Scott Webb (Host): It's very common for stroke patients to spend some time in an inpatient rehab unit. And Franciscan Health Physical Therapist Sandy Lim is here today, and she's here today to tell us what patients can expect in a typical day on the Stroke Inpatient Rehab Unit.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Sandy, thanks so much for joining me today. We're going to talk about a typical day for a stroke patient in the inpatient rehab unit. So, let's start there. What services are provided in an inpatient rehab unit?

Sandy Lim: An inpatient rehab unit is overseen typically by a medical doctor, usually a physiatrist or more commonly known as a rehab doctor. Sometimes a nurse practitioner will also be present to help the doctor. We have case managers and social workers to help with insurance, discharge planning, as well as community resources. The dieticians are present. They help make sure patients are getting all their nutrition to be able to heal correctly and have enough energy then to participate in therapy. And then, the bulk of it comes from physical therapy, occupational therapy and speech therapy.

Physical therapists typically work on walking, balance, leg strengthening and stairs, basically the ability to move around. Our occupational therapists work on what we call activities of daily living, which are basically the things we need to do to take care of ourselves. So, they will work on bathing, dressing, toileting, even managing in the kitchen or doing laundry, as well as upper extremity or arm exercises. They also work on visual issues that may arise because of the stroke. Then, speech therapy works on what it sounds like, speech therapy. But that's actually only a small portion of what they do. Speech therapy also works on swallowing with patients who develop swallowing issues from external causes or internal causes like stroke or cancer. They also work on cognition, things like memory or attention and problem solving. And then, of course, in our unit, we have wonderful and amazing nurses that we couldn't do without. And because we are part of a hospital and are healthcare professionals, you also can have other healthcare professionals come on board, people like neurologists, cardiologists, nephrologists as needed, depending on the patient's needs.

Host: Yeah. It really sounds multidisciplinary and comprehensive and really awesome. And I know you specialize in working with stroke patients. So, why is it important for stroke patients to receive treatment in a quality inpatient rehab unit?

Sandy Lim: A stroke typically causes brain cells to die, and that's usually what causes all the issues afterwards that we would see. The majority of stroke recovery, however, occurs within the first one to three months after a stroke. After about six months, recovery continues, but it's at a slower pace. So, rehab as soon as possible after a stroke is very important. This is why any type of rehab is recommended right after a stroke.

But stroke recovery is also based on neuroplasticity. And neuroplasticity is the brain's ability to form new neural connections. This is actually something that occurs throughout the whole life, not just after strokes. But neuroplasticity is the reason rehab on an inpatient rehab unit is so important.

On an inpatient rehab unit, patients can receive at least 15 hours of therapy a week, usually in the form of three hours of therapy per day, five days a week. The more intensive the rehab is, the more neuroplasticity occurs. The more frequent the therapy occurs, the more neuroplasticity occurs, and so you get better recovery.

Another aspect of inpatient rehab is the individual plan of care. For example, a patient who has no cognitive issues, but only physical impairments, would not necessarily need speech, and so they would instead receive 90 minutes of PT and 90 minutes of OT. Whereas a patient who has more speech or cognitive impairments, but less physical impairments, they may instead receive 90 minutes of speech therapy, 60 minutes of occupational therapy, and then only 30 minutes of physical therapy. This allows patients to really focus their treatment on their specific needs and to really make improvements in the areas they need to improve in.

And because of this individualized plan of care, we also have then interdisciplinary team meetings where all the Team members who work with that specific patient meet weekly to discuss goals, issues and plans. And then, that's where things like followup therapies, maybe to home health or outpatient and even family training is set up to ensure that patients continue to improve and recover, even when they discharge here and that they can return home safely.

Host: Yeah, I love that it's really customized to the patient. It's patient-specific, not a one-size-fits-all. So, tell us about a typical day for a stroke patient in the unit.

Sandy Lim: A typical day begins with breakfast, 7 a.m. That's usually when patients are eating breakfast. A patient with a stroke may then have their first therapy, say, at 8 a.m. Let's say it's occupational therapy. And then in OT, they may then work on showering, dressing, toileting during that session, or they may work on activities to increase use of their stroke-affected arm. The session may last an hour, let's say. The patient then would probably return to their room around 9:00 and their nurse may be in there getting their morning meds ready to give to them around that time. Their next therapy may not start until about 10:30. But until that time, patients may complete other tasks like speaking with a dietician, ordering their meals for the day or speaking with doctors that might be rounding on the unit at that time.

At about 10:30 in the morning, their speech therapist may arrive for a 30-minute session to, let's say, work on swallowing. Maybe they'll trial different kinds of foods or different liquid textures, to work towards improving and returning towards a regular diet. Then, lunch is at noon on the unit typically. Patients may also receive their afternoon medicines around that time. And then, at 1:00, let's say, the physical therapist comes by to work with them. And for the next hour, they may work on walking, stepping, stairs, working on balance activities.

After a short break, speech therapy may arrive again at 2:30 to do another half an hour session and they may work on cognition at that time. So, things like working on problem solving with memory cards or medication management or just memory or recall tasks. Then around 4 p.m., patients then receive their therapy schedule for the next days, letting patients know what time to expect their therapist and to be able to be ready for them. And then, dinner time's at 5, and then they have the evening to then relax and get ready for bed.

Host: Yeah, it's awesome. It's nice. I'm sure they appreciate knowing what's in store the next day. Kind of get, you know, mentally and physically prepared for that. And it's been really good today. It's always good to hear what services are available. And I'm sure listeners appreciate it as well. Just want to give you a chance here at the end, what's your favorite part about working with patients in the Inpatient Rehabilitation Unit?

Sandy Lim: My favorite part of working with patients on inpatient rehab has to be the progress that you get to see, the improvements that patients make while they're with us. It's great to see a patient who has speech issues. Maybe they arrive and they really can't say anything at all. And then towards the end of it, they're speaking small sentences, saying words. Sometimes I even hear them singing in their rooms when I'm walking by. I've also had patients who have their arms affected after a stroke and their arms don't move. And then, one day, I walk in and they wave at me and I'm like, "Oh my goodness, your arm moved." Or they wave to me as I'm leaving and it's so good to see.

And then, as a physical therapist, since I walk with patients a lot, I do a lot of walking training, it's great to see them take like one or two steps that maybe that first day or that first week. And then, by the time they leave me, they're walking 300, sometimes even 500 feet, making laps around the unit. And we even have sometimes patients come back months to years later and then we really get to see all the progress that they've made over that time and they want to show off. They want to show all the things that, "Oh, do you remember I couldn't lift my arm? Look at this now." And they raise their arm up in the air and they want to show all the things that they can do and sometimes they're not walking with anything and they get to show us that and it's such a great feeling to see how much progress they make and it really makes me happy to see them get so much better.

Host: I'm sure it does. It's great for them, obviously these milestones and accomplishments and just really gratifying for you and the entire team there at Franciscan Health. So, thanks so much. You stay well.

Sandy Lim: Thank you very much.

Host: And to learn more about inpatient rehab, visit franciscanhealth.org and search inpatient rehabilitation. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.