Ischemic Attack (TIAs), also considered precursors to a larger CVA (like warning tremors before an earthquake).
The brain is compartmentalized by lobes but here, we simplify the anatomy into two halves called hemispheres that are connected by a small structure (Corpus Callosum) which is how both sides communicate for whole-body functions. Each hemisphere specializes in specific function control and mirroring motor control of the opposite side of the body. Commonly, people who survive a stroke have one-sided weakness, usually the left side of the body to some degree; mildly where they can’t manipulate small objects very well, or severely when they can no longer hold their arm up or walk.
Some stroke survivors have difficulty speaking and swallowing; loss of recognition of themselves, loved ones; and disorientation to time and place. Others may have eyes that no longer work in unison or may have lost part of their visual field (called hemianopsia). In hemianopsia, there are several types of visual field cuts where the affected person cannot see part of their surroundings or even miss seeing part of what is on a plate in front of them. When eyes do not work in unison, there are spatial and depth perception dysfunctions that affect the person’s balance and ability to walk safely. For a wheelchair user, this can mean slamming into doorways, cabinets, and walls, sustaining injuries to lower legs, feet, arms, and hands.
Recovery from an ischemic stroke begins when the origin of the illness is effectively addressed medically. Once medically managed, in-patient rehabilitation begins. OT or speech therapy are often the first to assess depending on the medical presentation. For a speech therapy assessment, the first goal is to make sure the patient will not aspirate fluids or foods. OT and speech may address communication and orientation (to self, place, and time), but the OT is the expert at addressing a patient’s ability to manage bed-level self-care and beyond. PTs assess the need for a mobility aid and gets the person out of bed to get them moving with the goal to safely transition to a skilled-nursing or out-patient rehab center depending on the severity of the stroke.
Some people opt to go home with home health services, but this is rarely ideal as they will not be getting daily therapies, self-care retraining, and medication management around the clock. Outcomes are not optimal in comparison to in-patient rehab. After being discharged, some patients believe they are as good as they can get but that may not be true!
Stay tuned for the following installments that will cover case studies on people who were able to continue to make major improvements even THREE YEARS AFTER being discharged from out-patient rehab! If you or someone you know had a stroke and continue to have neurologic dysfunctions, do not give up, re-INTEGRATION IS STILL POSSIBLE!