Scott Webb (Host): Stroke survivors will often need inpatient and outpatient rehab following a stroke. And for family and caregivers, preparing their homes and supporting them throughout their recovery is essential. And joining me today to tell us how we can help stroke survivors once they return home is Crystal Davis. She's an occupational therapist with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Crystal, thanks so much for your time today. I was just mentioning that I have a family friend who just recently had a stroke. And so, I'm a little more familiar than I would normally be with inpatient rehab, outpatient rehab. And basically, we're talking today about how to support a stroke survivor at home.

So, let's talk about that. What are the main limitations that a stroke survivor will have when they return home?

Crystal Davis: Yeah. So, that truly depends on what type of stroke they had and what part of the brain was affected. They can have deficits such as hemiparesis, which is muscle weakness or partial paralysis on one side of the body; aphasia, which is like the inability to speak; impulsivity, neglect, ataxia, apraxia, like a lack of coordination, cognitive impairments; visual impairments, such as loss of peripheral vision, or diplopia, also known as double vision. But the list goes on. It really just depends on what part of the brain was affected.

Host: Yeah, I see what you mean, which type of stroke and which parts of the body were affected. And how can we as family members or caregivers of a stroke survivor best prepare homes for them? I know in the case of the person I was referencing, it was about like getting the rugs out of the way, right?

Crystal Davis: Most definitely. Yeah.

Host: The rugs and the toilet height and a bunch of different things. So, maybe you could take us through that.

Crystal Davis: Of course, of course. So, the best way to prepare the home for a successful transition is to modify your home to increase the overall safety of your loved one. That includes bathroom modifications, such as adding a shower chair, grab bars near the toilet and the shower, a handheld shower head, a raised toilet seat, toilet safety frame if needed, non-slip mats in the bathroom so that it's not slippery; bedroom modifications such as having railings for the bed, a hospital bed if needed, or a Hoyer lift if they're not able to transfer in and out of the bed on their own, a bedside commode if they're not able to actually ambulate to the bathroom on their own in the middle of the night; living room modifications such as eliminating throw rugs, loose cords, clutter, anything that can be a tripping hazard. You also want to install motion-activated nightlights. Good lighting is essential, especially if they have vision problems. A seated workspace for the kitchen, making sure that chairs that you have at home are not really low and that they have armrests because it'll be easier to transfer in and out of them, and then making sure equipment such as walkers and wheelchairs can fit through the doorways of the homes. And if not, you can actually take the door off the hinges and that can make the doorway a little bit wider so that wheelchairs and walkers can fit through them. And then also, maybe Installing a ramp if the patient is wheelchair-bound. Making sure all the stairs have railings. Doing so can help increase your quality of life and the overall safety of your loved one. But keep in mind that not everyone will need all this equipment or home modifications. It truly just depends on the severity of the stroke.

Host: Yeah, not everybody will need them and/or maybe not everybody can afford them, so you do what you can, you do the best that can, you know, for the stroke survivor. And I'm sure this varies, but generally speaking, how long will a stroke survivor need assistance at home after they've been discharged from the inpatient rehab?

Crystal Davis: So, like you said, it definitely varies. It truly depends on the severity of the stroke because some survivors will need more assistance than others. Some are able to fully recover, whereas others will have lifelong deficits. So, neuroplasticity is the brain's ability to rewire itself, and this is something that can continue on for years. For example, when you have a stroke, some of the connections in your brain can become damaged. However, the brain is an amazing organ and if you perform exercises, walk, talk, and continue to get stronger, the brain actually has the ability to make new healthy connections and rewire itself.

So when it comes to a stroke, I'll always say if you don't use it, you lose it, because the most important thing that you can do is to keep moving and to keep pushing so that your brain can continue to make those healthy connections.

Host: Yeah, the brain is amazing, isn't it? How it can sort of rewire itself.

Crystal Davis: Yes.

Host: And again, yeah, just generally speaking, will a stroke survivor need continued outpatient rehab, you know, well after they initially come home and sort of get acclimated to being at home?

Crystal Davis: Oh yeah, most definitely. Just because the patient has completed their inpatient rehab program does not mean that therapy is finished altogether. So depending on the severity of the stroke, we might even recommend a temporary subacute rehabilitation stay, home therapy if the patient has difficulty getting in and out of the house. But outpatient therapy will be most ideal, because it's forcing you to be more active by getting in and out of the house and plus they have a lot of equipment that can be beneficial in the recovery process as well.

Crystal Davis: just because inpatient rehab is finished doesn't mean that they're done healing. So, making sure that the patient is not only continuing therapy, but working on the home exercise program that their physical therapist, occupational therapist, and speech therapist gave them because it truly is essential for the best recovery. Making sure that the family fully understands what's going on and what kind of stroke they had and what their deficits are. So prior to being discharged from inpatient rehab, the family will actually participate in a family training where we educate the family on how to transfer their loved ones, how to use a gait belt if needed, performing passive range of motion if needed, education on positioning of their extremity if they need to use a splint, positioning when they're sleeping, how to put on orthosis, and then how they use their equipment to ambulate, whether that's using a cane, a rolling walker, a rollator, a hemi walker, a platform walker, et cetera. Educations on signs of another stroke, because once you've had one, you're at a higher risk of having another one, and to get to the hospital as soon as possible if you do notice signs of a new stroke.

But yeah, it can really be overwhelming and it can be a lot. So, education on support groups for the patient and the loved ones as well to make sure that the caregiver is taking good care of their health as well because taking on this type of responsibility, it can be a difficult journey.

Host: For sure. Yeah, then that's the experience of the person I was mentioning to you, you know, just that responsibility. And the person whom I know who's taking care of that person is in her mid-70s and she just had her hip replaced. And so, you know, some of the things you're talking about, I might be able to help, but she's having trouble.

And so, yeah, just education and support and everybody doing their best, you know, to try to help the stroke survivor. Good stuff today. Just want to finish up here, any additional advice you have for family members and caregivers when it comes to the stroke survivors and their return to home?

Crystal Davis: Just kind of reiterating what I said before, just, you know, making sure that you're well-educated on everything that's going on, making sure they have the correct equipment, making sure they have all the help that's needed because, like I said, it can be a difficult process and just making sure you're taking care of yourself as well because, you know, as a caregiver, that can also affect your mental health. So, you don't want to bring your health down as well trying to take care of your loved one. You really want to make sure everything is in order and you really do have that good family support and whatnot.

Host: Yeah, that's so right, right? You're trying to help the stroke survivor, but you also need to look out for yourself and allow yourself a little time to breathe and grace and all of that. Yeah, so like I said, good stuff today. Thank you so much and you stay well.

Crystal Davis: Thank you so much. You too.

Scott Webb: And to learn more about inpatient rehab, visit franciscanhealth. org and search inpatient rehabilitation.

Host: 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.