MANY OF US may know a loved one, a friend, a co-worker or a public figure who has suffered a stroke. And we wonder: What will life be like now for this person? Will he or she ever work again? Will he or she ever live independently again?
Stroke, after all, is a brain injury. A clot forms in a vessel of the brain, blocking the flow of blood to brain cells. These cells die and, as a result, abilities housed in that part of the brain are lost.
But these abilities are not necessarily lost forever. Care after stroke is dependent upon two things.
First is getting the stroke patient to the hospital as soon as possible if you suspect a stroke. Treatment given within the first three hours of stroke onset can “bust” the clot and help patients regain more function, more quickly.
Second is ensuring that patients begin stroke rehabilitation as soon as they are stable, often as soon as 24 or 48 hours after stroke. The ability of our brains to relearn and adapt, even after stroke, is known as neuroplasticity. It is possible for our brains to learn again how to walk, talk, reach and grasp after stroke, using different parts of the brain to “cover” for cells that have been lost.
Stroke recovery, however, does take time, and it also takes tremendous, continued effort on the part of the patient, their families and their rehab team. The typical continuum of care for stroke patients is the emergency room, then stabilization in an acute care hospital. Inpatient rehabilitation then begins almost immediately, ensuring patients have three hours of focused therapy daily, under the guidance of a rehabilitation physician, so they can begin relearning function as soon as possible.
STUDIES HAVE shown that the key to neuroplasticity’s success is for patients to repeat, repeat, repeat, to retrain the brain. A dedicated rehabilitation center ensures that patients receive more therapy in a short amount of time to help them meet their goals.
Outpatient care follows, where therapy continues. Other studies have found that stroke patients can continue to regain abilities a year or more after stroke, so it is important that patients and families remain focused. Psychological and social support also is vital during this time.
Therapy is targeted to helping patients recover from one or more of several deficits. They may experience paralysis affecting the face, arm or leg, or the entire side of the body, and may have difficulty walking or grasping simple objects. They may even have difficulty swallowing, and with balance and coordination.
Chronic pain or numbness may be an issue. Patients may not be able to speak or, if they are able, may find that they misuse words or have difficulty comprehending words. Deficits in memory and attention span, as well as emotional issues – fear, anger, depression – are other common effects of stroke.
THE IRONY IS that stroke is highly preventable through simple lifestyle changes. May is Stroke Awareness Month, and according to the Georgia Department of Public Health, the rate of strokes in this state is 16 percent higher than the national rate. If you smoke, have high blood pressure and practice poor lifestyle habits – such as a diet high in fat and cholesterol or lack of exercise – I encourage you to reach out to your physician and local community services to learn how to break these habits. I think all my patients would say that it would be far easier to practice healthy eating and regular exercise than to face intensive rehabilitation following a stroke.
Finally, I must share that I continue to be amazed and humbled every day by patients who go from being bedridden and unable to speak or walk to living their lives again – perhaps not exactly the same life, but a full and rich one. They inspire all of us to continue to do our utmost to help patients recover as fully as possible after stroke.
(The writer has served as medical director at Walton Rehabilitation Health System for the past 12 years. Walton is the only local health system accredited in stroke rehabilitation by the Joint Commission, the United States’ main accrediting body of health care organizations and programs.)