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Recovery and Rebounding After a Stroke

In this episode of the Better Edge podcast, Sonia V. Sheth, MD, medical director of the Northwestern Medicine Stroke Rehabilitation Program at Marianjoy, discusses symptoms and recovery after stroke. She talks about the effects of stroke on patient speech and cognition, including aphasia, and how rehabilitation plays a key role in the recovery process.
Recovery and Rebounding After a Stroke
Featured Speaker:
Sonia Sheth, MD
Sonia Sheth, MD is a Physical medicine & rehabilitation specialist. 

Learn more about Sonia Sheth, MD
Transcription:

Melanie: Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And joining me today is Dr. Sonia Sheth. She, She's a physical medicine and rehabilitation specialist and the Medical Director of the Stroke Rehabilitation Program at Northwestern Medicine's Marionjoy Rehabilitation Hospital. She's here to discuss recovery and rebounding after a stroke.

Dr. Sheth, it's a pleasure to have you join us today. I'd like you to start by just telling us a little bit about yourself and your role as the medical director of the Stroke Rehabilitation Program at Northwestern Medicine's Marianjoy Rehabilitation Hospital.

Dr. Sonia Sheth: Thank you for having me, Melanie. I've been working now as a stroke medical director at Marianjoy for approximately two years. We have almost 40 beds dedicated to stroke patients. Patients who've just had their stroke, they will transfer over to Marianjoy and stay for approximately two to three weeks, and receive an aggressive rehab program before they return home.

Melanie: So Dr. Sheth, recently, strokes and the residual effects on an individual's speech and cognition have been really in the news. When someone's speech is impacted following a stroke, does that also necessarily follow that their cognitive abilities are also affected? Speak about that just a little bit.

Dr. Sonia Sheth: So, it really depends on the location of the stroke. A patient's cognitive abilities might be intact or it could be damaged due to the stroke. But I often see patient's cognitive abilities 100% intact. It's just difficulty with expressing themselves. So, it can vary depending on where the stroke is.

Melanie: Stroke is so interesting. What you do is so interesting. So, can you explain a little bit about aphasia? Is that considered speech or cognitive? And how is that treated? Tell us a little bit about the Aphasia Center.

Dr. Sonia Sheth: So, aphasia is a language disorder, which affects a person's ability to communicate. They may have trouble speaking or they may have trouble understanding others when they are being spoken to.

So, we do have a wonderful Aphasia Center here at Marianjoy. It's led by a speech therapist who is an expert in language disorders. Her name is Michelle Armour and she's been doing it for many years now. Our Aphasia Center here at Marianjoy is designed for any patient who suffers from aphasia, whether that's from a stroke or traumatic brain injury. And the stroke may have occurred five years ago, and that aphasia may be chronic or it can be for somebody who has recently had a stroke.

Each session goes for about 11 weeks. They meet once a week and they do so many fun activities with these patients who have aphasia such as book club or music club and conversation club, or they just kind of meet together and play games. It seems like a really nice group of people who get together and I think there's some solidarity and some therapy just in getting together with other patients who have aphasia as well.

Melanie: That's a good point. Are there some situational factors that can further exacerbate symptoms for a patient with speech or cognitive issues that follow a stroke?

Dr. Sonia Sheth: Yes. So somebody who's suffering from aphasia after a stroke, if it's the end of the day, their aphasia may worsen. They just get tired, they fatigue easily. So, that can exacerbate their aphasia or stress can definitely cause the aphasia to worsen. And if there's a lot of pressure on the patient at that time to kind of speak quickly, that can be difficult for them.

Melanie: One of the things I find most fascinating, Dr. Sheth, is about the brain and how it heals. Can you speak a little bit about that? Tell us about neuro rehab and neuroplasticity and how long that healing process may take. Are there things that can help speed up that process? Speak about that fascinating form of brain healing.

Dr. Sonia Sheth: I agree. It's super fascinating and really interesting and so amazing. The brain definitely is able to heal after a stroke. What it does is it's called neuroplasticity, and it's essentially rewiring itself. It's making new connections inside the brain with healthy areas of the brain.

So after a stroke, like I had mentioned in the beginning, patients will come to acute inpatient rehab if they qualify and insurance approves and all these things. And they will start working with a speech therapist and a physical therapist and occupational therapist. And by performing repetitive activities, this will facilitate neuroplasticity and help the brain rewire itself and make those connections.

We have this amazing center, it's called the Tellabs Center for Neuro Rehab and Neuroplasticity here at Marionjoy. And we're so fortunate because the patients are able to work with robotic devices and virtual reality and a lot of really high technology things to help our patients continue to recover after a stroke or traumatic brain injury and develop those connections once again and help the brain repair itself. In the recovery time, the first month is very, very important, but it's usually six months to a year, but it can go on for many years. Every brain is different, every person recovers at a different time, but the first month is essential.

Melanie: Yeah. Again, that's so interesting. So, I'd like you to transition now, Dr. Sheth, to stroke rehab overall. When does that begin? Tell us some of the steps that you take to help stroke patients work towards independence, the type of providers that are involved and how the physical symptoms may be separate from the person's cognitive abilities, which makes this even more of a comprehensive way to rehabilitate somebody who's suffered a stroke.

Dr. Sonia Sheth: Yes. So, we have our acute inpatient rehab. After a patient has a stroke, they will transition over to an acute rehab facility. When they start acute rehab, they will work with a physical therapist, occupational therapist, speech therapist, a physiatrist and a neuropsychologist. The physiatrist is the physician. The neuropsychologist is there to kind of help with the coping and stress after a stroke. The physical therapist works mainly on the lower body to work on walking and ambulation and stairs. The occupational therapy works with the patient on their activities of daily living, such as going to the bathroom, brushing their teeth, feeding themselves. And the speech therapist works on their cognitive abilities as well as their language and aphasia if they have that after their stroke. This is typically a three-week stay where the patient works three hours a day up to 15 hours a week with all of those disciplines.

During that time, we really try and get the patient's family in to kind of see what the patient will need, what type of equipment they'll need during the return home, and try and organize everything.

As a physiatrist, that's who I am, I kind of oversee everybody and answer all the medical questions a patient may have or the family may have and manage the medical issues that may occur during their rehab stay. And I also communicate with the neurologists and any of the physicians that were involved prior to them coming to the acute rehab. So, it takes a village to get someone home. But it's really nice to be able to see people go home from here and get the therapy that they need to make them successful. But it doesn't stop there because it goes on then to the outpatient rehab. After inpatient, they'll transition hopefully over to day rehab or our outpatient program here at Marianjoy.

Melanie: Such a comprehensive approach. And as we wrap up, can you leave us with one parting piece of information for providers who are listening and this multidisciplinary approach at Northwestern Medicine's Marianjoy Rehabilitation Hospital when it comes to recovery and rebounding after a stroke.

Dr. Sonia Sheth: So, improvement can be seen for months to years following a stroke. Stroke rehab is an ongoing process. It's not something that's going to get better overnight. It takes time. Patients will have setbacks, a urinary tract infection or they'll have another stroke. So, continuing rehab is a part of their life now. So, it's very important to have patients continue to do therapy and to see their stroke physiatrist after they've had a stroke or traumatic brain injury, and just to check in to make sure things are still going well.

Melanie: So important. Thank you so much, Dr. Sheth, for joining us today. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/rehabilitation to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians. Please always remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.