Strategic Stroke Treatment

Helping patients recover from this condition is challenging yet rewarding

Nearly 800,000 Americans experience a stroke every year. Healing begins early, and the rehabilitation involved can be intense.

Despite the fact that it is such a commonplace condition in the United States, there are several misconceptions about the treatment, severity and effects of stroke.

Effects of Stroke

Jessica Finnegan, PT, MPT, NCS, a board-certified specialist in neurologic physical therapy and senior physical therapist at HealthSouth Rehabilitation Hospital of Toms River, N.J., has worked with post-stroke patients for seven years in an inpatient setting.

She sees each patient for stroke rehab individually, and the goals that each patient may want to reach vary.

“If they have stairs at home or they have to get back to being able to reach down to the floor to feed their pet, we work on that,” Finnegan said. “We work on very specific, task-oriented activities to get the patient back to being able to function in their daily lives like they used to before their stroke.”

Stroke symptoms she treats include hemiparesis, or weakness on one side of the body. According to Finnegan, this is found on the side of the body opposite the brain hemisphere where the stroke occurred.

Hemianesthesia, or loss of sensation on one side of the body, is also common. Those who suffer a stroke frequently experience a loss of vision in both eyes but in one visual field. Finnegan also tends to see loss of coordination and motor planning in her patients.

In addition to these symptoms, Sonia Rapaport, PT, rehabilitation instructor and NPT consultant for Partners in Care, an affiliate of the not-for-profit Visiting Nurse Service of New York, tends to see similar patient conditions while working in home healthcare.

She also treats foot drop, in which muscles in the ankle become weak and cause the front of the foot to hang. This can place patients at higher risk of falls. People who experience stroke are also at a higher risk for shoulder subluxation and impairments in balance and walking abilities.

Those at risk for stroke have many factors to consider. Some can be changed, such as high blood pressure and cholesterol, smoking, managing atrial fibrillation and diet and exercise; however, some factors cannot be changed, such as age and race.

Both therapists note that it’s very important to follow a multifaceted treatment plan, including care from physical therapists, occupational therapists and speech-language pathologists, because there are so many conditions that can occur following a stroke. To achieve a patient’s goals, there must be communication and collaboration among the care team.

Current Technologies

With Rapaport and Finnegan working in different environments, technologies they use for this patient population vary. Rapaport regularly gets creative with her treatments depending on her patients’ environments or economic status.

“Instead of using one-pound weights, we may use a can of vegetables or one pound of dried beans in a sock,” she said.

Much of her time is spent performing hands-on treatment with therapeutic exercise, ambulation training, transfer training, strengthening of the core and leg muscles for better balance and proprioceptive neuromuscular facilitation, or a combination of movements performed during everyday functions that a patient may lose after stroke.

To treat possible pain and swelling, heat or cold packs may be used with careful supervision, especially if sensation is lost. TENS units may be used for muscle spasms and pain, and patients can learn how to operate one themselves.

In an inpatient facility, different technologies are used, especially as they pertain to early mobility. HealthSouth has a special piece of equipment that assists in achieving this mobility: a bodyweight-support treadmill system with robotics.

According to Finnegan, some facilities may have one or the other, but the combination of the treadmill with robotic technology is able to lift the patient up and out of their wheelchair and supports their weight while robotics carry their legs through a normal motor pathway for walking.

Finnegan also uses neuromuscular electrical stimulation to rehabilitate smaller muscle groups and functional electrical stimulation to address muscles while they are in use.

Difficulties in Treatment

Treating a patient who has experienced a stroke can be a different type of challenge for physical therapists.

“It’s always really hard when the person cannot get better due to a medical condition and they’re trying really hard,” Finnegan said. “There are usually one or many other medical conditions that affect this person or have led up to this stroke.”

Rapaport added that a major factor in a patient’s healing in home healthcare is family involvement. “You need someone to continue the treatment when [the physical therapist] is not there,” she said. “If the family is not participating, it definitely makes a difference in them getting better.”

Finnegan finds that stroke rehabilitation can become frustrating at times because information about the condition is usually incorrect or simply not known at all. “The patient may see that their arm isn’t moving, and they think there’s something wrong with the arm, not the brain,” she said.

But misinformation is not limited to a patient’s knowledge prior to a stroke. There are a few incorrect ideas about how stroke heals even within the medical community.

Both Rapaport and Finnegan mentioned that many professionals at one point thought that a patient would only progress up until six months after their stroke. If they did not regain the skills they needed before then, they would never get them back. Both claimed this idea is not accurate anymore.

Other difficulties may include limited capabilities in communication and additional considerations such as dietary and hydration needs, environmental concerns and incorporating other medical needs into treatment. But both physical therapists mentioned that the reward of watching someone heal and reach their goals makes the process worthwhile.

The Bright Side

While the difficulties in treating stroke patients may seem overwhelming, the payoff is definitely worth it. “Being a catalyst to get them where they were before they had their stroke and watching them get better has always been very rewarding,” Rapaport said.

She mentioned a specifically rewarding instance in which she was treating a woman who had been released from the hospital very early and was not able to work due to mobility and speech issues.

“She had a really hard time. By applying all of these modalities and exercises, in just five weeks, she improved enough to go back to work,” Rapaport said. “She was almost at 100% compared to her premorbid state, and she was walking just with a cane.”

Finnegan mentioned a similar reason for enjoying her work. “I think as a physical therapist, the one thing that we tend to take the lead on is getting the patient to walk, and that’s very often that patient’s main focus. To be able to work with them and see them make progress towards that is a very rewarding experience,” she said.

She also shared a story of a woman in her 30s who was very active and suffered a stroke during strenuous exercise. Her doctors originally told her she would be wheelchair-bound for the rest of her life, and both Finnegan and the patient refused to accept that prognosis. By the end of her treatment, the patient was out jogging on the lawn of the hospital with Finnegan.

Though experiencing and attempting to recover from a stroke may seem daunting, dedicated physical therapists are always ready for the challenge and ready to help patients achieve more than they ever thought they would after stroke.

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