Cheryl Martin (Host): No one wants one, a stroke, but each year here in the United States about 800,000 people get one. Coming up next, what everyone needs to know about a stroke and how to recover from one, with our panel of experts here at Memorial Health System Ohio. Physical Therapist Amy Bowles, Occupational Therapist Taylor LeMasters, and Speech Language Pathologist Miranda Black. This is Memorial Health Radio with Memorial Health System Ohio. I'm Cheryl Martin. So glad all of you are on to talk about this important topic that impacts so many people. So Taylor, let me begin with you. Who is at risk for a stroke?

Taylor Lemasters, Occupational Therapist: There are several lifestyle and medical risk factors associated with a stroke occurrence. Some controllable risk factors include obesity, physical activity, increased drug, alcohol or nicotine use, high blood pressure and cholesterol, diabetes, and sleep apnea. There are also some risk factors that a person cannot control, and these include being above the age 55, being African American and Hispanic or being a male.

Host: Do you know why those particular ethnic groups are more susceptible?

Taylor Lemasters, Occupational Therapist: Just based on the anatomy, actually you are more at risk for having a stroke being male, but with being female, the severity of the stroke is higher.

Host: Amy, what types of stroke can we have?

Amy Boles, Physical Therapist: Well, I did want to mention that stroke is the common word that we use for the medical term cerebrovascular accident or CVA. And it's a medical condition in which poor blood flow to the brain causes cell death. And when a stroke happens, the types are the best kind, transient ischemic attack, TIA. That simply means it comes and then it leaves fairly quickly.

And the TIA is the ischemic, which I will speak about now, that is 87 percent of strokes are ischemic, and that's when a blood clot blocks blood flow to part of the brain, and brain cells begin to die in minutes. The brain tissue does not get oxygen and nutrients. So this can be blood clots, fatty deposits, or other debris that becomes lodged in the blood vessels of the brain.

And then the other type is the hemorrhagic stroke in which a blood vessel in the brain ruptures or breaks and it spills blood into those surrounding tissues. So when that happens, the blood increases pressure on the brain and the cells get damaged and die.

Host: What are the symptoms of a stroke, Miranda?

Miranda Black, Speech Language Pathologist: There are many different warning signs of a stroke, and they can vary in the symptom itself and in the severity. It's very important to recognize these warning signs and act quickly if you observe any of these. The traditional acronym for recognizing stroke symptoms is known as FAST, which stands for face, arms, speech and time.

The F stands for face. Ask the person experiencing the potential symptoms to smile. Does one side of the face droop? Is there facial symmetry? Or is there an observable change? The A in this acronym stands for arms. Arm weakness. If you raise both arms, does one arm droop or is one arm unable to move up? S stands for speech. Is the person's speech slurred or is it strange or different? Ask the person to repeat a simple phrase, such as counting to 10, or their name or address. Is the person's speech slurred or different from their usual speech? And the T stands for time. If you see any of these signs or symptoms, it is very important to act quickly in the event of a stroke.

It's also important to note the time that the first symptom started.

Additionally, if the symptoms have resolved, it is still important to seek out medical attention. If you experience any of these symptoms, do not wait and immediately call 911 or go to the emergency room. Like I said, even if these symptoms have resolved.

But now there is a new acronym that stands for BE FAST. The B stands for balance and the E stands for eyes. Be aware if you have any balance difficulty or changes or visual changes.

Host: Miranda, thank you for that. So really, the quickness has a lot to do, I'm assuming, with

the severity of the stroke and the quicker you get to the hospital can make a big difference, correct?

Miranda Black, Speech Language Pathologist: Yes, absolutely.

Host: So, Taylor, what does rehabilitation following a stroke look like?

Taylor Lemasters, Occupational Therapist: This really depends on the severity of the stroke and the deficits that a person is experiencing. But for example, while a person is in the hospital, it is likely the occupational, physical, and speech therapy will all come to do an evaluation to get an idea of what deficits a person is experiencing.

Once a person is medically stable, the therapist will then decide where they will get discharged to. And this can include their home, a skilled nursing facility, or an inpatient rehabilitation stay. If a person is discharged home, they will either get home health therapy in their own home or outpatient therapy locally.

If a person goes to a skilled nursing facility, they will get therapy at that facility until they're strong enough to go home, and then again they will get home health or outpatient therapy. If a person goes to inpatient rehab, this includes an intense rehab of three hours a day, six days a week, until they're strong enough to go home, and then again they will get home health or outpatient therapy.

We recommend that anybody that has a stroke, no matter how severe their deficits are, come see outpatient therapy at least one time when they're discharged home, just to ensure that they're fully capable of functioning in their home and their community.

Host: So, Amy, how is neurological rehab different from traditional rehab?

Amy Boles, Physical Therapist: There are a few similarities and that includes that each receive a thorough eval by a qualified therapist and then that therapist together with the patient develops the most effective treatment plan to remedy the dysfunction. Now the biggest difference in neuro versus traditional therapy is that in neurotherapy the central nervous system is affected, the brain, and that has so many subcategories, which I will mention in a moment.

With traditional therapy, it's usually one joint, one area of the body and the central nervous system is intact. With the central nervous system affected, that affects tone. Now, tone is how your muscles are at rest. There's hypertonicity where they're really tight or spastic is another word for that, or spasticity.

There's hypotonicity, which is, can be either low or flaccid, completely no tone. So the tone of the muscles is almost always affected with a stroke. Reflexes are also affected. And one of my favorite ones to give the example is we fall forward, we naturally put both hands forward to catch ourselves. That can be inhibited as well as balance reflexes.

So many different reflexes that are mediated in the brain. Those are not there. So, safety isn't there. Balance is almost always affected with a central nervous system deficit. And what we go back to and use in therapy is the developmental sequence that happens from birth to full development, wherein we start as babies, and we cannot do anything necessarily volitionally, and then we learn to roll, then we learn to sit up, we learn to crawl, we use those stages in adult therapy to build the building blocks that are going to be needed to return back to function.

So it's a whole body experience. Another thing that varies a lot is the time involved. For a traditional therapy treatment, it would be a few weeks, maybe to a couple months. In neurotherapy, it can be months to years, and previously, it was thought you are going to get all the return you're going to get within one year of your stroke, and thankfully, that's been found to be wrong, and there is no finite ending to the time you can make improvements, so your treatment can be years.

Many times, that is a therapeutic time in therapy for a few months and if you hit a plateau in your progress, then you'll take a break from therapy and when you notice more healing happening, you'll come back and resume and make further progress. Another thing that's different, I mentioned, is the body.

The entire body, head to toe, is involved in neurotherapy and typically, traditional therapy is, focuses on one part. The sensory issue is also very important in neuro, because many times people can't feel anything in the part they're trying to rehabilitate. That makes it very, very challenging because they might have motor function, they might be able to move it, but they can't feel it.

So that affects it terribly or they might be hypersensitive where everything that is against their skin is painful. Another thing that's very different is typically who's involved and usually with traditional therapy it's just the patient and with neurotherapy there can be family, caregivers, support group.

Early on there's the regular doctor, the physiatrist, the rehab nurse, dietician, all the therapists, pT/OT speech, also recreational therapy, social workers, psychologists, chaplain. It's a big deal and that's another difference in the therapies is this is a complete change in function. You're yourself until your stroke and then with your stroke you're a new person, and so you're learning to function in an entirely different manner, which takes all kinds of support, which is the last thing I'll mention in the differences. With stroke rehab or neuro rehab, we use a variety of durable medical equipment, and that can evolve over time of recovery from braces, to canes, to walkers, to wheelchairs, to special beds, and the list is endless, but there's a lot, lot more involved in neurorehab.

Host: Thank you Amy. What is a Certified Stroke Rehabilitation Specialist, or CSRS, Taylor?

Taylor Lemasters, Occupational Therapist: Yeah, so I am actually a certified stroke rehabilitation specialist. I got this certification back in June of 2023, and in order to obtain the certificate, you have to complete a series of seminars, including an online seminar, and then 3 days of in person classes and labs, discussions, 3 full days of in-person learning.

After this, you have to pass an online examination and then you obtain your certification. In order to keep this active, you have to complete extra continuing education specifically with stroke rehabilitation. And this will ensure that we have all the latest evidence based practice and research driven rehabilitation techniques for those patients who've experienced a stroke.

Host: Okay. Now, are there any support groups locally for patients or their caregivers after having a stroke? Miranda?

Miranda Black, Speech Language Pathologist: Yes, Memorial Health System actually provides a monthly in person stroke support group for patients that have experienced the stroke themselves and family members or caregivers. This group has been meeting for well over 10 years. And in July, we had the opportunity as a therapy staff to take over the planning and organizing of this stroke support group. We have really enjoyed this opportunity. As a therapy team, we get to walk alongside of our patients in their recovery process, but now we get to continue to support them, but in a different capacity. This support group meets on the second Tuesday of every month. It meets from 5 to 6 p. m. and it is located at the Frontier Outpatient Therapy Clinic, which is located at 158 Grove Street in Marietta.

The meeting includes social support, informational speakers and presentations, leisure activities, community outings, and more. We love to welcome new members, caregivers, and family members. It's also important to know that this group, even though it is facilitated by Memorial Health System, it is not specific to Memorial Health System patients, and we would love for new members to join us from all over the Mid Ohio Valley.

If anyone would like additional information about the stroke group, there is a Facebook page and it is titled MOV Stroke Support Group by Memorial Health System.

Host: Thank you for that. This has been a great conversation. You've provided a lot of information about strokes and as I was listening to you it just sparked even some additional questions on my end because I've noticed that some people can recover from a stroke and kind of go back to their normal life. Some seem to never recover or have multiple strokes. Why is that?

Taylor Lemasters, Occupational Therapist: We kind of all have talked about the severity of the stroke, depending on where the stroke occurs in the brain. Each part of your brain controls a different part of your body and depending on the time, the time it took you to get medical help, or the severity of either the bleed or the blockage, that can affect your recovery with the body.

It's important to know that the body still works and the brain still works, but when you have a stroke, it's the connection between the two that is interrupted. So just depending on how fast you got treatment and how severe that stroke is, it's harder to make that connection happen. And then some people get immediate recovery right after they get medical attention and some people it takes years. And unfortunately, some people might not ever get a hundred percent return of the body.

Host: So, is there anything a person can do to prevent them from getting another stroke?

Amy Boles, Physical Therapist: This goes back to the first question of who is at risk. We have all those lifestyle risk factors, that we can change. So if you have a stroke and have the ability to change things, for instance, if you smoke, stop smoking. If you're overweight, work on a program to get healthy. And there's a lot of great things that can be information on how to do that within our system. If you are a person who struggles with high blood pressure, work with your medical professional about that. If you're diabetic, work with your medical professional about that. And again, there's some really great lifestyle changes that have been proven to even reverse diabetes.

So there are great things you can do. Now doing all things, if you control every single lifestyle risk factor, it doesn't guarantee you won't have another one, but that is going to decrease your risk.

Host: That's great, Amy. Any other lifestyle changes that come to mind in addition to those that you mentioned? Even for those who've never had a stroke?

Amy Boles, Physical Therapist: The most Important thing I didn't mention as the therapist, activity. We got to be active.

Host: Anything else you would like to add as part of our dialogue today?

Miranda Black, Speech Language Pathologist: Something else that helps with the severity of the deficits is the importance of rehab. So we really like to get it in there as rehab specialists really early, you know, post day one, two, three of the stroke. And people that have early intensive rehab do seem to make better recoveries overall.

Host: Great. So, the more effort a patient puts into that, it can make a big difference then.

Miranda Black, Speech Language Pathologist: Absolutely.

Host: Amy Boles, Taylor Lemasters, and Miranda Black, thanks for your time and for sharing your expertise on this critical topic, strokes and stroke rehabilitation. Thank you so much.

That wraps up this episode of Memorial Health Radio with Memorial Health System. Head on over to our website at mhsystem.org/therapyservices for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other Memorial Health System podcasts.

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