Cheryl Martin (Host): Coming up, discover valuable tips and resources to help you or your loved ones recover after a stroke. From lifestyle changes to rehab strategies, Lindsay Goff is here to offer guidance for recovery and improving quality of life. She's the Primary Stroke Program Coordinator at University of Maryland Upper Chesapeake Health.

 Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm Cheryl Martin. Lindsay, so glad to have you here to talk about this important topic that affects so many people.

Lindsay Goff, BSN, RN, NRP: Thank you guys for having me. Good morning, Cheryl.

Host: Good morning. So, when someone has had a stroke and they're discharged from the hospital, what comes next?

Lindsay Goff, BSN, RN, NRP: After patients are discharged from the hospital after suffering an acute stroke, they focus on rehabilitation. So during the hospital, the first steps to determine where that patient goes after discharge, we go by our physical therapy, occupational therapy, and speech therapy recommendations. So there are three different types of rehab.

So you have acute rehab, which is more vigorous, and it does do three to five hours a day of rehabilitation with patients. Acute rehab specifically focuses on neuro rehab, specifically for acute ischemic stroke patients, hemorrhagic stroke patients. And then after acute rehab, the next lower level is sub acute rehab.

This is a lower level of rehab, so not as intense as acute rehab, but both of them do aim to return these patients to their baseline functional mobility and to also return them home. Those are the two different types of acute and subacute, and then there, we can also do rehab at home with these patients. If patients need a lower level of care, they don't need an inpatient rehab, they do have that ability to do that at home, as well as speech therapy and occupational therapy.

Host: Lindsay, talk about some of the ways that stroke can affect someone, especially when you look at the categories that you mentioned. So, if someone has had an acute stroke, how does that affect them and then go from there?

Lindsay Goff, BSN, RN, NRP: Stroke can affect patients in a myriad of different ways. The difference between the stroke patient population and this disease process, when you compare it to others, is that the neurologic damage that these patients experience is irreversible. So once that damage is done to those neurons in your brain, we cannot get it back.

So strokes can affect multiple different things. It can affect your cognitive ability of thinking, your emotional regulation, your cognitive ability to make decisions, your proprioception, how you walk, how you talk, how you eat, how you drink, how you speak, and how you perceive things. These deficits truly are debilitating to patients. And I think I love to take this out to the community that again, time is brain because these deficits are irreversible.

Host: And so, talk more about then why early mobility is so important.

Lindsay Goff, BSN, RN, NRP: Early mobility is very, very important because, like I said, our goal is to return these patients to, back to their baseline functional mobility. The earlier that you move these patients and get them to move their extremities, get them sitting up in a chair, get them moving their facial muscles, practicing swallowing, getting their grip strength, and innervating those muscles, the better their rehab and their prognosis is going to be.

Getting these neurons to fire and getting your muscles to move and function after an acute stroke is very important. Because when you have a stroke, your brain essentially goes through war and it's trying to learn how to rebuild itself and reperfuse. So, the faster you get these patients up and mobile and at least trying to get back to their baseline, the better their outcome is going to be long term.

Host: So, if you've had a stroke, how often should you schedule follow up appointments to monitor your progress and ensure that your overall health is being managed effectively?

Lindsay Goff, BSN, RN, NRP: Your follow up with neurology and rehab all depends on the type of stroke that you experienced and the severity of your stroke. Also, we look at your baseline functional mobility. That is going to affect how often you follow up. After an acute ischemic stroke, we generally like to see patients in the office outpatient to follow up within the next two weeks.

After that, it should be a six month follow up, unless there are any issues or any other reasons to see the neurologist for further testing.

Host: Now, Lindsay, you talked about and explained, did a great job of explaining acute, subacute, and at home PT. Anything else on that as well as possible outpatient speech therapy?

Lindsay Goff, BSN, RN, NRP: Yes, there are numerous different outpatient speech therapists available in Harford County. They work with patients who are discharged from our inpatient speech therapy. These patients need, maybe not an acute setting for this type of speech therapy, but it's more of a follow up and helping them, again, return back to their baseline and try to achieve as much of their baseline back as they can.

Host: Provide some guidance on managing all of these emotional and psychological changes that may occur after a stroke.

Lindsay Goff, BSN, RN, NRP: There are many challenges that these patients experience. Post stroke depression is generally something that is overlooked by patients, by their families, by clinicians. It can be very subtle, it can be very vague. A lot of people chalk this up to someone had a stroke and it made them very upset and very sad. It is devastating to have a stroke, but we do have to realize that post stroke depression is something that happens after a stroke.

It's when your brain undergoes an acute event, a traumatic event, why we call them brain attacks; it has to learn how to regulate itself emotionally again. And so we do, do screenings prior to discharge in the hospital. They also screen these patients for post stroke depression in rehab as well.

Host: That brings up a question, then, what role does having a positive attitude and a great outlook when going through therapy or recovering after a stroke saying, I may have had a stroke, but I'm really going to push for the best quality of life that I can.

Lindsay Goff, BSN, RN, NRP: Having that positive outlook is going to directly impact your prognosis. When patients go into rehab, I try to tell them and I encourage them to have that positive outlook because the more that they put into rehab in that first three months after an acute stroke, rehab is very, very important. So the more that these patients put into rehab, the better their prognosis is going to be. The harder that they work in that first three months in rehab after a stroke is the most important time frame for their long term prognosis.

Host: So what are your recommendations for any assistive devices or modifications to the home or daily routines that may help someone regain independence and improve safety?

Lindsay Goff, BSN, RN, NRP: There are many ways to improve safety. We have a lot of occupational therapists, both inpatient and outpatient, that will assess the patient's level of need and level of disability. I know in acute rehab, prior to discharge, both in the hospital and outpatient, our neurorehab therapists assess the level of disability, and that is when they make their recommendations for modifications such as canes, walkers, braces, any other assistive devices. There are also occupational therapists outpatient that will come and evaluate your home and assess the patient's home to determine if there are any barriers to discharging that patient home safely.

And we look at do we need any bars on the showers, any guardrails, any extra ramps, or to make any stairs a little less steep. Those are all things that we do look at for safety. Again, our goal is to return these patients home as safely as possible.

Host: That is great. So what types of physical activities or exercises are safe and beneficial after a stroke, especially if you're at home?

Lindsay Goff, BSN, RN, NRP: When you're at home, I have a lot of patients that ask me the same question. I do send them home with a folder that has a list of exercises. Again, it's all going to depend on the type of stroke, the severity of the deficit, and also on the patient. But I do encourage all patients that suffer a stroke to practice cognitive exercises.

This includes card games, matching. This can be Jeopardy, it can be flash cards, these are things that, again, get your brain trying to relearn how to rebuild itself. In addition to the cognitive exercises, I do also give them little brain stress balls to help them just engage those muscles for their upper extremities.

So, I have them squeeze that ball to engage those arm muscles, so your biceps, your triceps, your deltoids, just to get those deficits, if they have hemiparesis in that area, it helps those neurons fire to get that mobility back. I also have patients just if they're laying in bed, they can just do leg raises, even if it's a simple just pointing your toe and getting those quad muscles to engage. Any kind of movement and engagement of those muscles, even facial muscles will definitely help your recovery as a post stroke patient.

Host: How can family members or caregivers, what can they do to help improve the recovery process, their role?

Lindsay Goff, BSN, RN, NRP: Caregivers and family play a very important role in post stroke recovery. As neurology, we look at patient and the family to try to develop a plan that is geared toward patient and family centered care. Family members and a support system are what is going to help these patients get through this recovery.

It can be a very long process and like I said, these patients lives are changed from that very moment they suffer a stroke. We also cannot forget that this does impact the family also. So when I see patients, I try to assess you know, for post stroke depression, in not just the patient, but also the family member. And we want these family members to be involved and engaged. We also need them to have a positive outlook so that they can help the patient have a positive outlook. In that, we also do try to be realistic with these patients as well as their family members. Family members that have unrealistic expectations may cause some depression regarding stroke with their family members.

So we try to have the patient and their family all on the same page and try to have a positive outlook so that they have a great prognosis moving forward in their recovery process.

Host: That's great. Lindsay, any dietary recommendations or restrictions that will support recovery and overall health after a stroke?

Lindsay Goff, BSN, RN, NRP: Diet is a very, very important risk factor for stroke. It is one of the modifiable risk factors, meaning that we can modify diet to decrease your risk of having a stroke. Your diet plays a very important part in this, in that you want to eat a lot of fruits, a lot of vegetables, decrease your salt intake, you want to decrease your fat intake. You want to have exercise. The AHA recommends 30 minutes a day of aerobic exercise. All of these modifiable risk factors, diet, exercise, play a very, very important role in preventing secondary stroke as well as primary prevention for a stroke.

Host: Are there general resources available for those who don't live in Harford County?

Lindsay Goff, BSN, RN, NRP: Yes, there are many resources. The internet is a lovely thing for stroke resources. The AHA has an amazing website with a list of resources for not only patients, but also their family members. The NIH also has a great list of resources for post stroke patients as well as their caregivers. The internet is a great thing and that is where most of the resources are and it's a great resource for patients.

Host: Any support groups or resources available for stroke survivors and their caregivers?

Lindsay Goff, BSN, RN, NRP: There are many. In Harford County, I have a stroke support group that is held once a month at Upper Chesapeake. It is the second Wednesday of every month in the Lyle Sheldon Conference Room. It runs from 10:30 in the morning until 12:00. We have an amazing group of patients that are in different steps of their recovery process.

My longest stroke patient has had a stroke 20 years ago. He is an amazing mentor to my newer stroke patients and helps them understand and comprehend the recovery process from a survivor standpoint. So that is something available and they are all over the country. They are both online and in person. If anybody would love to come to mine, it is the best part of my job.

Host: That is wonderful. Thank you so much for sharing that. And Lindsay, in closing, what would you want to be the key takeaways for listeners?

Lindsay Goff, BSN, RN, NRP: The key takeaways that I would like the public to understand; not only just the public, but also healthcare providers, is that time truly is brain. These patients do suffer strokes and it is life changing. These deficits can be debilitating. It can drastically change a patient's life or also their family members lives.

So I always like them to, people to take away that these deficits that these patients experience is irreversible and it is permanent. So please be patient with them and understand that suffering a stroke is truly an acute event that is drastically life changing.

Host: But there are ways and you've provided some great tips for how to make the best of it and after a stroke. Lindsay Goff, thanks so much for sharing expert insights on post stroke care and recovery. Very, very informative. Thank you so much.

Lindsay Goff, BSN, RN, NRP: Cheryl, thank you so much for having me. Have a great day.

Host: You can find more shows just like this one at umms.org/podcast and on YouTube. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again and please share this episode on your social media.