Transcription:

Scott Webb (Host):  Dealing with the effects of a stroke can be both challenging and confusing. We’re here today to talk about how rehabilitation can help you after a stroke. My guests in this panel discussion today are Physical Therapist Allison Yemm, Speech Language Therapist Lyndi LeMay, and Occupational Therapist Brianne Hamstra; all of whom work for CGH. This is the About Your Health Podcast from CGH Medical Center. I’m Scott Webb. Ladies thanks for joining me today. Allie start things off, what’s involved in stroke rehabilitation?

Allison Yemm, PT, DPT (Guest):  There are many approaches to stroke rehabilitation. It really depends on the patient’s body part or type of ability affected by the stroke. But here, we look at physical therapy, we have an occupational therapist and a speech therapist. Everybody does an evaluation and from there determines what is important for the patient to work on.

Host:  That’s great to know Allie that there’s a full evaluation done. And Brianne how soon after a stroke can people begin rehabilitation?

Brianne Hamstra, OTR/L, CLT (Guest):  Typically, it’s within the first 24 to 48 hours after you have a stroke. But the most immediate concern is to make sure that the person’s medical condition is stabilized and any other life threatening things that are happening and also to prevent any other strokes. But really, within the first 24 to 48 hours after a stroke is usually when you start in the hospital.

Host:  I had no idea that rehab could begin so soon after a stroke. That’s amazing. And Lyndi, where does rehabilitation take place?

Lyndi LeMay, MS, CCC-SLP (Guest):  Well we are very lucky here at CGH to have several different facilities. Right away we want to start with the stroke rehab as soon as possible in the inpatient setting if possible, if the patient is here at CGH. Once they discharge from the inpatient setting, there are a couple of different options. If the patient is able, we are able to se them at our outpatient facility on Locust Street which again, offers both physical therapy, occupational therapy and speech therapy. Or we also offer home care services. So, we could see the patient actually in their home if they are unable to get out to one of our facilities.

With our home care, we also offer speech therapy, occupational and physical therapy.

Host:  That’s so great to know Lyndi that not only do patients come to you but you all will go to them as well. That’s really cool. And so, Brianne, how long does stroke rehab usually last?

Brianne:  That’s really variable patient to patient. It kind of depends on how severe the stroke was, if there is any other complications, but when they meet with the therapist for the first time; goals will be set for each specific discipline and then they have a timeframe associated with them and kind of once you meet the goals; either new ones can be set or if for whatever reason you are not meeting goals; they can be kind of revamped so to speak. But it’s very variable. Sometimes it could be a couple of months, it could be longer than that. So, it’s very variable person to person.

Host:  Yeah, it does sound like it’s variable and flexible and does give people something to shoot for but can always be adjusted later. So, Allie, who participates in CGH’s stroke rehabilitation?

Allison:  There is always a primary care physician or a neurologist who is kind of in charge of everything. But there’s also nurses that participate in acute or inpatient rehabilitation like we’ve kind of talked about, physical, occupational and speech therapists that all work with the patient. In the hospital, the patient will also have a social worker that helps them determine where they go from the hospital, whether that’s home or to skilled nursing facility. There are psychologists and then the most important thing is the patient and the patient’s family or caregivers. We want to make sure they are getting what they need and are set up for what they need.

Host:  And Allie, staying with you, what does physical therapy focus on during stroke rehabilitation?

Allison:  Physical therapy really focuses on the gross motor skills affected by the stroke. So, when a person comes in, we automatically look at how they are walking, or if they are in a wheelchair; how do they sit in their wheelchair. We look at how they stand. Are they able to stand without an assistive device? Are they able to balance? We look at how they can transfer in and out of bed or with toileting. We look at their coordination. We check their sensation, reflexes. We check range of motion and make sure that they have enough range to be able to stand up or walk. I think strength is always the one that people think about first. But that is also something we look at, not necessarily the most important for stroke rehab.

The most important is always what the patient’s main goal is. And oftentimes it’s getting back to walking. So, that’s usually it’s taken care of first.

Host:  That sounds great Allie. It does sound like families really do help with setting and reaching goals. So, Brianne how does occupational therapy help patients after a stroke?

Brianne:  We help people regain skills that they need to do for either their basic daily tasks or any sort of extra stuff that they do at home. So, it may be like helping them relearn to get out of bed or cooking, laundry. We also can help them learn how to do things like leisure tasks like painting or playing an instrument or if it’s that they were working before they had a stroke; we can kind of adapt any sort of environment so they can help go back to work. We also focus on rehabbing if they have had any upper arm issues, we work on that. Any sort of visual deficits we can focus on those as well. Lyndi and I kind of overlap with the speech therapy as far as working on the memory or cognitive problems that somebody may have following a stroke. We can go to your home and kind of do a home assessment, kind of make sure your environment is safe. Adapt anything. Set things up for you. Provide any sort of equipment. Sometimes people use adaptive equipment after they’ve had a stroke to kind of help be more independent. So, we recommend things like that. Any sort of caregiver training with family; that’s usually a big part of it as well.

Host:  Yeah, I see Brianne. It’s not just that you are helping people with their occupations, but you are really helping them to do all the things they need to do. When we think of the effects of strokes, we usually probably think about speech being affected, so Lyndi tell us about how speech language therapy can help people.

Lyndi:  I think a lot of people when they hear speech language therapy just think of the speech aspect and slurred speech and difficulty with word finding, things like that. But we really offer so many more services than that. We definitely do work with slurred speech and can provide exercises and different things to help strengthen those muscles again and coordinate their movements. But we also like Brianne mentioned, work with cognitive aspects following a stroke as well. Some patients notice memory changes or difficulty with executive functions. Organizing tasks, or even getting started with a task. So, we work in all areas of cognition as well. We’ve also provided patients following strokes with speech generating devices.

So, some patients end up losing the ability to speak and communicate all together. And they benefit from a device that actually speaks for them. So, we can train the patient and the family on using those devices, some of them being high tech devices like the use of an iPad or computer system. Some of those are even lo tech devices where it’s just a picture board and things like that that they can use pretty basically with their family and physicians and whoever they may need to communicate with on a daily basis.

And last, but not least, we work with swallowing. And a lot of patients following a stroke may notice changes with swallowing because some of those nerves and muscles are affected. So, we can assess the patient’s ability to swallow and how that function is working. We can make modifications to their diet. We can provide swallowing exercises and different strategies that can keep them safe and hopefully prevent them from developing aspiration pneumonias and different things like that.

So, speech therapy is kind of an all encompassing therapy that a lot of people don’t necessarily realize.

Host:  You all are doing such amazing work at CGH. What else can we tell people before we end today?

Brianne:  I think we are really lucky that we have therapy settings in the hospital. We are able to see people in their homes and able to see people in an outpatient basis. So, it kind of helps familiarize people with our faces. Sometimes people get comfortable with us, familiar with us, they trust us and we’re able to see them transition from place to place and really get to see how well they improve. So, I think that’s really important that we’re able to kind of show that continuum of care across a variety of settings.

Allie:  I would just recommend patients and family members and caregivers of patients if they have any concerns following a stroke; don’t hesitate to bring those concerns up to their physician or neurologist or whoever they may be working closely with just to get the services that they need. Because they are definitely out there.

Host:  That’s well said Allie. Thanks all for being on today. if you or a loved one is in need of stroke rehabilitation, please call CGH Rehab at 815-622-1210. For more information, visit www.cghmc.com. And thanks for listening to this episode of About Your Health from CGH Rehabilitation. I’m Scott Webb. We’ll talk again soon.