Transcription:
Acute Rehab After Stroke

Melanie Cole (Host): Many, if not most stroke patients need additional care after their stroke in order to maximize their recovery and return home and it’s really helpful for families and patients to understand the different levels of care so that they can make the best choices for them. My guest today, is Dr. Stefan Humphries. He’s a physiatrist and the Medical Director of the Rehabilitation Institute at Palmdale Regional Medical Center. Dr. Humphries, tell the listeners first what is a physiatrist?

Stefan Humphries, MD (Guest): So, many people don’t actually know what a physiatrist is. Sometimes I’m referred to as a podiatrist, sometimes I’m referred to as a physical therapist, but a physiatrist is a physician that specializes in physical medicine and rehabilitation. So, we actually take care of patients who have had catastrophic injury like stroke and spinal cord injury and traumatic brain injury, and our goal is functional recovery or functional restoration. On the outpatient side, we see a lot of patients with musculoskeletal injuries, neurologic injuries and help them to return back to some normal functioning in their lives.

Host: What I love about that is that you are helping people to come back from those catastrophic injuries as opposed to just treating them. So, it’s kind of a very positive field of medicine. When we are talking about stroke, Dr. Humphries, what are some of the most complicated stroke complications that you see as a result?

Dr. Humphries: Well, it depends on what kind of impairment an individual is left with after stroke. Sometimes it has to do with their ability to speak. Sometimes it has to do with their ability to swallow. Other times, it’s related to their functional mobility and things that we take for granted, the ability to do self-cares and sometimes it’s all of the above. So, each stroke presents a little differently. And then of course, there are medical comorbid conditions that we also have to treat during the course of their rehab stay.

So, that’s what makes it really so interesting to me is that everybody presents a little differently and they all come in with a kind of a different challenge for the rehab team.

Host: Since it is so different for each patient, what’s involved in the assessment for poststroke to determine what type of rehab they even need?

Dr. Humphries: Well it usually starts off with a referral to the rehab department and a physician like myself will usually go see the patient and evaluate the patient to see if they are appropriate for an acute inpatient rehab stay versus continuing their rehab as an outpatient or with Home Health. The post-acute continuum includes all the above in addition to skilled nursing facilities. So, some patients actually are fairly low level and may start off in a skilled nursing facility before they come to an acute inpatient rehab facility.

But I use my Gestalt as a physiatrist to determine whether or not the best post-acute option is one of the above, whether it’s acute inpatient rehab versus skilled nursing facility versus home with Home Health Services versus home with outpatient physical therapy. Additionally, I work with usually a nurse liaison who has the ability to look into the psychosocial aspects of the patient that we are considering, talk to the family members and see what kind of support they have at home. That helps me make my decision.

Host: One thing I’ve learned over the years as an exercise physiologist Dr. Humphries is like in cardiac rehab, that begins right after an event. I mean get them up, walk them around. When does stroke rehab begin? Does it take a little while? Is there a recovery rest period or does rehab start right away?

Dr. Humphries: It really starts fairly rapidly. Doing the assessment, when you come into the hospital, usually the Emergency Room with a stroke, you may see a speech therapist who is looking at your swallowing mechanism to see if it’s been affected by the stroke. Most of our stroke patients actually admit to us within two days to a week of having the stroke, depending on what kind of acute medical complications they have; and we are getting involved with them earlier and earlier as the evidence shows that to optimize recovery after stroke, starting these acute therapy interventions is very important.

Host: Now a person is looking towards rehab. As they are looking, whether it’s acute and inpatient or as you say in-home or outpatient; what are some of the factors? Before we talk about some of treatments and technologies that you have to use; what are some of the factors that people tend to look for as far as maybe geography or facility characteristics? What are people looking for when they’re looking for an acute stroke rehab?

Dr. Humphries: They are looking for a facility that has some expertise in stroke rehab. Usually it’s affiliated with an acute hospital that actually is a stroke center of excellence and so you want to look for that experience when you are subjecting yourself to an acute inpatient rehab intervention so that you can optimize your outcome. Sometimes it’s very relevant that that patient go to a facility that’s within a comfortable area for their loved ones to be a part of that rehab process. That support is very important as you try to determine that safe transition to home after acute inpatient rehab or after an acute hospital stay with a stroke that may not require acute inpatient rehab. So, that social support is integral in trying to determine a plan to transition that patient back to independent living.

Host: Many people have attended physical therapy before Dr. Humphries, but it’s a little bit different and as you say, each stroke is different. What might some of the treatments at acute rehab look like as far as motor skill exercises, or mobility training. There’s technology assisted physical activities. Tell us about your facility and all the cool things that you have available.

Dr. Humphries: Well the facility that I work at is fairly new and it’s been well-thought out in terms of an acute inpatient rehab facility. All the rooms are individual rooms that accommodate patients with different kinds of functional deficits. We have an overhead track system that if a patient is not able to walk, we can actually move them around the room within the confines of the room both safe for the patient and safe for the provider. We have large bathrooms that accommodate adaptive equipment that a stroke patient may use including a wheelchair.

We have some weight supported devices that help us to mobilize the patient in an effort to provide the optimal rehab care to promote functional recovery with mobility. I think that some of the devices that we have to promote neuro reeducation of the extremity that’s affected include electrical stim devices, that help promote recovery. And we are always looking to continue to develop ways to promote recovery with new technology so, every year, there’s different technology that comes out and some of the technology may be cost prohibitive compared to the potential outcomes you might see with it. But it’s always in our budgeting process to consider newer devices that actually will help our patients recover quicker.

Host: It’s really an amazing field that your in Dr. Humphries and when we think of the physical therapy that’s involved in acute rehab for stroke; people that suffer a stroke also have cognitive and emotional setbacks. Certainly, it’s a big issue. So, does acute rehab help with some of those issues as well?

Dr. Humphries: Absolutely. I mean I think you hit on a very important point. If somebody has a catastrophic event, you are probably seeing that person at their most vulnerable time in their life. So, what’s great about rehab or a couple of things. Number one, it treats the whole person. Not only the physical self but the psychological and social self as well. So, a lot of these patients do come to us with a sense of loss because of the impairments that they have and as a result, do develop depression or an adjustment reaction to that disability.

Additionally, you have family members who are distraught by the catastrophic event and want to be a part of that patient’s recovery so of course, those family members don’t actually know what they don’t know. So, we help them with caregiver training and training about all aspects of stroke including how to prevent another stroke and, in that way, they are a part of the process.

So, not only are you treating the patient, but you are treating the patient’s loved ones and family. Additionally, it’s a multidisciplinary interdisciplinary approach to care so, the team members usually include in addition to the physiatrist, physical therapists, occupational therapists, speech therapists, recreational therapists to help with reintegration into a normal lifestyle, into society. Psychologists, rehab nursing, therapy aides, and other specialists that may be involved in that care as a result of the medical complications that continue to potentially exacerbate during their hospital course.

So, at any time, a stroke patient may have up to six or seven clinicians working with them as their rehab team. Again, thinking about treating that whole person, not only does the team include those clinicians, it includes the actual patient and their family members. So, every week, in most acute inpatient rehab facilities; there’s a team conference where you get together with the rehab team, the patient’s family, and most importantly the patient and give them an update on how they’ve done over the last week.

And talk about barriers to discharge, talk about barriers to continued recovery, talk about what’s working, what’s not working and so, that conversation leads to more trust, more respect for what everybody is doing and what the patient is going through and inevitably, it seems like you are forming this family. And that’s again, what also is so special about the vision of rehab services is that you really get to know these patients to the extent that you become somewhat of an extended family for them.

Host: What a wonderful program that you have Dr. Humphries and you got to some of my questions before I asked them as far as the providers in your multidisciplinary approach and you told us about your team. Wrap it up for us. What would you like listeners to take away from this segment if they have a loved one or they themselves have suffered a stroke about what they can expect with acute rehab and recovery and really what it looks like. Give us your best advice Dr. Humphries.

Dr. Humphries: So, first and foremost, having had a family member that had had a stroke, make sure that as a family member, as a stroke survivor that you work to educate yourself about why you had the stroke and how to prevent yourself from having a recurrent stroke. And then in terms of what’s next after the acute hospitalization. Make sure that you ask for an evaluation by someone specialized in stroke rehab like a physiatrist or an acute rehab unit that’s in the area or that may be affiliated with the hospital that you are getting your treatment at for your acute episode.

Once you have had the evaluation by a rehab facility; it’s important that you feel comfortable with the facility that your loved one may go to that you as a patient are choosing. And so, more often than not, the loved one is the one who goes and tours the facility and as you walk onto the facility floor, you want to get a sense of whether or not this is a good fit for your loved one, the patient that has had this stroke. So, talk to the staff there. Get a sense for how passionate they are.

Sometimes you can ask for a reference list where you can talk to former patients and investigate what kind of experience they had. Sometimes you can go to the website of the facility and they’ll have some performance data that gives you an indication of what kind of facility they actually are. Look at patient satisfaction. Look at infection rates. Look at outcomes. Do patients that go to this facility actually go back to community? Do patients that go to this facility have great outcomes?

And that way you go in eyes wide open. Ultimately, you want to go to a facility that as a patient, is going to enable you to return to some normalcy in your life, get back to work, back to play, back to living.

Host: Great points all and that is really good advice to look and see whether the return to community is prevalent and it’s all such great information. Thank you so much Dr. Humphries for coming on today and sharing your expertise about acute rehab after stroke. You’re listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit www.palmdaleregional.ocm, that’s www.palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for tuning in.