Brenda Cicero, M.S., CCC-SLP, is a speech language pathologist with Sentara Outpatient Rehabilitation Department. She currently co-facilitates the Williamsburg stroke support group.

Stroke Rehabilitation: A Team Approach by Brenda Cicero, M.S., CCC-SLP Published: August 2006 When a stroke occurs a life can change dramatically in a matter of seconds. A little over a year ago, after playing a round of golf, Bill Petersen, age 45, suffered a stroke that greatly impacted his life. He lost most of the use of his left hand and arm, so he was unable to return to work as a heavy equipment operator. At first he experienced swallowing difficulties even though he was able to talk. A year of rehabilitation plus many lifestyle changes have enabled him to drive a car (using a wheel adaptor), and he has regained some of his left arm strength. Petersen admits to having been overweight and, as a bachelor, living a less-than-healthy lifestyle. He had had a heart attack while in his 30’s, but it was the stroke that changed everything. He’s experienced enormous frustration in trying to navigate the paperwork process to qualify for disability payments. Petersen has come to truly appreciate the support and care provided by his mother, brother, and members of the stroke support group during this difficult time. Many stroke victims may find they are no longer able to walk or talk after a stroke. They might be paralyzed on one side of their body. They may find their ability to understand others difficult or impossible. They may face difficulty with grooming, dressing, eating, swallowing and many of the other basic tasks that are essential to maintaining their quality of life. Sometimes a person’s vision and memory may suffer, as well as the ability to read, write, reason or think. After Florence Moore had a stroke last December, she says she couldn’t understand what other people were saying to her. “I couldn’t even recall my own birthday,” she says. Once an avid piano player, Moore is now trying to regain use of the two impaired fingers on her right hand. In addition to many physical and mental limitations, a stroke may also cause emotional disturbances such as fear, anxiety and depression due to changes in physical, communicative or thinking abilities. Because a stroke can be a life-altering event, rehabilitation is critical to recovery. Rehabilitation helps stroke survivors relearn the skills that are lost as a result of the stroke. Rehabilitation helps patients rebuild physical strength and relearn how to perform the activities of daily living (walking, grooming, bathing, eating, etc.). The goal is to help the person return to activities that were once enjoyable (e.g., golfing, singing, reading). Rehabilitation also teaches stroke survivors new ways to perform tasks by compensating for disabilities. For example, people may need help learning how to bathe and dress themselves using only one hand, or how to communicate effectively when their ability to speak has been compromised. A good rehabilitation program is one that is well-coordinated, patient-focused and able to incorporate a multidisciplinary “team” approach. Team members will vary depending on the severity of the stroke and the patient’s specific needs, and may include the patient, his or her family members, physicians, speech language pathologists, occupational therapists, physical therapists, recreation therapists, nurses, dietitians, case managers, neuropsychologists, mental health specialists and vocational counselors. Rehabilitation begins in the hospital. Once a patient is stabilized (usually between 24 and 48 hours after the stroke), the process can start. Depending on family circumstances, the patient’s medical status and the severity of the stroke, rehabilitation may involve several different environments across a continuum of care. For instance, a patient may initially receive rehabilitation services in the acute care hospital and, once stabilized, may then transfer to an inpatient rehabilitation program. Once the patient masters certain skills, he or she may then be discharged and receive further therapy through home health or outpatient services. An intensive inpatient facility may be too aggressive for a patient with some specific medical needs; or, if a patient is very weak as a result of the stroke, he or she may need to access rehabilitation services via a long-term care facility. Initially, rehabilitation may focus on helping a paralyzed or weak patient move independently. Patients progress from turning over in the bed, to sitting up, to transferring from a bed to a chair, to standing, to bearing their own weight, to walking with or without assistance. Physical and occupational therapists encourage the patient to perform more complex and demanding activities such as bathing, dressing, toileting and using a stroke-impaired limb. Communication difficulties caused by a stroke may vary from person to person, as will the severity of limitations. A stroke survivor may have an occasional problem coming up with the right word (anomia) or may be completely non-verbal or have difficulty understanding what has been said (aphasia). The individual may exhibit slurred speech due to weakened speech muscles (dysarthria) or may have difficulty coordinating speech muscles to produce words (apraxia). Additionally, he or she may have difficulty recalling information or solving problems (such as what to do if the electricity goes out); it may also be harder for the stroke survivor to pay attention and concentrate. A speech language pathologist works with the stroke survivor to recover speech, communication abilities, memory and thinking skills. The patient may also be trained to use compensatory strategies to improve speech intelligibility, functional communication, memory and thinking abilities. A stroke survivor may also have swallowing problems (dysphagia). These also can range from mild to severe. The speech language pathologist will work with the patient to restore swallowing abilities through a series of exercises and compensatory strategies. At age 51, after going through a series of nearly unrecognizable “mini strokes,” James Hall suffered a major stroke that would ultimately take his ability to speak and swallow. Now, two years later, he still cannot read or write, and he still has speech deficits. But Hall finds encouragement through the support group, which he and his wife Lou Ann attend regularly. Hall is a great example of how despite a stroke’s debilitating effects, through hard work and determination (and assistance from a good rehabilitation team), a survivor can continue to lead a full and rewarding life.

Williamsburg Health Journal 4808 Courthouse Street, Suite 204 Williamsburg, VA 23188 757-645-4475 © 2007 RIAN ENTERPRISES, LLC