This presentation is presented by Dipika Aggarwal, MD, Neurologist at University of Kansas Medical Center.
In 2018 and 37 years old Dipika was diagnosed with stage four colorectal cancer. After treatments, by 2019 the cancer taken care of. She was back to work.
Shortly after, she suffered from a stroke – a Hemorrhagic stroke because of an unknown aneurysm rupture. Completely weak on the right side she had aphasia which effects speech. She has been doing constant therapies and is able to talk and work again in the neurology clinic.
She has been through the items she is presenting here. This post from the American Stroke Foundation lays out the key points to the video, but we encourage you to watch as well.
“How the stroke survivor can rebuild his or her life. “
Life after stroke
Recovery & Rehabilitation
Role of caregiver, family or friends
There is life – and hope – after stroke.
It’s an event which is caused by the blood vessels (mainly the arteries) in the brain. It is common.
Approx. 800K cases per year.
If blood vessels are clogged or blocked.
Tissues of the brain can’t get oxygen and nutrients and the nerve cells (neurons) can’t function.
Ischemic Stroke – 87% Dry Stroke – occurs because of blocked blood vessels. Lodged blood clot.
Hemorrhagic stroke – Small blood vessel ruptures – brain tissue is not getting nutrients. Sometimes the blood vessel forms a balloon called an aneurism where the blood vessels become thin.
Transient ischemic attack (“mini-stroke” or warning stroke) Most important category short lasting – few minutes or an hour sometimes 24 hours no permanent damage – but a warning sign – don’t ignore it Call 911
FAST Face Drooping Arm Weakness Speech Difficulty Time to call 911
Every 40 seconds – someone has a stroke in US
Time is Brain Sooner it is treated the better the outcome
How Stroke Affects people
Weakness or paralysis on one side of the body
Numbness or abnormal sensations on one side of the body
Balance or coordination problems
Speech difficult – slurred speech or aphasia (difficulty in understanding or producing the speech)
Bodily neglect – patient neglects the side affected by the stroke – for example they might not eat on the plate the side where the stroke affected
Attention deficit / cognitive problems
Other: Fatigue Bowel and bladder problems Sexual problems Personality Changes Depression
Treatment – admitted to the hospital
Return to community living Preventing another stroke
Greatly influence health outcomes and recovery
First few months – acts like a new born brain – rapid recovery This phenomena is called neuroplasticity – ability of our brain to learn, make new connections, adapt and adjust in response to brain injury
The good thing is there is no expiration date – few months to few years – no one can predict – how soon – how much – NO PREDICTOR BE PATIENT – KEEP HOPE – NEVER GIVE UP KEEP doing your therapies – REPETITION is the key!
What to expect during Rehabilitation Inpatient Rehabilitation Facility – 3 hours a day / 5 days a week – medically stable With a team: Physiatrist (rehab doctor), therapists, psychiatrist / psychologist, social worker, recreational therapist, support group
Main goal – all team members assess you, evaluate you, talk amongst themselves, the patient (stroke survivor) caregiver and family to: Set rehabilitation goals
Achieve those goals through Individual therapies, group therapies, psychological support, setting routines, educate
Caregiver training, community resources
Other Rehab settings
Where: Skilled nursing facility (SNF) For Whom: Daily skilled nursing or rehabilitative care but cannot tolerate the intensity of IRF What to expect: No minimum therapy registered nurses / therapists
Where: Long-term acute care facility (LTAC) – For Whom: multiple chronic medical conditions What to expect: Hospital level of care
Where: Nursing Home For Whom: Don’t require skilled nursing What to expect: Long-term care
Where: Outpatient clinic For Whom: Don’t require inpatient care What to expect: Outpatient therapies
Where: Home health agency For Whom: Homebound What to expect: Skilled nursing therapists; health aid
Things to consider when choosing a rehab facility
Is it certified to care for people with a stroke
Are there team members, do they have experience with stroke
Rehabilitation services available Intensity – how intense are they Medical service / physician available Cardiologist, nephrologist
What other clinicians / therapists do they have Nutritionist, dietician, spiritual therapist
Their recovery goals match yours
Help / educate caregivers How involved can caregivers be? Educate on how they can take care longer term
Location Close enough
Insurance – is it in-network – what all therapies does it cover? As of 2018, the former Medicare caps now are annual thresholds that physical therapists are permitted to exceed when they append claims with the KX modifier for medically necessary services. This change from the earlier “hard” therapy caps is the result of the Bipartisan Budget Act of 2018 (BBA of 2018) which provides for Medicare payment for outpatient therapy services including physical therapy (PT), speech-language pathology (SLP) and occupational therapy (OT) services.
Continue Recovery Self exercises / home program Remember – slow process, be patient, don’t give up Stroke recovery has no timeline or expiration date Repetition is key
How can family, friends or a caregiver help?
Support to your loved one – encouraging survivor to be involved and go to therapy
Visit and talk – play cards – listen to music – hang out
If the patient has trouble communicating, ask the speech therapist how you can help Attend some rehabilitation sessions
Participate in education offered Encourage and help the patient to practice the skills
Avoid doing things that the patient is able to do. Promote repetition. Example – if speech is coming back, don’t complete their sentences for them. Let them finish their thoughts.
Promote repetition Be an advocate for yourself and your love one Take care of yourself – avoid care taker burn out (something from Medicare called respite care – medical provider can apply for it – Medicare will pay for it to give you a break and have some me time)
Preventing another stroke
Lifelong commitment Follow your health care providers Take your medications regularly Never stop without talking to your provider – if you’re having side effects, talk to your provider.
Lifestyle modifications – Heart and Brain Wellness American Hearth Association’s Life’s Simple 8 – lifestyle modifications Manage Blood Pressure – Take your medications on time / monitor your BP / write down your numbers / share with your provider
Control cholesterol – HDL is good / LDL is bad Talk to your HCP what that goal is for you
Reduce Blood Sugar Diabetic – be on medication / Check regularly
Get Active – AHA – extensive research on how active you should be
Lose weight if you are overweight or instructed by HCP
Common Emotional and Personality Changes
Depression 1/3 to 2/3 of survivors Early stages of stroke recovery If untreated, can limit functional recovery Thoughts of death or suicide – professional help right away
Anxiety – so much has happened in life. Financial. Work. Career changes or family changes.
Pseudobulbar affect (PBA) / emotional lability – stroke survivor might have unreasonable crying or laughter – talk to HCP – good treatment Anger outbursts
All of these can be treated
Do not ignore mental health – as important as physical well being Don’t hesitate to ask for help Medication, psychotherapy or both Mindfulness, mediation Yoga or tai chi, etc.
What is mindfulness Medication?
Mindfulness meditation is a mental training practice that teaches you to slow down racing thoughts, let go of negativity and calm both your mind and body. Also helps your physical health – lowers BP, improves sleep, improves memory
Free of cost No side effects Improves mood, mental health, memory, sleep, physical health several websites – mindful.org several apps – insight timer, headspace, calm Go to YouTube – type in mindfulness videos for anxiety / sleep / depression – list of good videos –