Recovery from stroke involves making changes in the physical, social and, emotional aspects of your life. You will make changes to prevent additional strokes as well as to facilitate your life-long recovery. It is normal to feel angry, anxious or depressed after a stroke.
Listen as Mary Dombovy, MD, helps you better understand your path to recovery and better health after a stroke.
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Stroke Recovery
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Learn more about Mary Dombovy, MD
Mary Dombovy, MD
Dr. Mary Dombovy is a neurologist at Rochester Regional Health and the Vice President of the Neuroscience Institute. She received her medical degree from Mayo Medical School and has been in practice for more than 20 years.Learn more about Mary Dombovy, MD
Transcription:
Stroke Recovery
Bill Klaproth (Host): Recovery from stroke involves making changes in the physical, social, and emotional aspects of your life, and making changes to prevent additional strokes, as well as to facilitate your lifelong recovery. And remember, it is normal to feel angry, anxious, or depressed after a stroke. Here to tell us more is Dr. Mary Dombovy, a neurologist at Rochester Regional Health, and the Vice President of the Neuroscience Institute. Dr. Dombovy, thanks for your time today. Can you talk about the approach that you take at Rochester Regional Health for stroke rehabilitation?
Dr. Mary Dombovy (Guest): Well, strokes affect people in several different ways. It can affect them in terms of their ability to walk or dress themselves. It can affect their speech. It can affect their memory. It could affect maybe just an arm, or it could affect an arm and a leg, or perhaps, a part of your face. The rehabilitation really begins with an assessment of what are the difficulties that each person is having. And then, based on what we find with that and what the person’s goals are – what do they want to return to doing – our therapy group, our interdisciplinary team, will come up with a program that’s specific to that patient.
Bill: Your team, then works together to coordinate patient care?
Dr. Dombovy: yes, the team is comprised of physical, occupational, speech therapists, a case manager, a dietician, nurses, physicians, consults from other people in the hospital as needed, depending on what circumstances the patient is in. For example, someone who has diabetes, or someone who has heart disease is going to require medical treatment as well as rehabilitation treatment to optimize their health.
Bill: And then, how do you communicate with the patient and the families since there are so many potentially moving parts to recovery?
Dr. Dombovy: Our patients are seen several times a day by the therapist. They’re seen every day by the physician team, and we meet as a team to also coordinate our services. We can explain to each other where the patient is having difficulties, what are the things that we need to focus on for that patient to return home. It could be some aspect of dressing; it could be – for example, learning how to get in and out of a car, or working with the family, and making sure that family can safely walk with the patient or move with the patient. Rehabilitation is extremely hard work, and the basics of rehabilitation are repetition.
We are learning, now, through something called functional MRI scanning that when you learn a new skill -- whether you’re a person who hasn’t had a stroke, and you’re learning how to play the piano, for example, or you’re a person who has had a stroke, and you need to relearn how to walk – as you repeat that activity over and over again, your brain actually changes in response to you learning a new task. In some ways, rehabilitation after a stroke is very similar to learning any new skill.
The problem is that you’re relearning things that you could do before, and that gets very tough when you have to repeat a specific activity over and over again -- that you used to take for granted -- to get it right. That leads, at times, to frustration and depression, and our team is very attuned to those things. We try to come up with tasks and activities that add a difference to what the patient is doing so that it doesn’t become routine and boring to them to accomplish.
In addition, it is very important to treat all the underlying medical conditions. As I mentioned before, diabetes, heart disease, many people who are older also have arthritis, and having a weak right leg could put a lot of extra stress on your left knee or hip and cause problems with that, or aggravate preexisting arthritis. It takes a very detailed assessment to understand each patient, and then one needs to devise an approach that takes all of that under your wing, and not just apply a boilerplate – well, we’re just going to do this, and do that – after a stroke, to each patient.
Plus, each patient needs – focus on different things. Some people may not have much in the way of physical problems, but struggle to speak clearly, or struggle to find words. The focus of therapy for those patients is different in that it would focus on mostly speech and language. However, that underpinning of repetition still holds true.
Bill: In general, then, what’s more challenging, the mental aspects of recovery, or the physical?
Dr. Dombovy: I think it depends on the patient. Some of us are prone to be a bit on the pessimistic or downside or maybe a little bit more anxious as our underlying personality, so then, depression, frustration, may hinder one’s ability to participate in rehabilitation. For other people, they’re the kind of people that – okay, this is a challenge in my life. I’m going to meet it head on; I’m going to move forward. I have great family support. And then, it’s really dealing with the physical aspects. Some of our most difficult patients have both physical and cognitive-behavioral issues, and that does present a special challenge to try and optimize what they can do and how independent they can be.
Bill: And I would imagine that families do play an important part of this. What is important to know for family members who have a loved one in stroke rehabilitation?
Dr. Dombovy: Well, number one, most patients do get better. Most patients who are in our rehabilitation do return home, and they return home to the point that they require what we call general supervision. Meaning, in the beginning, that first week or two when they’re home they need somebody to be in the house. They may not need somebody right next to them, but they may need somebody to observe them, and then if they need help, to provide it.
Recovery after stroke general continues for about six months to a year. It’s fastest in that first three to six months, and it’s critically important to get the intensive rehabilitation during those first few months after a stroke. We will work with every family so that they feel confident and safe in caring for their loved one who has had a stroke, and that they feel confident in understanding what they need to do, and also in understanding the things that they need to pay attention to medically to prevent recurrent stroke.
Bill: And can you briefly tell us about the amenities that patients and families will find at Rochester Regional Health?
Dr. Dombovy: Well, at Rochester Regional Health, we’re very fortunate due to a generous gift from Mr. Tom Golisano. We were able to build and open our new rehabilitation unit and move in three years ago. This is a unit that has all private rooms. The rooms include full bathrooms with showers. It’s got extensive space and equipment for rehabilitation, and we have many of our therapists, nurses, physicians, that have been here working in this field for ten, fifteen, twenty years. We have a lot of experience.
We also work with all of the schools in the Rochester area in terms of training for healthcare. This would include residents and medical students, physical therapy, occupational therapy, speech therapy, psychology, nursing, RIT, PA students, biomedical engineering students. We bring that new knowledge and excitedness that students have to our program, as well, which keeps us on the leading edge of new ad novel treatments in rehabilitation.
Bill: That’s wonderful, and thank you, so much, for sharing that with us. I think one of the most important things you said is stroke patients do get better, so there is hope, and that’s great to know. Dr. Dombovy, thanks again. You’re listening to Rock Your Health Radio with Rochester Regional Health. For more information, you can go to RochesterRegional.org, that’s RochesterRegional.org. I’m Bill Klaproth. Thanks for listening.
Stroke Recovery
Bill Klaproth (Host): Recovery from stroke involves making changes in the physical, social, and emotional aspects of your life, and making changes to prevent additional strokes, as well as to facilitate your lifelong recovery. And remember, it is normal to feel angry, anxious, or depressed after a stroke. Here to tell us more is Dr. Mary Dombovy, a neurologist at Rochester Regional Health, and the Vice President of the Neuroscience Institute. Dr. Dombovy, thanks for your time today. Can you talk about the approach that you take at Rochester Regional Health for stroke rehabilitation?
Dr. Mary Dombovy (Guest): Well, strokes affect people in several different ways. It can affect them in terms of their ability to walk or dress themselves. It can affect their speech. It can affect their memory. It could affect maybe just an arm, or it could affect an arm and a leg, or perhaps, a part of your face. The rehabilitation really begins with an assessment of what are the difficulties that each person is having. And then, based on what we find with that and what the person’s goals are – what do they want to return to doing – our therapy group, our interdisciplinary team, will come up with a program that’s specific to that patient.
Bill: Your team, then works together to coordinate patient care?
Dr. Dombovy: yes, the team is comprised of physical, occupational, speech therapists, a case manager, a dietician, nurses, physicians, consults from other people in the hospital as needed, depending on what circumstances the patient is in. For example, someone who has diabetes, or someone who has heart disease is going to require medical treatment as well as rehabilitation treatment to optimize their health.
Bill: And then, how do you communicate with the patient and the families since there are so many potentially moving parts to recovery?
Dr. Dombovy: Our patients are seen several times a day by the therapist. They’re seen every day by the physician team, and we meet as a team to also coordinate our services. We can explain to each other where the patient is having difficulties, what are the things that we need to focus on for that patient to return home. It could be some aspect of dressing; it could be – for example, learning how to get in and out of a car, or working with the family, and making sure that family can safely walk with the patient or move with the patient. Rehabilitation is extremely hard work, and the basics of rehabilitation are repetition.
We are learning, now, through something called functional MRI scanning that when you learn a new skill -- whether you’re a person who hasn’t had a stroke, and you’re learning how to play the piano, for example, or you’re a person who has had a stroke, and you need to relearn how to walk – as you repeat that activity over and over again, your brain actually changes in response to you learning a new task. In some ways, rehabilitation after a stroke is very similar to learning any new skill.
The problem is that you’re relearning things that you could do before, and that gets very tough when you have to repeat a specific activity over and over again -- that you used to take for granted -- to get it right. That leads, at times, to frustration and depression, and our team is very attuned to those things. We try to come up with tasks and activities that add a difference to what the patient is doing so that it doesn’t become routine and boring to them to accomplish.
In addition, it is very important to treat all the underlying medical conditions. As I mentioned before, diabetes, heart disease, many people who are older also have arthritis, and having a weak right leg could put a lot of extra stress on your left knee or hip and cause problems with that, or aggravate preexisting arthritis. It takes a very detailed assessment to understand each patient, and then one needs to devise an approach that takes all of that under your wing, and not just apply a boilerplate – well, we’re just going to do this, and do that – after a stroke, to each patient.
Plus, each patient needs – focus on different things. Some people may not have much in the way of physical problems, but struggle to speak clearly, or struggle to find words. The focus of therapy for those patients is different in that it would focus on mostly speech and language. However, that underpinning of repetition still holds true.
Bill: In general, then, what’s more challenging, the mental aspects of recovery, or the physical?
Dr. Dombovy: I think it depends on the patient. Some of us are prone to be a bit on the pessimistic or downside or maybe a little bit more anxious as our underlying personality, so then, depression, frustration, may hinder one’s ability to participate in rehabilitation. For other people, they’re the kind of people that – okay, this is a challenge in my life. I’m going to meet it head on; I’m going to move forward. I have great family support. And then, it’s really dealing with the physical aspects. Some of our most difficult patients have both physical and cognitive-behavioral issues, and that does present a special challenge to try and optimize what they can do and how independent they can be.
Bill: And I would imagine that families do play an important part of this. What is important to know for family members who have a loved one in stroke rehabilitation?
Dr. Dombovy: Well, number one, most patients do get better. Most patients who are in our rehabilitation do return home, and they return home to the point that they require what we call general supervision. Meaning, in the beginning, that first week or two when they’re home they need somebody to be in the house. They may not need somebody right next to them, but they may need somebody to observe them, and then if they need help, to provide it.
Recovery after stroke general continues for about six months to a year. It’s fastest in that first three to six months, and it’s critically important to get the intensive rehabilitation during those first few months after a stroke. We will work with every family so that they feel confident and safe in caring for their loved one who has had a stroke, and that they feel confident in understanding what they need to do, and also in understanding the things that they need to pay attention to medically to prevent recurrent stroke.
Bill: And can you briefly tell us about the amenities that patients and families will find at Rochester Regional Health?
Dr. Dombovy: Well, at Rochester Regional Health, we’re very fortunate due to a generous gift from Mr. Tom Golisano. We were able to build and open our new rehabilitation unit and move in three years ago. This is a unit that has all private rooms. The rooms include full bathrooms with showers. It’s got extensive space and equipment for rehabilitation, and we have many of our therapists, nurses, physicians, that have been here working in this field for ten, fifteen, twenty years. We have a lot of experience.
We also work with all of the schools in the Rochester area in terms of training for healthcare. This would include residents and medical students, physical therapy, occupational therapy, speech therapy, psychology, nursing, RIT, PA students, biomedical engineering students. We bring that new knowledge and excitedness that students have to our program, as well, which keeps us on the leading edge of new ad novel treatments in rehabilitation.
Bill: That’s wonderful, and thank you, so much, for sharing that with us. I think one of the most important things you said is stroke patients do get better, so there is hope, and that’s great to know. Dr. Dombovy, thanks again. You’re listening to Rock Your Health Radio with Rochester Regional Health. For more information, you can go to RochesterRegional.org, that’s RochesterRegional.org. I’m Bill Klaproth. Thanks for listening.