About 700,000 strokes occur in the United States each year. To serve the healthcare needs of these patients, Shepherd Center provides a full continuum of services – from inpatient rehabilitation to outpatient care for stroke rehabilitation.
The hospital’s program specializes in rehabilitation for people who may be in college, raising a family or in the prime of their career.
In today’s podcast, Dr. Andrew Dennison, a board-certified physical medicine and rehabilitation physician with an additional subspecialty board certification in brain injury medicine, discusses symptoms and risk factors of a stroke, as well as some therapies and treatments that are typically used in rehabilitation.
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Stroke: Recognizing Symptoms is Vital to Recovery
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Dr. Dennison also currently serves on the Brain and Spinal Injury Trust Fund Commission.
Before joining Shepherd’s medical staff, Dr. Dennison served as the medical program director for brain injury and stroke at Walton Rehabilitation Health System in Augusta, Georgia, from 2009 to 2011.
Dr. Dennison received his bachelor’s degree from Emory University in 2000 and his medical degree from the University of Pennsylvania in 2004. He completed his residency in physical medicine and rehabilitation at Baylor College of Medicine/University of Texas-Houston PM&R Alliance in 2008. Following his residency, Dr. Dennison, completed a fellowship in traumatic brain injury at Carolinas Rehabilitation in Charlotte, N.C.
Learn more about Andrew Dennison, MD
Andrew Dennison, MD
Andrew Dennison, M.D., is a board-certified physical medicine and rehabilitation physician with an additional subspecialty board certification in brain injury medicine. Dr. Dennison joined Shepherd Center’s medical staff in July 2011 as a staff physiatrist. He treats patients who are recovering from traumatic or non-traumatic brain injuries, as well as people who have had complications from a stroke or tumor.Dr. Dennison also currently serves on the Brain and Spinal Injury Trust Fund Commission.
Before joining Shepherd’s medical staff, Dr. Dennison served as the medical program director for brain injury and stroke at Walton Rehabilitation Health System in Augusta, Georgia, from 2009 to 2011.
Dr. Dennison received his bachelor’s degree from Emory University in 2000 and his medical degree from the University of Pennsylvania in 2004. He completed his residency in physical medicine and rehabilitation at Baylor College of Medicine/University of Texas-Houston PM&R Alliance in 2008. Following his residency, Dr. Dennison, completed a fellowship in traumatic brain injury at Carolinas Rehabilitation in Charlotte, N.C.
Learn more about Andrew Dennison, MD
Transcription:
Stroke: Recognizing Symptoms is Vital to Recovery
Melanie Cole (Host): About 700,000 strokes occur in the United States each year. To serve the health care needs of these patients, Shepherd Center provides a full continuum of services from inpatient rehabilitation to outpatient care for stroke rehabilitation. My guest today is Dr. Andrew Dennison. He's a board-certified physical medicine and rehabilitation physician with an additional sub-specialty board-certification in brain injury medicine at Shepherd Center. Welcome to the show, Dr. Dennison. Let's just start with a little working definition. What is stroke?
Dr. Andrew Dennison (Guest): Well, stroke fits into a couple of different types of patterns. There are ischemic strokes, which are when there's a lack of blood flow to a part of the brain, and then there's hemorrhagic strokes where there's bleeding into certain parts of the brain. The ischemic strokes, the lack of blood flow strokes, are a lot more common than the bleeding strokes.
Melanie: And what are the risk factors for stroke? Are some controllable and some not?
Dr. Dennison: Well, particularly for the ischemic strokes, with the lack of blood flow, high blood pressure, smoking, diabetes, obesity, a sedentary lifestyle, and also high cholesterol levels are things you can actually modify and make better, and then there are some other non-modifiable risk factors like age and sex and ethnicity. On the other hand, for hemorrhagic strokes, with bleeding, the modifiable risk factors are high blood pressure, smoking and alcohol abuse.
Melanie: If somebody is thinking that they are having a stroke, please, Dr. Dennison, go over the stroke symptoms that are so important for people to note and for their loved ones to recognize.
Dr. Dennison: Well, there's a great acronym that they use, in particular I think the American Heart Association does, called the FAST, which "F" stands for facial droop, "A" stands for arm weakness, "S" stands for speech difficulties, and then "T" stands for time. And the “T” is on there because time is very critical after stroke because there are certain therapies that you could receive at the hospital that if you wait too long, then you can no longer receive them, such as clot busters or certain catheter-guided treatments for strokes.
Melanie: And, with stroke, they say "time is brain", so it's so important to recognize these symptoms, but some of the symptoms might be a little ambiguous. Slurred speech, you could think maybe somebody's been doing something, so are there some other ones that can go along with the FAST acronym that would sort of cement the idea that this is what's happening?
Dr. Dennison: I think it's always the human habit to try to downplay when these things are occurring, but if there's weakness, in particular, that's developing in the face or the arm, that would make me particularly worried. Also, a significant headache associated with any of those features could be a sign of a hemorrhagic stroke and would definitely need to be going to the emergency room right away.
Melanie: If somebody thinks their loved one is having stroke, do they drive them to the hospital, or is it very important to call EMS, call 9-1-1, right away?
Dr. Dennison: No, they should call 9-1-1 and notify an ambulance. That way, they can set up the appropriate measures for notifying hospitals and get them to the right kind of stroke center and they know what hospitals have the right kind of procedures to be able to handle this best.
Melanie: And, just to reiterate, it is very important to call 9-1-1 if you do think someone is having a stroke. Dr. Dennison, what happens when they get to the hospital if EMS has had a chance to get started on the situation?
Dr. Dennison: Well, they'll be immediately evaluated in the emergency room, and often a head CT scan will be done to try to evaluate if there is any bleeding. If there's bleeding, then, of course, you don't want to give any of the clot busters, but if there's not bleeding and the syndrome is consistent with a stroke, the practitioners at the emergency room will be able to initiate the more advanced treatments that could help improve outcomes in the long run.
Melanie: And, what are some of those treatments?
Dr. Dennison: There is a medication called “TPA”, which is a clot buster that they give intravenously, and that's one thing they can do. If they have certain sizes of clots, at some major stroke centers like Grady and Atlanta, for example, they can give catheter-guided treatments and try to pull some of the thrombus out and I've seen some remarkable recoveries with that when done appropriately. On the other hand, if somebody had a hemorrhagic stroke, and it was starting to build up a certain degree of pressure, then the neurosurgeon would be able to be notified and possibly be able to decompress the problems with swelling and midline shift where the brain is being pushed over to avoid the secondary complications that you would have on top of the bleed.
Melanie: And, it certainly depends on the severity of your stroke, but with stroke, the amount of debilitation that could possibly happen based on treatment and the severity, what is life like for somebody right after a stroke?
Dr. Dennison: Well, directly after the stroke, usually the impairments are rather dramatic in compared to where they would be say, several weeks down the road. So, of course, every stroke is different. Some people will only have what they call a TIA, or just a transient ischemic attack, where they will be able to recover within twenty-four hours to totally regular, normal function; whereas, others will have some very minor impairments, but most of the people that we would be admitting to Shepherd would have some very obvious and significant impairments that would be found initially and then getting better over the next few days once the swelling has started to turn around. And then, that's when they come to our services in rehabilitation.
Melanie: What's that like for the patient?
Dr. Dennison: Well, they would normally be transferred from an outside hospital to our hospital so there's a very busy time of just when they first come to our hospital. They often will meet the therapy teams and the nurses and the physicians the same day to get an initial evaluation and the work really gets started after they've spent the night a Shepherd Center for one night. I think people are usually surprised about how busy they are and I know from what a lot of folks have told me after having stayed at Shepherd, they note just how tired they were because they're kept so busy and there are so many therapies that are ongoing.
Melanie: What do you tell the families, Dr. Dennison, about life after stroke and even after they've gotten out of Shepherd Center, things that they need to be mindful of so that maybe they're not at risk for another stroke?
Dr. Dennison: Well, there's some very basic recommendations that most any hospital should abide by for decreasing secondary stroke risk. For an ischemic stroke, that would particularly be no smoking and managing blood pressure appropriately, making sure any diabetes is managed appropriately, and then there are two medications: the antiplatelets and then the statin medications that are normally used for cholesterol, but have also been shown to decrease stroke risk after having had one. So, pretty much anybody that has a blood blockage stroke is on an antiplatelet medication and at statin unless they have a certain type of clot stroke disorder, where they might be put on a full dose of anticoagulation instead of the antiplatelets.
Melanie: And, what is rehab like in terms of maybe swallowing, balance, vision --any of these things that might have been affected by the stroke?
Dr. Dennison: Well, that's where a comprehensive evaluation by the rehab team is important, because given all the sound and fury that happens in the initial hospitalization, I think some of the more subtle types of things can be missed. Every stroke is a little bit different. There are some very common syndromes, but then there are some more uncommon things that can show up, as well. The most common things we see are weakness on one side, trouble with swallowing, trouble with bowel and bladder incontinence, sometimes visual and perceptual problems, and then one of the main things that really causes some issues in the long run is that because the area of the brain that processes a certain type of function isn't working well, the patient sometimes doesn't really appreciate that there is a problem in the first place. So, this lack of awareness can lead to some significant safety concerns and requires us to be really vigilant about maintaining safety and looking at how well people are supervised and families are trained at time of discharge.
Melanie: And is there sometimes, or often, outpatient rehabilitation that continues after the patient goes home?
Dr. Dennison: Pretty much in any case that would come to Shepherd, we would be having continued outpatient therapies after they've left the inpatient environment. That would usually include physical therapy, occupational therapy, and speech therapy based on the individual needs of the patient.
Melanie: So, wrap it up for us, Dr. Dennison, with some of your best advice for stroke symptoms and the importance of recognizing these symptoms, possible prevention, and why they should come to Shepherd Center for their care.
Dr. Dennison: Well, I think, again, looking at that FAST acronym, so the facial droop, arm weakness, speech difficulties, and time and remembering that even if you are controlling all of your risk factors perfectly and you lead an exemplary healthy lifestyle, you still are at risk for stroke. So, if you see those signs, you need to come in and get evaluated, and that way you'll make sure that you'll have the best possible treatment. The thing that I often say to families and patients when they arrive to us is that things are going to get a lot better. They're still in the time period where you expect recovery to occur and often, people are very anxious that things are not going to change, but there's reason to be hopeful and have a lot of hope for further improvement.
Melanie: Tell us about your team at Shepherd.
Dr. Dennison: Well, we really have an amazing team at Shepherd. The therapists are incredibly compassionate and I'm very happy with our administrative team that makes sure that we have all of our programs running smoothly. We also have the most well-funded and participatory recreation therapy team I've ever seen at a rehab hospital and that really helps people to get out in the community and do outings so that they're really looking at getting back to their home environment. I think one of the things that we can be most proud of at Shepherd is the rate of home discharges we have rather than to facilities and I think that speaks a lot to the overall team approach that we take.
Melanie: Thank you so much for being with us today. It's really great information. You're listening to Shepherd Center Radio and for more information, you can go to www.shepherd.org. That's www.shepherd.org. This is Melanie Cole. Thanks so much for listening.
Stroke: Recognizing Symptoms is Vital to Recovery
Melanie Cole (Host): About 700,000 strokes occur in the United States each year. To serve the health care needs of these patients, Shepherd Center provides a full continuum of services from inpatient rehabilitation to outpatient care for stroke rehabilitation. My guest today is Dr. Andrew Dennison. He's a board-certified physical medicine and rehabilitation physician with an additional sub-specialty board-certification in brain injury medicine at Shepherd Center. Welcome to the show, Dr. Dennison. Let's just start with a little working definition. What is stroke?
Dr. Andrew Dennison (Guest): Well, stroke fits into a couple of different types of patterns. There are ischemic strokes, which are when there's a lack of blood flow to a part of the brain, and then there's hemorrhagic strokes where there's bleeding into certain parts of the brain. The ischemic strokes, the lack of blood flow strokes, are a lot more common than the bleeding strokes.
Melanie: And what are the risk factors for stroke? Are some controllable and some not?
Dr. Dennison: Well, particularly for the ischemic strokes, with the lack of blood flow, high blood pressure, smoking, diabetes, obesity, a sedentary lifestyle, and also high cholesterol levels are things you can actually modify and make better, and then there are some other non-modifiable risk factors like age and sex and ethnicity. On the other hand, for hemorrhagic strokes, with bleeding, the modifiable risk factors are high blood pressure, smoking and alcohol abuse.
Melanie: If somebody is thinking that they are having a stroke, please, Dr. Dennison, go over the stroke symptoms that are so important for people to note and for their loved ones to recognize.
Dr. Dennison: Well, there's a great acronym that they use, in particular I think the American Heart Association does, called the FAST, which "F" stands for facial droop, "A" stands for arm weakness, "S" stands for speech difficulties, and then "T" stands for time. And the “T” is on there because time is very critical after stroke because there are certain therapies that you could receive at the hospital that if you wait too long, then you can no longer receive them, such as clot busters or certain catheter-guided treatments for strokes.
Melanie: And, with stroke, they say "time is brain", so it's so important to recognize these symptoms, but some of the symptoms might be a little ambiguous. Slurred speech, you could think maybe somebody's been doing something, so are there some other ones that can go along with the FAST acronym that would sort of cement the idea that this is what's happening?
Dr. Dennison: I think it's always the human habit to try to downplay when these things are occurring, but if there's weakness, in particular, that's developing in the face or the arm, that would make me particularly worried. Also, a significant headache associated with any of those features could be a sign of a hemorrhagic stroke and would definitely need to be going to the emergency room right away.
Melanie: If somebody thinks their loved one is having stroke, do they drive them to the hospital, or is it very important to call EMS, call 9-1-1, right away?
Dr. Dennison: No, they should call 9-1-1 and notify an ambulance. That way, they can set up the appropriate measures for notifying hospitals and get them to the right kind of stroke center and they know what hospitals have the right kind of procedures to be able to handle this best.
Melanie: And, just to reiterate, it is very important to call 9-1-1 if you do think someone is having a stroke. Dr. Dennison, what happens when they get to the hospital if EMS has had a chance to get started on the situation?
Dr. Dennison: Well, they'll be immediately evaluated in the emergency room, and often a head CT scan will be done to try to evaluate if there is any bleeding. If there's bleeding, then, of course, you don't want to give any of the clot busters, but if there's not bleeding and the syndrome is consistent with a stroke, the practitioners at the emergency room will be able to initiate the more advanced treatments that could help improve outcomes in the long run.
Melanie: And, what are some of those treatments?
Dr. Dennison: There is a medication called “TPA”, which is a clot buster that they give intravenously, and that's one thing they can do. If they have certain sizes of clots, at some major stroke centers like Grady and Atlanta, for example, they can give catheter-guided treatments and try to pull some of the thrombus out and I've seen some remarkable recoveries with that when done appropriately. On the other hand, if somebody had a hemorrhagic stroke, and it was starting to build up a certain degree of pressure, then the neurosurgeon would be able to be notified and possibly be able to decompress the problems with swelling and midline shift where the brain is being pushed over to avoid the secondary complications that you would have on top of the bleed.
Melanie: And, it certainly depends on the severity of your stroke, but with stroke, the amount of debilitation that could possibly happen based on treatment and the severity, what is life like for somebody right after a stroke?
Dr. Dennison: Well, directly after the stroke, usually the impairments are rather dramatic in compared to where they would be say, several weeks down the road. So, of course, every stroke is different. Some people will only have what they call a TIA, or just a transient ischemic attack, where they will be able to recover within twenty-four hours to totally regular, normal function; whereas, others will have some very minor impairments, but most of the people that we would be admitting to Shepherd would have some very obvious and significant impairments that would be found initially and then getting better over the next few days once the swelling has started to turn around. And then, that's when they come to our services in rehabilitation.
Melanie: What's that like for the patient?
Dr. Dennison: Well, they would normally be transferred from an outside hospital to our hospital so there's a very busy time of just when they first come to our hospital. They often will meet the therapy teams and the nurses and the physicians the same day to get an initial evaluation and the work really gets started after they've spent the night a Shepherd Center for one night. I think people are usually surprised about how busy they are and I know from what a lot of folks have told me after having stayed at Shepherd, they note just how tired they were because they're kept so busy and there are so many therapies that are ongoing.
Melanie: What do you tell the families, Dr. Dennison, about life after stroke and even after they've gotten out of Shepherd Center, things that they need to be mindful of so that maybe they're not at risk for another stroke?
Dr. Dennison: Well, there's some very basic recommendations that most any hospital should abide by for decreasing secondary stroke risk. For an ischemic stroke, that would particularly be no smoking and managing blood pressure appropriately, making sure any diabetes is managed appropriately, and then there are two medications: the antiplatelets and then the statin medications that are normally used for cholesterol, but have also been shown to decrease stroke risk after having had one. So, pretty much anybody that has a blood blockage stroke is on an antiplatelet medication and at statin unless they have a certain type of clot stroke disorder, where they might be put on a full dose of anticoagulation instead of the antiplatelets.
Melanie: And, what is rehab like in terms of maybe swallowing, balance, vision --any of these things that might have been affected by the stroke?
Dr. Dennison: Well, that's where a comprehensive evaluation by the rehab team is important, because given all the sound and fury that happens in the initial hospitalization, I think some of the more subtle types of things can be missed. Every stroke is a little bit different. There are some very common syndromes, but then there are some more uncommon things that can show up, as well. The most common things we see are weakness on one side, trouble with swallowing, trouble with bowel and bladder incontinence, sometimes visual and perceptual problems, and then one of the main things that really causes some issues in the long run is that because the area of the brain that processes a certain type of function isn't working well, the patient sometimes doesn't really appreciate that there is a problem in the first place. So, this lack of awareness can lead to some significant safety concerns and requires us to be really vigilant about maintaining safety and looking at how well people are supervised and families are trained at time of discharge.
Melanie: And is there sometimes, or often, outpatient rehabilitation that continues after the patient goes home?
Dr. Dennison: Pretty much in any case that would come to Shepherd, we would be having continued outpatient therapies after they've left the inpatient environment. That would usually include physical therapy, occupational therapy, and speech therapy based on the individual needs of the patient.
Melanie: So, wrap it up for us, Dr. Dennison, with some of your best advice for stroke symptoms and the importance of recognizing these symptoms, possible prevention, and why they should come to Shepherd Center for their care.
Dr. Dennison: Well, I think, again, looking at that FAST acronym, so the facial droop, arm weakness, speech difficulties, and time and remembering that even if you are controlling all of your risk factors perfectly and you lead an exemplary healthy lifestyle, you still are at risk for stroke. So, if you see those signs, you need to come in and get evaluated, and that way you'll make sure that you'll have the best possible treatment. The thing that I often say to families and patients when they arrive to us is that things are going to get a lot better. They're still in the time period where you expect recovery to occur and often, people are very anxious that things are not going to change, but there's reason to be hopeful and have a lot of hope for further improvement.
Melanie: Tell us about your team at Shepherd.
Dr. Dennison: Well, we really have an amazing team at Shepherd. The therapists are incredibly compassionate and I'm very happy with our administrative team that makes sure that we have all of our programs running smoothly. We also have the most well-funded and participatory recreation therapy team I've ever seen at a rehab hospital and that really helps people to get out in the community and do outings so that they're really looking at getting back to their home environment. I think one of the things that we can be most proud of at Shepherd is the rate of home discharges we have rather than to facilities and I think that speaks a lot to the overall team approach that we take.
Melanie: Thank you so much for being with us today. It's really great information. You're listening to Shepherd Center Radio and for more information, you can go to www.shepherd.org. That's www.shepherd.org. This is Melanie Cole. Thanks so much for listening.