About 700,000 strokes occur in the United States each year. A stroke can affect a person physically and emotionally, and can affect the way a person thinks (cognition) and acts (behavior). Living with and returning home following a stroke can be daunting, requiring preparation for a patient’s ongoing safety, accessibility and independence.
Listen in as clinical nurse specialist Tiffany LeCroy joins us to discuss stroke education for Shepherd Center patients undergoing rehabilitation in the stroke program, addressing stroke awareness, prevention and how to manage life after a stroke.
Selected Podcast
Stroke Education for Patients Undergoing Rehabilitation
Featured Speaker:
Tiffany LeCroy, MSN, RN
Tiffany LeCroy, MSN, RN, FNP-C, ACNS-BC, CRRN, is a clinical nurse specialist at Shepherd Center. She currently serves as a Clinical Nurse Specialist in the Brain Injury Program. She has over 21 years experience specializing in brain injury rehabilitation. In her current role, she oversees the orientation and education of clinical nursing staff, as well as develop and present educational materials for patients and caregivers at at Shepherd Center. She frequently provides brain injury presentations to acute care hospital staff, local university nursing students, and at national nursing conferences. She is a co-author for The Association of Rehabilitation Nurses “The Specialty Practice of Rehabilitation Nursing: A Core Curriculum” (7th Ed.); Traumatic Injuries Chapter 23. Tiffany is board certified as Adult Clinical Nurse Specialist and Family Nurse Practitioner. Transcription:
Stroke Education for Patients Undergoing Rehabilitation
Melanie Cole (Host): About 700,000 strokes occur in the United States each year. Stroke can affect a person physically and emotionally and can affect the way a person thinks, cognition and acts, behavior. Living with a returning home following a stroke can be daunting, requiring preparation for patient’s ongoing safety, accessibility and independence. My guest today is clinical nurse specialist at Shepherd Center, Tiffany LeCroy. Welcome to the show, Tiffany. So, tell us about stroke and what happens just after a stroke. What’s involved in rehab?
Tiffany LeCroy (Guest): Thanks for having me Melanie. Stroke can affect people in many different ways. One thing that we really focus on is the individualized care and the individualized needs of a stroke and, not only the stroke patient, but the patient’s family and the people that will be involved with their care. Here at Shepherd Center, we use a team approach when we’re taking care of any patient and family that have experienced a stroke and so, depending on whether or not there’s cognitive impairment, physical impairment, medical needs that have to be addressed as well as the emotional needs of patients that have experienced a stroke. So, our services are very individualized, looking at what’s needed from a medical standpoint, from an educational standpoint, supporting them and knowing where their needs might be down the road, even once they have discharged from an in-patient setting. So, we really focus on care throughout a continuum. Physical therapy, occupational therapy, speech and language, cognitive therapy. There could be intensive swallowing therapy needs, nutritional counseling, and respiratory therapy. So, it really depends on what that individual needs are where our focus is. We organize activities beyond just an in-patient setting. We really try to facilitate smooth transitions back home and to the community and to maybe an out-patient program, whether the person’s going back to work, school or just in their home and helping them to identify what is needed for them.
Melanie: Tiffany, is stroke similar to brain injury, where cognition and certain acts can then become almost involuntary and need to really be retrained?
Tiffany: Yes, absolutely. Stroke is actually considered a brain injury itself. It’s very similar. Patients have very similar needs to that of an acquired brain injury itself. That’s what makes it very individualized itself. What the needs might be depends on the location of the stroke, where the stroke actually occurred, the type of stroke somebody had, whether it’s ischemic or hemorrhagic, and whether it was mild, moderate or severe stroke. Cognition can be impaired. Again, when we’re looking at where the stroke actually occurs in the brain, which lobe it occurs in helps us to kind of plan and determine what needs might a person have. For example, if somebody has a stroke in the brainstem, that patient is going to look and appear and have deficits that are very different from somebody who had a stroke in the frontal lobe. A mild stroke is going to be very different and might not require the intensity of therapy that a person with a severe stroke has. So, it’s all over the map and no two are actually exactly the same, just like brain injuries; very similar.
Melanie: So, when you’re educating stroke patients and their family, if you’re talking about safety after the stroke, when they’re going to move home, what are some of the things they should be thinking about?
Tiffany: One of the biggest risks that we really focus on is the fall risk, particularly in strokes and particularly with a right stroke. You have a stroke that occurs on either the right or left side of the brain. The fall risk in stroke is high in the in-patient setting and throughout the continuum. So, not only are we focusing on decreasing the risk of fall in-patient but once a patient goes home, they’re still at an increased risk for several reasons. We know that strokes can have physical abilities or can cause weakness or even paralysis as well as cognitive impairments. So, what happens often times when a person is transitioning from the hospital, or in-patient, and then home, they’re doing much better probably cognitively and physically, but sometimes they over-estimate a person that has had a stroke, their ability or they might become more fatigued throughout the day. So, more in the evening, we found, that there’s a higher risk because the person becomes more fatigued as the day goes on. However, they might not recognize or realize based on some cognitive impairment that they’re not as strong and so they might try to transfer themselves or not recognize and stumble across something on the floor. In the hospital, the hospital setting is built to try to prevent falls with widened doorways and really not having items around that could be stumbled upon. However, when somebody gets in the home, we’re then dealing with dim lighting, high-piled carpeting, and so there’s hazards that patients and caregivers might not recognize that could actually increase their fall-risk. We know that falls are one of the highest reasons that people actually return to the hospital. So, it could be a cause of alarm for re-hospitalization in this group.
Melanie: What about post-stroke conditions, some of the fear and apprehension, even the worry from patients and caregivers about going home and that independence in everyday living situations? What do you tell them about that?
Tiffany: Again, every patient as well as family and caregiver needs are different. So, some people or patients might be returning home and going back to work, some might be returning home and going back to school and then there’s those that might not be returning back to work or school but are returning home. Some of these patients require extended or increased supervision just because of the safety risk involved or maybe with the cognitive impairment require more supervision with assistance, maybe with getting dressed, maybe with just those regular activities of daily living or it could be that they’re pretty much able to take care of themselves, however, they might just need someone around to assist with certain tasks or supervising them. So, there’s a lot of change that might be taking place to facilitate their transitions back home. Keep in mind that these patients, once they have actually left rehab, they still continue to improve over a period of time. We know that as they get better and stronger, they’ll probably require changes in their supervision level but it does leave the patient and caregiver and family in a situation where they might have to plan differently to accommodate the needs that are going to take place. And, again, they’re very individualized needs whether they’re physical or emotional. You know, lots of times we really have to watch during the transition where we see a lot of the emotional. They’re medically stable and they’ve gone through rehab and they really count highly on rehab as having a lot of changes and so, when they go home they think, “Oh, I’m doing much better,” or “Maybe this is as well as I’m going to be doing,” without really recognizing, “I’m going to continue to change. I’m going to continue to improve,” as they might get individual therapy still even in the out-patient setting. Maybe they go to one or two sessions, whatever the team decides is really needed and necessary, whether it’s speech therapy, physical therapy or occupational therapy. So, I think that the anxiety comes a lot with transition and just not knowing what to expect because we know, very similar to a brain injury, patients recover at different rates. It’s very individualized. We do have a good majority of our patients that are actually discharged to their home. That’s really the goal, of course, which is pretty high.
Melanie: And are they worried about recurrence? What’s the risk of having that second stroke and what would you like to tell the families and patients about lifestyle modifications after that stroke?
Tiffany: Absolutely. Well, one of the big focuses in our education is always about stroke prevention. So, people who have had a stroke are at a 43% higher rate of a second stroke. We have had patients who have actually been here for rehab with their second or third or fourth stroke. So, we really focus on continuing with the regimen that’s recommended for you at discharge. So, for example, if there are certain medications, the importance of really focusing and insuring that those medications are taken routinely will help prevent a second stroke as well as the lifestyle. Really looking at physical activity, again, depending on the physical impairments the individual might have, it’s not the same regimen for every single person. We have some for some patients that might not have the physical goals that a second patient might have, for example. Looking at maintaining a blood pressure that was within a good range that the team has determined for them is not the same for everybody. Looking at nutritional intake, are we recommending a low-sodium diet or are we really looking at cholesterol? Does the person have a history of heart disease or diabetes? So, a good healthy diet for that individual is recommended. Taking their medications and number one, is really recognizing what the signs of a re-stroke are. So, we use an acronym called FAST. We like for anybody who’s being a part of a patient’s care--so caregivers, families, friends that are going to be involved--to be familiar with this. This is nationally known, this is not something that’s specific to Shepherd Center. But, FAST is really a quick way for anybody who’s listening to recognize, whether you’re in a grocery store and see somebody with these signs or you’re at an event with your kids at soccer, how would you know someone is having a stroke? The “F” is for “face”. If you are having a situation where you think there’s a possibility that someone’s having a stroke, one of the first signs is in looking at their face is their smile is not equal. Maybe one side of their mouth looks like it dropped. If you ask them to lift their arms, the “A” is for “arms”, the person can maybe only raise one side or one side is significantly weaker than the other. The “S” is for speech or “swallow”, where the person might have sudden slurred speech or the inability to talk or maybe difficulty swallowing. And then the “T” is for “time” because time lost is brain lost, meaning that once we see these symptoms, we assume that the person is having a stroke and we need to get them to the ER immediately or call 911 immediately. There are medications that might be available for certain strokes that can prevent true disability with prevention of a further stroke or a more severe stroke, in fact. So, FAST is something that we all should be able to recognize. Stroke is so common in our world that we live in today, so just keeping people safer and education in the community to really recognize what a stroke might look like. And, surprisingly enough, I think people assume that it’s an older population or that it’s a population of men when, in fact, it’s really not. A national average age might be 67 but for patients we see here, it’s about 48. We see about twelve percent of our patients are below age 30. So, we have lots of young people who do not have those traditional things that we consider like high cholesterol and high blood pressure that are causes of stroke that we typically wouldn’t see in a younger group that we’re seeing more frequently these days.
Melanie: Why should they come to Shepherd Center for their care? What great information, Tiffany. So wrap it up for us.
Tiffany: Because at Shepherd Center, we take a team approach and we treat everybody like an individual. Staff members here understand that after a stroke, people go through so much more than just recovery. They’re learning a new way of life and so stroke rehab at Shepherd is designed to meet the medical, physical, cognitive and emotional needs of the patient while we’re supporting and coordinating what the patient’s family might also need. We integrate the patient’s rehab program and high-tech pieces of therapeutic equipment to maximize the recovery, their independence and support them upon their return to their productive lifestyle.
Melanie: Thank you so much for being with us today. You’re listening to Shepherd Center Radio and for more information you can go to Shepherd.org. That’s Shepherd.org. This is Melanie Cole. Thanks so much for listening.
Stroke Education for Patients Undergoing Rehabilitation
Melanie Cole (Host): About 700,000 strokes occur in the United States each year. Stroke can affect a person physically and emotionally and can affect the way a person thinks, cognition and acts, behavior. Living with a returning home following a stroke can be daunting, requiring preparation for patient’s ongoing safety, accessibility and independence. My guest today is clinical nurse specialist at Shepherd Center, Tiffany LeCroy. Welcome to the show, Tiffany. So, tell us about stroke and what happens just after a stroke. What’s involved in rehab?
Tiffany LeCroy (Guest): Thanks for having me Melanie. Stroke can affect people in many different ways. One thing that we really focus on is the individualized care and the individualized needs of a stroke and, not only the stroke patient, but the patient’s family and the people that will be involved with their care. Here at Shepherd Center, we use a team approach when we’re taking care of any patient and family that have experienced a stroke and so, depending on whether or not there’s cognitive impairment, physical impairment, medical needs that have to be addressed as well as the emotional needs of patients that have experienced a stroke. So, our services are very individualized, looking at what’s needed from a medical standpoint, from an educational standpoint, supporting them and knowing where their needs might be down the road, even once they have discharged from an in-patient setting. So, we really focus on care throughout a continuum. Physical therapy, occupational therapy, speech and language, cognitive therapy. There could be intensive swallowing therapy needs, nutritional counseling, and respiratory therapy. So, it really depends on what that individual needs are where our focus is. We organize activities beyond just an in-patient setting. We really try to facilitate smooth transitions back home and to the community and to maybe an out-patient program, whether the person’s going back to work, school or just in their home and helping them to identify what is needed for them.
Melanie: Tiffany, is stroke similar to brain injury, where cognition and certain acts can then become almost involuntary and need to really be retrained?
Tiffany: Yes, absolutely. Stroke is actually considered a brain injury itself. It’s very similar. Patients have very similar needs to that of an acquired brain injury itself. That’s what makes it very individualized itself. What the needs might be depends on the location of the stroke, where the stroke actually occurred, the type of stroke somebody had, whether it’s ischemic or hemorrhagic, and whether it was mild, moderate or severe stroke. Cognition can be impaired. Again, when we’re looking at where the stroke actually occurs in the brain, which lobe it occurs in helps us to kind of plan and determine what needs might a person have. For example, if somebody has a stroke in the brainstem, that patient is going to look and appear and have deficits that are very different from somebody who had a stroke in the frontal lobe. A mild stroke is going to be very different and might not require the intensity of therapy that a person with a severe stroke has. So, it’s all over the map and no two are actually exactly the same, just like brain injuries; very similar.
Melanie: So, when you’re educating stroke patients and their family, if you’re talking about safety after the stroke, when they’re going to move home, what are some of the things they should be thinking about?
Tiffany: One of the biggest risks that we really focus on is the fall risk, particularly in strokes and particularly with a right stroke. You have a stroke that occurs on either the right or left side of the brain. The fall risk in stroke is high in the in-patient setting and throughout the continuum. So, not only are we focusing on decreasing the risk of fall in-patient but once a patient goes home, they’re still at an increased risk for several reasons. We know that strokes can have physical abilities or can cause weakness or even paralysis as well as cognitive impairments. So, what happens often times when a person is transitioning from the hospital, or in-patient, and then home, they’re doing much better probably cognitively and physically, but sometimes they over-estimate a person that has had a stroke, their ability or they might become more fatigued throughout the day. So, more in the evening, we found, that there’s a higher risk because the person becomes more fatigued as the day goes on. However, they might not recognize or realize based on some cognitive impairment that they’re not as strong and so they might try to transfer themselves or not recognize and stumble across something on the floor. In the hospital, the hospital setting is built to try to prevent falls with widened doorways and really not having items around that could be stumbled upon. However, when somebody gets in the home, we’re then dealing with dim lighting, high-piled carpeting, and so there’s hazards that patients and caregivers might not recognize that could actually increase their fall-risk. We know that falls are one of the highest reasons that people actually return to the hospital. So, it could be a cause of alarm for re-hospitalization in this group.
Melanie: What about post-stroke conditions, some of the fear and apprehension, even the worry from patients and caregivers about going home and that independence in everyday living situations? What do you tell them about that?
Tiffany: Again, every patient as well as family and caregiver needs are different. So, some people or patients might be returning home and going back to work, some might be returning home and going back to school and then there’s those that might not be returning back to work or school but are returning home. Some of these patients require extended or increased supervision just because of the safety risk involved or maybe with the cognitive impairment require more supervision with assistance, maybe with getting dressed, maybe with just those regular activities of daily living or it could be that they’re pretty much able to take care of themselves, however, they might just need someone around to assist with certain tasks or supervising them. So, there’s a lot of change that might be taking place to facilitate their transitions back home. Keep in mind that these patients, once they have actually left rehab, they still continue to improve over a period of time. We know that as they get better and stronger, they’ll probably require changes in their supervision level but it does leave the patient and caregiver and family in a situation where they might have to plan differently to accommodate the needs that are going to take place. And, again, they’re very individualized needs whether they’re physical or emotional. You know, lots of times we really have to watch during the transition where we see a lot of the emotional. They’re medically stable and they’ve gone through rehab and they really count highly on rehab as having a lot of changes and so, when they go home they think, “Oh, I’m doing much better,” or “Maybe this is as well as I’m going to be doing,” without really recognizing, “I’m going to continue to change. I’m going to continue to improve,” as they might get individual therapy still even in the out-patient setting. Maybe they go to one or two sessions, whatever the team decides is really needed and necessary, whether it’s speech therapy, physical therapy or occupational therapy. So, I think that the anxiety comes a lot with transition and just not knowing what to expect because we know, very similar to a brain injury, patients recover at different rates. It’s very individualized. We do have a good majority of our patients that are actually discharged to their home. That’s really the goal, of course, which is pretty high.
Melanie: And are they worried about recurrence? What’s the risk of having that second stroke and what would you like to tell the families and patients about lifestyle modifications after that stroke?
Tiffany: Absolutely. Well, one of the big focuses in our education is always about stroke prevention. So, people who have had a stroke are at a 43% higher rate of a second stroke. We have had patients who have actually been here for rehab with their second or third or fourth stroke. So, we really focus on continuing with the regimen that’s recommended for you at discharge. So, for example, if there are certain medications, the importance of really focusing and insuring that those medications are taken routinely will help prevent a second stroke as well as the lifestyle. Really looking at physical activity, again, depending on the physical impairments the individual might have, it’s not the same regimen for every single person. We have some for some patients that might not have the physical goals that a second patient might have, for example. Looking at maintaining a blood pressure that was within a good range that the team has determined for them is not the same for everybody. Looking at nutritional intake, are we recommending a low-sodium diet or are we really looking at cholesterol? Does the person have a history of heart disease or diabetes? So, a good healthy diet for that individual is recommended. Taking their medications and number one, is really recognizing what the signs of a re-stroke are. So, we use an acronym called FAST. We like for anybody who’s being a part of a patient’s care--so caregivers, families, friends that are going to be involved--to be familiar with this. This is nationally known, this is not something that’s specific to Shepherd Center. But, FAST is really a quick way for anybody who’s listening to recognize, whether you’re in a grocery store and see somebody with these signs or you’re at an event with your kids at soccer, how would you know someone is having a stroke? The “F” is for “face”. If you are having a situation where you think there’s a possibility that someone’s having a stroke, one of the first signs is in looking at their face is their smile is not equal. Maybe one side of their mouth looks like it dropped. If you ask them to lift their arms, the “A” is for “arms”, the person can maybe only raise one side or one side is significantly weaker than the other. The “S” is for speech or “swallow”, where the person might have sudden slurred speech or the inability to talk or maybe difficulty swallowing. And then the “T” is for “time” because time lost is brain lost, meaning that once we see these symptoms, we assume that the person is having a stroke and we need to get them to the ER immediately or call 911 immediately. There are medications that might be available for certain strokes that can prevent true disability with prevention of a further stroke or a more severe stroke, in fact. So, FAST is something that we all should be able to recognize. Stroke is so common in our world that we live in today, so just keeping people safer and education in the community to really recognize what a stroke might look like. And, surprisingly enough, I think people assume that it’s an older population or that it’s a population of men when, in fact, it’s really not. A national average age might be 67 but for patients we see here, it’s about 48. We see about twelve percent of our patients are below age 30. So, we have lots of young people who do not have those traditional things that we consider like high cholesterol and high blood pressure that are causes of stroke that we typically wouldn’t see in a younger group that we’re seeing more frequently these days.
Melanie: Why should they come to Shepherd Center for their care? What great information, Tiffany. So wrap it up for us.
Tiffany: Because at Shepherd Center, we take a team approach and we treat everybody like an individual. Staff members here understand that after a stroke, people go through so much more than just recovery. They’re learning a new way of life and so stroke rehab at Shepherd is designed to meet the medical, physical, cognitive and emotional needs of the patient while we’re supporting and coordinating what the patient’s family might also need. We integrate the patient’s rehab program and high-tech pieces of therapeutic equipment to maximize the recovery, their independence and support them upon their return to their productive lifestyle.
Melanie: Thank you so much for being with us today. You’re listening to Shepherd Center Radio and for more information you can go to Shepherd.org. That’s Shepherd.org. This is Melanie Cole. Thanks so much for listening.