Recovering After a Stroke: A Patient and Family Guide

welcome to Washington Hospital today dedicated to informing residents about healthcare topics and issues through programs featuring community forums and free health and wellness classes our goal is to empower community members with the information needed to make informed health decisions Washington Hospital has been providing health care to the residents of the Washington Township healthcare district for the past 60 years [Music] today's presenters are Denise Lynch and ELISA curry Denise Lynch is a registered nurse and Stroke Program Coordinator at Washington Hospital ELISA curry is a physical therapist and coordinator of rehab clinical programs at Washington Hospital thank you everyone for coming out and listening to our presentation tonight about recovering after a stroke a patient and family guide let's sort of get started here so what I'm going to do is I'm going to go over a brief overview of stroke and the treatment and then the effects following a stroke and then some tips on how to navigate the recovery process so some facts first about stroke there are nearly 800,000 strokes per year stroke is actually the fifth leading cause of death in the u.s. one person dies of stroke every 4 minutes and there are more than 4.5 million stroke survivors living in the u.s. stroke is actually the leading cause of serious long-term disability and preventable disability 80% of strokes are actually preventable 40% are left with moderate impairment and about 15 to 30% are left with severe impairment only 50 to 70% of stroke survivors regain functional independence 20% are institutionalized within 3 months 22 percent of men and 25% of women die within the first year of having a stroke locally african-americans have 50% more strokes than Caucasians and twice as many as Asians and Hispanics so women and stroke stroke actually kills more women than men stroke stroke if so a woman who is 30 years old and who smokes and is on oral contraceptives our 22 times more likely to have a stroke and this is a huge fact stroke kills more than twice as many American women every year as breast cancer ovarian cancer uterine and cervical cancer combined okay so let's talk about the two different types of strokes that there are there are what we call an ischemic stroke and the other one is called a hemorrhagic stroke an ischemic stroke is caused by a blood clot that interrupts disrupts the flow of blood in the blood vessel and so the blood the nutrients in the blood the oxygen can't get to the brain cells and the brain cells die and that is your stroke the other one being a hemorrhagic stroke is when a weakened blood vessel bursts and blood goes into the brain it's about an 8020 there's more ischemic strokes and hemorrhagic strokes so what is a TI a a TI a is a transient ischemic attack it's a mini stroke it stroke like symptoms that go away within 24 hours and it's estimated that between 200 and 500 thousand occur annually and these are really important because 9 to 20 percent of those patients that have a TI a they may go on to have a stroke in the next 90 days so here at Washington Hospital we take that very seriously and all our suspected Ti patients are brought into the hospital and a full stroke workup is done on these patients determine if there's any risk for stroke okay so risk factors for ischemic strokes you have uncontrollable risk factors and controllable risk factors uncontrollable are those things that we really can't do anything about such as our age our gender our race our genetics we want to look at our controllable risk factors what can we control so those things being high blood pressure high cholesterol diabetes atrial fibrillation smoking lack of exercise obesity and excessive alcohol or drug usage common signs and symptoms of stroke so the key word here as you can see is sudden it's sudden onset of weakness or numbness on one side of the body it's a sudden headache no headache like you've ever had before with no known cause it could be a sudden onset of confusion trouble getting your words out trouble understanding it could be trouble seen in one or both eyes trouble walking dizziness loss of balance coordination issues so depending on where the stroke occurs in the brain is sort of your symptoms so for example if you have a stroke in your frontal lobe you're going to have more cognitive problems if you have a stroke in your parietal lobes you're going to have more of motor sensation symptoms another example might be the occipital lobe back here that's where your vision is so you might have trouble seen in one or both eyes now if they're stroke occurs in your left brain the tracks cross over and affect the right hand side of your body and vice versa right hemisphere affect the left hand side of the body time is so important with the brain so that is why it's so important that if you think you or somebody else is having a stroke is that you dial nine-one-one and you get to the hospital as fast as you can we have to remember that for every minute the brain is left untreated there is 1.9 million brain cells that will die so the faster you treat the brain the better your outcome is now this is a slide of a CT scan of small ischemic strokes so here you say this is the person lying down right face up you have the right hemisphere and this is your left hemisphere this black area right here is where there is a small ischemic stroke shows up black on a CT scan this right here is a very large ischemic stroke in the right hemisphere remember this is left hemisphere and you can see it's even pushing over onto the left hemisphere this is this is a very severe stroke may not be survivable stroke assessment scales so there are many different types of stroke assessments scales that can kind of determine whether or not the person is having a stroke the two that I'm going to talk about is the Cincinnati and fast so the Cincinnati pre-hospital Stroke Scale is actually the scale that is used out in the field for EMS emergency medical services so what they do is they look at the face they have the patient smile is it symmetrical is it asymmetrical is there a little bit of facial weakness you want to look at the folds in the face then they ask the person to put their arms out and hold it for 10 seconds is there some drift is there some weakness can they maybe not even lift their arm and then they ask him to repeat after me the sky is blue in Cincinnati so if they can't get those words out or it's slurred or it makes no sense whatsoever that could be a sign of a stroke and this actually this tool is actually 80% reliable the other one is fast you may have seen this hopefully on commercials and stuff the acronym fast FAS T it stands for faith again arms is their weakness speech is it clear or not and time so if you're on the outside of the hospital of course you dial 911 one get to the hospital as soon as you can and then off you're inside the hospital we use this and we call codes and such things like that and the real important thing here is knowing when the person was last seen normal that makes the differential makes the difference in treatment so say you're having a stroke you come through our emergency room you come through the front doors and obviously an ER physician comes and sees you quickly there's nurses you get your lab drawn you get EKGs done and then we take you off to imaging imaging gives us a lot of information so we do what's called a CT scan of the brain we do a CT perfusion and we do a CT angiogram on most of our patients and again this is just a normal CT scan we're looking to see you know is the patient having acute ischemic stroke that might show up on CT are they having a hemorrhagic stroke that tells us information on how we're going to treat the patient here is a CT perfusion so with all the technology we have this is amazing is see this blue area right here this is actually showing us that there are brain cells that are dying they're not dead we can't do anything with dead tissue but this is this is dying tissue so this is salvageable tissue we actually call it penumbra and so this is somebody that we want to actively treat if they meet the requirements and then a CT angiogram CT angiogram is when we inject contrast into your IV and the contrast goes through your blood system goes up to the brain it highlights the blood vessels and it can show us if there's a clot there so by looking at this you see that this is the right side you see the blood vessels nicely but it does look a symmetrical you don't see here you don't see a go out here well in fact there's a blood clot sitting right there and so okay so what can be done for an acute stroke so if you come to the hospital with symptom onset less than four point four point five hours you can get what's called tissue plasminogen activator TPA so it's a clot busting agent we give it through the IV and it dissolves the clot but you have to meet all of those stringent criteria in order for us to give it and here at Washington our goal is to be able to give that to you within 45 minutes of walking in the front or the other approaches is what called interventional approaches so here at Washington we have specialized doctors that can actually go up to the brain and get the clot so what they do is they make a small incision in your groin they run a catheter all the way up to where that clot is in the brain and mind you the vessels in the brain are very tiny they use devices such as the retrieval the penumbra device and they're able to extract that clot out of the brain and here's an image of a clot that was pulled out of the brain and then you can see on imaging right so you can see the clot was right there there's no blood flow that brain tissue is dying and then here after the doctor was able to pull that clot out the flow was restored revascularisation occurs that brain tissue is not dying any longer okay so let's talk a little bit about hemorrhagic stroke hemorrhagic strokes unfortunately are more likely to result in death and severe disability there's about 37,000 hemorrhagic strokes per year thirty five to fifty two are actually dead within one month and only 10% are living independently after one month so what are the risk factors for hemorrhagic strokes hypertension being the number one thing advancing age right as we get older our blood vessels get a little bit weakened may be coagulopathy disorders alcohol abuse drug use methamphetamine cocaine that all weakens blood vessels and also the ischemic stroke so if you have like that one slide that I showed you that very large ischemic stroke that area is at risk for bleeding so you could have a hemorrhagic stroke in that area presenting signs so the number one thing is a severe headache like I said like you've never had before oftentimes they come in the emergency room they're not it they're vomiting they have decreasing level of conscious yes they're often very sleepy or they're in a coma and they have extremely high blood pressures it's not uncommon for somebody to come in with a blood pressure of 258 over 150 okay so uncie t scan blood shows up as being white so that's actually in the right basal ganglia a very small hemorrhagic stroke that's typical of a hypertensive bleed and then this is a very large hemorrhagic stroke you see where the white is this is quite alarming so the treatment options for hemorrhagic strokes are usually conservative what we want to do is we want to drive the blood pressure down from where it was because that stops the bleeding if the blood is more towards the surface of the brain the neurosurgeon may be able to take that blood out take that blood clot out sometimes they can put a drain into the ventricle the ventricle is where the cerebral spinal fluid is and they're able to drain out the blood that way sometimes they'll correct the kawaii' allopathy but again managing the blood pressure is key the effects of stroke so problems associated after having a stroke well there's emotional problems inadequate ventilation disorders of sensation and I'm going to go through all of these one by one real quick here so definitely emotional problems in social deprivation right there's definitely after having a stroke there's a change in body image there's loss of Independence there can be a pain associated with the stroke if the person was to get a contracture something they can get pain in the shoulder or the elbow they could have altered ability to communicate and this all leads to isolation so unfortunately depression is the most serious complication of stroke they estimate that about 50% of stroke patients will have signs of depression and the few months following a stroke and this can either be because of the stroke obviously having the stroke cause depression or can be actually biochemical problem in the brain and oftentimes it'll manifest itself and look as to be you know patient will have fatigue they may have sleepiness or a poor appetite or they may actually say why me so inadequate ventilation of the lungs so some stroke patients will have de Spacia and that is trouble swallowing so if you have abnormal tone in your face if you have facial weakness you're at risk for not being able to eat correctly right you make choke you make off you may pocket your food and if the food doesn't go into your stomach and invert enly goes into your lungs you may acquire aspiration pneumonia and this is actually the leading cause of death in our stroke patients disorders of sensation okay so if you have numbness or complete numbness to one side of the body you know maybe you're making breakfast in the morning trying to get yourself some breakfast in you inadvertently put your hand on the burner and it takes a while for that impulse to get to the brain because you have no sensation there it can lead to burns and skin breakdown in infections incontinence of bowel and bladder so 50% of stroke patients will have incontinence in the acute phase this will lead to often leads to embarrassment sometimes it's hard for the family or caregivers to sort of deal with this it can lead to skin breakdown communication forming clear language can be impossible sometimes sometimes patients with aphasia they can't get any of their words out they may not even be able to nod yes or no to you and maybe they're not able to be understand what is being told to them or asked of them and this can lead to isolation as well abnormal tone so if someone it has weakness on one side or paralysis that makes it very difficult to walk and take care of themselves this leads to dysfunction and impaired hygiene alter body-image certainly so what's the answer the answer is rehabilitation and at Washington that's the first thing that we think about is after the acute acute phase we want to get in there our physical therapists occupational therapists effective rehabilitation interventions initiated early after stroke enhanced the recovery process and minimize functional disability so our goals here at Washington rehab we want to prevent another stroke from ever happening so we try to identify what caused the stroke maybe it was blood pressure maybe you hadn't seen your doctor in a couple of years and you've been walking around with high blood pressure and now we've put you some on some medication for that and we want to prevent complications certainly like the aspiration I talked about and maintain safety so after the acute phase of being in the hospital we want to get you ready to go to acute rehab and this is a place where you go and you exercise morning tonight and it's generally about a three week stay or so and the rehab team consists of doctors and nurses physical therapists occupational therapists speech therapists etc but the patient and the family are key members of this team so the golden window of opportunity they say the first two months are after having the stroke are when you get your most improvement back I've talked to a lot of stroke survivors and they say you know what tell your survivors don't give up don't give up stay the course because they find that they improve one year two year I was just talking to a gentleman the other day and he had severe aphasia and I had no idea he had a stroke he says it's been ten years and every every day I'm still getting better and better you know so I was like wow another alternative could be home rehabilitation so therapists can come out to your home they evaluate your home make everything saved the first thing they want to do is remove all those throw rugs those are a trip hazard make sure that you're wearing good shoes perhaps you need handrails in the bathroom in the shower where the commode is they can also provide medical equipment wheelchair or walkers so continued goals to increase independence improve cognitive and physical function improve communication maintain safety prevent another stroke and achieve a satisfactory quality of life okay so now let's talk a little bit about the caregiver living with stroke is so intimately associated with caregiving of the stroke survivor we must consider both the survivor and the caregiver the caregiver is generally a spouse caregivers have a major influence on the long-term well-being of stroke survivors they help to maintain and the gains achieved while in rehab and because rehab has done so much to improve stroke induced disabilities eighty percent or stroke survivors do return home caregivers typically get minimal education there's no really any classes out there that tell us how to be good caregivers the studies highlight the limited use of services available there's not a whole lot of resources out there caregiving is usually a long-term for the stroke survivor so who's the average caregiver it's like I said it's typically a spouse maybe there's somewhere between the fifth and seventh decades and many may have health issues of their own so it's really important for us to understand that both the stroke survivor and the caregiver have profound sense of loss right stroke survivor definitely has a sense loss of and independence they can't do things like they used to be able to do and then the caregiver the caregiver may be they don't have the leisure time that they once had they have loss of freedom another problem is relationship adjustments right maybe pre stroke the marriage was hopefully a partnership right and now it's become caregiver care receiver new responsibilities so maybe now all of a sudden has caregiver you're not just doing all of that work but you're also maybe the breadwinner now and maybe you weren't before the the other person had the stroke now maybe you're making all the decisions financial decisions whatever decisions feeling the demand of caregiving caregiving is hard work there's no doubt about it and sometimes we're poorly repaired prepared to take on that role care caregiver health is often adversely affected so it's hard to have to depend on others it's it's difficult to ask for help but we have to be able to ask for help when we need it good outcomes embrace the new relationships and contact with others so hope and optimism stroke survivors must maintain hope to help improve function and overcome barriers need to have a positive attitude you need to stay the course so the caregiver helping someone you care for to continue living independently in the community is valuable work caregiving can be satisfying experience it demonstrates fulfillment of a commitment to a loved one true enough though caregiving is not a role anyone really chooses it seems to choose us emerging from events and circumstances outside our expectations and beyond our control so a few tips to navigate the recovery process so you need as a caregiver you need to ask questions you need to get all the information you possibly can you want to know what type of stroke did my loved one had what caused the stroke how can prevent it what are the long-term effects of this stroke and a couple of sources here I highly recommend that you visit the website Stroke Association there's lots of information on that website for caregivers there is also a hotline of 188 for stroke and then it's called the stroke family warm line and this is actually staffed by people that are very knowledgeable and Stroke actually have personal experience with stroke and it's a really good resource and you can ask questions or maybe you just need to talk okay so some other tips for the caregiver it's so important you've got to reach out to family and friends and ask for help you can't do it all by yourself and you got to take care of yourself right so that means calling up a friend and going to get a cup of coffee or going to the movies with a friends it's also very important that you build a network right with other stroke survivors so here at Washington we have an excellent stroke support group that meets the fourth Tuesday of every month from one o'clock to 2:30 and there's my telephone number there there's flyers in the back as well we'd love to have you join us it's also important as a caregiver to think about your mental health and sometimes that means maybe seeing a therapist there's nothing wrong with that they can help you with your coping skills okay so definitely you got to take time to take care of yourself right you can't give to others if your your well is empty so you've got to fill up your well you got to take care of yourself you got to eat you know balanced diet you got to exercise you got to spend time with friends and family respite care is very important and there's a website there WW eldercare.gov also many say a journaling is very important to get your thoughts and ideas onto paper can be very soothing also to navigate the recovery process it's important for you inquire about sort definitely inquire about rehab services maybe a social worker maybe support groups nutritional care I highly recommend that everyone have a an emergency kit for your loved one and for yourself and this consists of having a list of contacts so have a list of all your doctors have a very accurate list in case something were to happen to you or or your loved one right you want to have an accurate list of medications to when you're coming into the hospital and you want to have a copy of your insurance card you want to be able to communicate effectively with the healthcare team the doctors and the nurses you want to be able to know when the past illnesses were what year was the surgeries done in you want to know your family history allergies those are all very important when an emergency is happening being a caregiver is a difficult job but it makes all the difference in the world to the stroke survivor it takes patience strength creativity and resourcefulness use the resources available so final word for the caregiver rule number one for all caregivers is to take care of yourself the more imbalance you keep your own well-being the more you will enhance your coping skills in stamina Dana Reeves 1961 to 2006 and here's just a list of some resources again the stroke association is an excellent website the National Stroke Association and then of course Washington Hospital and my I have my email up there a phone number please you can call me if you have any questions at all I would love to talk to you and that's it for me thank you so welcome everybody I'm glad that you're here my name is Lisa Curry and I have the good fortune to work with a fantastic team Denise and our stroke team are very well known in this area uh one thing that I don't I didn't hear you mention is that Washington Hospital is a stroke receiving center for Al County and that's important because from where we're positioned in the Bay Area we are a central location so it's important to be able to provide services not just for the community but for people outside the community because as many of you probably know strokes don't happen just at home they can happen on vacation they can happen on business trips they can happen anywhere and so if you haven't noticed there is a large building across the street that is going to be opening to the to the community as of October 10th 2018 that is our new Morris Hyman critical care pavilion that is going to house about 100 beds of critical care it's going to have a brand new emergency department which is about four times as large as our current emergency department it will have five pods of twenty eight beds of critical care ice critical care services which right now is ICU and CCU if anyone has been in our current ICU and CCU there is no privacy there is no space and there's no way we can continue to operate in that in that place so we have to expand the top floor of the building is also going to be our telemetry neurology and our excuse me oncology and intermediate care services so that is a huge boost for the community and for Washington Hospital as well so to start I want to talk about a few things post-stroke where do we start what do we do how do we handle it I'll cover physical therapy occupational therapy and speech is focus and then we'll talk about caregiver training I've got some other things that kind of overlap with what Denise said but I think it's an important point because it is important as a caregiver to understand more so not not the physical task of caring for patients but how do how to manage and so I want to make sure that we cover that and some resources I will have actually one of my favorite people in this hospital Editha Hernandez come up and share her experiences as a stroke survivor and then just give you guys some final points so some additional statistics about stroke and recovery guidelines I think it's important that you understand that 10 percent of stroke survivors recover almost completely from stroke 25 percent have minor impairments 40 percent the largest amount of those patients have moderate to severe impairments that require some sort of specialized care 10 percent of these patients may require care in a long-term care facility and 15 percent of people actually died shortly after stroke the the thing that I try to do is I always try to bring a little bit of levity to this so if you've ever been to San Francisco this is a map of San Francisco downtown San Francisco and I think many of us have driven around San Francisco and I think many of us have driven around San Francisco on a Monday okay and maybe you've driven around San Francisco on a Monday at 4:30 which you know is a little chaotic at that point in time and think about driving around San Francisco on a Monday at 4:30 in a large truck that takes some navigation and so let's say that you wanted to get from Coit Tower to Mission Dolores okay there's some straightforward ways we all know that there's some one-way streets in San Francisco but if you have a knowledge of driving in the city then you figure out the best way to get there and it's usually a way that's pretty straightforward pretty fast I did not take the time to look at a map to make sure that Laguna did not is was not a one-way street in the opposite direction so I don't encourage anyone to do that but it's usually a straightforward path and how this relates to stroke is that a stroke is basically a big block and you have to learn a new way around what was familiar what was normal what was routine is now completely obstructed and the sooner that we can clear that obstruction the that everything else starts to back up and so that's essentially what a stroke does for patients I think Denise covered very well how the right and the left side of the brain work but I think it's important to to reemphasize that your left side brain is your speaking reading writing all of your analytical side all of the the solid when I say the engineering side people who are very structured they're very left brain your right side brain is your abstract understanding your understanding context understanding intuition emotion that's more of your creative side I think we all know people that fall very hard left or very hard right and some of us that fall pretty close to the middle but when you lose skills are engineering brain if you want to think about it that way they can lose that understanding of spoken and written language difficulty expressing themselves changes in speech they're memory impaired logic and you can see how frustrating that would be for someone who lives their life that way to have a left-side stroke and think about your creative person if they lose their skills that person can experience neglect problems with memory loss of just that that big abstract thinking and it is a blow to their way of being and so not to say that an engineer can't have a right side stroke or an artist can't have a left side stroke but you can see how devastating this can be to a patient who's living their life in a certain way and that gets obstructed so rehab is really about all of these different areas it's about the ot the physical therapists the occupational excuse me the speech therapists the services the the orthotist and prosthetists the physicians nursing is missing from this but we all work together this is a very overlapping group and you know I always want to highlight the fact that it's really the patient and your family whether it's your family or friends I always say that family friends are the family you choose for yourself and so it becomes those people that help as part of the team and have to help with creating a new normal for patients the resources that people have you don't become wealthy taking care of patients you've taken care of someone you actually have to replan your entire way of being you don't have to invest a lot of money to be creative but you have to think about what's going to work the best with the situation you have modifying the environment to look at what's realistic for someone to exist in so these are the things that as therapists we are constantly looking at this is how we live our lives is problem-solving and helping patients and their families to problem-solve a stroke as Denise also mentioned can really cause five types of disability problems with movement including those visual deficits sensory disturbances including pain stroke patients can have increased tone which actually translates to pain and and that is something that may or may not be fixed with medications sometimes it's fixed with actual positioning or stretching or you know movement the problem is understanding language and problems with memory and also just the emotional disturbances that I think she covered very well many times patients may have a reaction of crying when they're happy crying when they're sad crying when they're too frustrated and it's not an emotion it's not a sadness it's just that is that biochemical change sometimes that can occur with stroke patients the levels of care this just also highlights that same average on average going to an acute rehab hospital patients can go for about twelve point seven days this is a acute rehab facility back east that I pulled this information from so their length of stay for inpatient they predict about twelve point seven days skilled nursing there's our a lot more time that patients can spend in skilled nursing in an average of twenty six point five days home health and outpatient can be variable you can see that the level of services available in the level of care provided varies with the setting in acute rehab being able to tolerate three hours of day of therapy and typically five to six days a week of that therapy that is what acute rehab therapists are trying to provide as opposed to a skilled nursing setting where your patients may need to go slower because their level of understanding or their level of disablement is much higher they're still trying to provide as much therapy as possible but the patients may just not be able to tolerate that much activity right away and then as you get to home health and outpatient you can vary your session sometimes even short frequent sessions are much more beneficial to a patient than long sessions going in and working with a patient and a short bit of time on something focused like an OT may go in work with a patient on setting them up for eating and they eat and then they get a chance to rest for a while because again it's retraining the person on how to do these activities it's not the length of time it's the quality so always think of it as quality not quantity the other thing is our physician involvement as much as I respect and love our physicians they're there helping to drive what patients need but it is a interprofessional relationship you have to have your nursing staff involved just as much as you have to have your rehab staff your social workers your patients your families everybody is important no one entity is more important sometimes things are magnified but everybody's working together just focusing on rehab physical therapists primarily are looking at moving and balance we're looking at the ways that people can function physically occupational therapists take that a step further and they're helping people to their physical function as it relates to self-care and daily activities and then speech therapists actually overlap a little with our occupational therapists because they both work on the physical aspect of eating or swallowing they both can work on language speech therapists can work with the patients on that repetitive nature of language and you know all of the olive rehab overlaps it's really about all three disciplines looking at the same problem with a different lens that's how we that's how we come up with our our primary rehab techniques with PT we're concerned about the fixing of the impairment and the disability or making modifications to the current disability whereas occupational therapy is looking for that patient to apply themselves for purposeful and meaningful activities that help their quality of life the concept of neuroplasticity this is a big word that essentially explains what we try to do we're helping patients to rework the neural pathways there is a lot of science now around the concept of neuroplasticity and 20 years ago when I was in physical therapy school this terminology didn't exist but they've actually given it a name it is redeveloping the pathways it's the practice it's the constant work and there's there's a lot of articles now that people can access that talk about how your brain functions this isn't just related to stroke this is how the everyday person functions if you've ever learned a new skill like playing the piano that's neuroplasticity if you've ever learned a new way to drive you know that's neuroplasticity if you've ever played you know done Sudoku those are the things that actually help to exercise our brain and that's what it is it's exercising the brain so patients who have stroke you can see that they're developing a new normal they're essentially trying to create new pathways and to have those stick and how we get them to their end goal we continue to try we continue to work with what we get but we're helping patients and their families to establish a new normal that's what our goal is as healthcare professionals there are ten concepts in neuroplasticity Michael Marisnick the the person that's quoted at the bottom here he is one of the primary people in neuroplasticity and the 10 concepts that they try to emphasize is that first change is limited mostly limited to the situations in which your brain is in the mood for so essentially you have to be ready to make change for change to occur number two the harder you try the more motivated the more alert the and for better or worse the potential outcome the bigger the brain change so essentially you you really have to direct your behaviors to be able to affect change on the brain the things that change the brain are the strength of the connections of the neurons that are engaged together moment by moment time by time it's the repetitiveness that help people to gain learning driven changes and connections increased cell-to-cell cooperation which is crucial for increasing reliability this is that cellular level of how our neurons in the brain work and for the for the stroke patient we may not we may not be able to make them understand that but if we have someone working on a very small task it's that it's that constant repetition of tasks it's that constant finding new ways to get people to do that same task that's what helps them to retain it the brain can strengthen its connections between neurons that are representing separate moments of successive things that reliably occur in cereal time so it's working on steps if you think about the steps that you took to get here tonight you had to get dressed you had to finish things at your house you had to lock the door you had to walk out you had to get in the car you had to make sure you had gas those are all the steps that go along with breaking down a task for people to remember it initial changes are temporary so if you make a small change and you only do that change once that's not gonna stick okay the brain is changed by internal mental rehearsal in the same ways and involving precisely the same processes that control changes achieved through interactions with the external world we can't isolate these patients we have to expose them sometimes to other input because you don't know what they're going to retain what's going to stick so making sure that we expose people to things so that we can help them to exercise those how the brain is working memory guides and controls most of our learning so as people can retain information they can then apply that over and over again every movement of learning provides a moment of opportunity for the brain to stabilize and reduce the disruptive power of potentially interfering backgrounds and noise so as you develop more specific routines your your brain can start to filter out the things that are unnecessary which is the noise and then brain plasticity is a two-way street it's just as easy to generate negative changes as it is positive ones so if we don't provide the type of input that we want patients to follow we can be reinforcing things that aren't beneficial to a patient okay that's the whole concept that dr. Mirza Nick was trying to get across and I think that these are things like I said that don't just apply to stroke but learning behaviors in our regular life so physical therapists what we do what I do as a physical therapist is I'm that person that sits in the airport and watches people walk okay and I will sit there and mentally go that person's cane is too short that person didn't do their hip exercises this person had a stroke and this person has balance issues I you know physical therapy is constant analysis constant tweaking constant change and so we are looking at a person with stroke not a stroke patient but a person with stroke we are looking at that person too see how we how they are accommodating for their deficit their transfers their their balance their coordination for performing activities whether or not they have the sensation that you need to be able to tackle II feel I think the analogy of putting your hand on something hot and not necessarily having that not that feedback that heat is hot and you can burn yourself okay figuring out not just how far someone can walk because there's patients who can walk far but there's patients who can't walk well and so that in itself is another piece of the puzzle it's again the quality not the quantity okay figuring out assistive devices there are so many devices and and gadgets and in computer generated things that can help and enhance someone's quality of life and unfortunately we don't know what we don't know so that's why you guys are here because we want to expose you to as much as possible so that you get more tools in your tool bag as I like to say okay environment modification that to me is the number one thing because everyone's environment is different and how someone was functioning and how we need to modify their environment makes a huge difference many times one of the one of the most common behaviors that happens is that patients who have a stroke or very independent and they get very frustrated and angry because depending on where the stroke is they may be able to process they may be able to think about what they want to do but they physically can't they want to pick up a cup and feed themselves they don't want to be fed but they can't physically do it they want to be able to take a shower but they maybe can't get in over the bathtub and those are the frustrations that can manifest into larger problems we think that it's about that small task when in actuality it's about a bigger picture and so sometimes making just the the time taking the time to think about how do I make one task a little bit easier those types of modifications those can be something as simple as installing a grab bar in the transition between a garage and coming into the house or installing a grab bar in the hallway you know putting a rail in the hallway that allows someone to be able to walk down a hallway as opposed to having to wheel down the hallway the education and training piece is also very critical because we train constantly therapists are constantly not only trying to treat but we're trying to educate because the more that someone understands the why as to why you're doing something the more likely they are to carry it out okay occupational therapists as I talked about a second ago there can they're more concerned with self skills they are looking at a person's ability to perform what we call activities of daily living basic ADL's which are dressing and bathing and eating and also what's called instrumental ADL's which are those multi tasks those carrying groceries or grocery shopping or balancing your checkbook even though I don't balance my checkbook it's balancing your checkbook okay it's things like cooking a meal or planning a meal planning a party those are instrumental ADL type activities multi-step activities parenting this is something else parenting is a big part of it because when someone who is middle aged has a stroke and has children that is a skill that our occupational therapist also help them to retrain I remember one of my one of my favorite patients was a woman who had had a stroke after childbirth and so she had a newborn who her husband was having a care for in addition to having a stroke and it's a very challenging situation as a lot of emotional component with that okay occupational therapists also focus on community reintegration getting patients out into the community to have those external forces so you see how the concepts of neuroplasticity apply to what we do as therapists okay also making recommendations or modifications in someone's workplace your higher-level patients you saw that that 10% of patients can get back to a fairly normal way of life sometimes they can do that with modifications maybe someone who works in an office may need to reorient things in their office or they may need to think about changing a workstation to make their space work for them if they have that that sort of recovery someone who can't go back to work anymore maybe they have to retrain in another skill or try to use their time of their recovery to treat it like a job because that helps them to get some quality of life back as well okay occupational therapists also work with a younger population to help them return to school and they also work with older people who have to change jobs to get them to be able to return to education as I talked about childcare related tasks and adaptations they also work with swallowing difficulties and coping strategies these are all very important tasks that occupational therapists perform they as well as physical therapists want to look at in addition those help those lifestyle habits that someone had maybe someone was a smoker before and that was a primary cause of their stroke and so we need to look at how do we retrain someone to then get back to a healthier lifestyle to recognize that the smoking is not helping their current situation someone who may be sitting around not having anything to do begins to eat more and it when you're inactive and you eat more the weight gain can make it much tougher on the patient on the caregivers and on the emotional situation okay for couples overcoming barriers to sexual intimacy this is something that isn't discussed and it's a part of life so we need to be realistic and address the situations for couples who are dealing with neurologic interferences okay driving and driving evaluations driving is a very it's probably in the top three requested tasks of patients who have stroke those are things that they want to get back to because driving equals independence and when people can't drive when they have to rely on someone that makes it difficult for them because now they're dependent so in from an occupational therapy standpoint we need to consider how much we protect patients we don't give them enough responsibilities and it's it's I don't want to treat a patient as a child but giving someone responsibilities makes them feel whole or it makes them feel like they're contributing so figuring out activities that patients can participate in is therapy because if someone can feed the pets let's say they're the one who has to get the food and has to open the cat food container and they have to put that into a bowl maybe that becomes their daily task that's gonna make them feel like they're participating they may not be able to put the bowl down on the ground but they certainly can get everything ready and someone else can put it down on the ground okay or setting the table for dinner organizing the mail sorting clothes a simple recipe prep those types of things are things that help someone to feel like they are participating in their life again and so the more that we give patients those activities the more that we can get them to to become more a part of their family life physical therapists and occupational therapists have these techniques that we can use to treat patients NDT therapy is a positioning type therapy I'll go through all of these in a little more detail but all of the ones listed here are certain techniques that you can use to work with patients it's again looking at the same thing from different perspectives NVT is facilitating normal postural alignment it is getting patients to use the involve side so it's weight-bearing exercises through and involve limb it's standing exercises where patients are actually bearing weight through a leg that may be weak from surgery or have decreased sensation it's giving them that sensory feedback as they turn as they move and it can start with things as basic as sitting on the side of the bed or sitting on a mat these are things that not only are practiced in a clinic but they can be facilitated at home and so these are techniques that people can use PNF this is movement patterns PNF patterns involve stretching and when you stretch you're giving feedback to the muscle and to the nerve so the improvement you can see in muscle elasticity helps to facilitate that connection between the brain and the weak side so for example there's movement patterns that you can do that take a patient from full extension to adduction across the body and turning the hand and you can do the same pattern across this way back down so these are techniques that as therapists we're taught and we can integrate a lot of these different techniques based on what we see there's no one right way okay functional electrical stimulation so FES is the electrotherapy units that are being developed there's a lot of progress in the last probably 10 years the the field of electronics and mechanical engineering in rehabilitation the two fields have come together and so you see a lot more products being developed for patients and all discs in all disease processes in neurology and orthopedics in many and so a couple of devices out there this is a neuro stimulator that's connected to a glove so you think about someone who's lost the use of their hand the neuro stimulator when put on the correct muscle groups can help to stimulate more of an opening of the hand and as you get that electrical stimulation you start to use that with movement so that can be coordinated with movement or foot drop this is a stimulator called a walk aid and when the walk aid is placed around the calf and the electrical stimulator is a person who has foot drop which is which is essentially being able to not lift your foot up when you take a step in the gait cycle when you step you actually lift your foot up and you land on your heel and then when you push off in the back you push off with your toe as someone who's had a stroke has difficulty with that coordination so the walk aid stimulates anytime they go to take a step that walk aid kicks in it helps to lift the foot so it clears and these device the device like this can help someone to be less of a fall risk okay in it prior to the development of this you saw bracing you racing type called a ankle-foot orthosis and that's a plastic that's a plastic brace that can be placed into someone's shoe and continue to support their foot the full way so now we've progressed to the point where we can do this electrically and we can stimulate the nerve that transmit that transmits that message to the muscle I get excited about this because this sort of technology this is the technology that we want it to be used for because as Denise said the sooner that we find these strategies that can work for a patient the less brain cells we lose we're redeveloping that pathway motor imagery and mental practice this is I love this because this is this is something that people can do at home that cost as little as a dollar okay because a mirror at the dollar store you could place it propped in front of a person and let's say that someone has a deficit in their right hand you can prop a mirror and the patient is looking in the mirror and watching their right hand and you can direct them to do movements and when they're trying to do movements what their brain is seeing is they're seeing a mirror image of their hand so that starts to facilitate with the opposite hand movements and the practice and the repetition those types of things can sometimes help patients to stimulate that part of the brain that helps them to regain function it's not the end-all be-all but it's an it's yet another tool in the tool bag okay so it's the mental rehearsal to help to facilitate affected body parts virtual reality and interactive video games this is yet another video gaming is it's a field that I still can't understand I still don't know what fortnight is this is some video game that everybody every kid is playing but you know there's actually a medical application of video games the first one that therapist started using in the clinic was the Wii and when they came out with the Wii everybody was playing games on it dancing on it and jumping on skis well guess what you can actually put a patient in the clinic on the Wii Balance Board and that helps to give them feedback for weight bearing that helps to give them feedback for using their arm because then they're actually focused on a task as opposed to focus on the deficit other apps I'll show you a few of them the constant therapy app these are apps that you can actually purchase online or some of them are free put them on your phone or a tablet you can put them on a Kindle or an or an iPad and these are apps that allow someone to practice games at home that are actually developed by neuroscientists and they look at how the brain works how the brain operates and they're able to take that sort of strategy and get patients to stimulate that part of the brain that they can then apply in other areas so constant therapy is an app that is available to patients clock yourself I'll show that one to you in just a sec balance yourself it's the same developer of clock yourself and these are apps that help patients in balance and in upper extremity and lower extremity usage and luminosity is an app that's been advertised on television but it is also a series of games and skills that has have been developed by neuroscientists with that same idea of reinforcing neuroplasticity partial weight bearing support these are devices that are used in the clinics and used in acute rehab we at Washington Hospital actually happen to have these two devices so the light gate is a large walking frame it allows us to put a vest on a patient and to actually support them from overhead so the therapist is our therapists the aide the occupational therapist the physical therapist three or four people that it would take to sometimes hold a person up to get them weight-bearing we can now do this with a device and the therapist can actually be more they can facilitate the lower extremity better because they don't have to hold the patient up or a patient can safely practice weight-bearing and gait activities without worrying about falling one of the greatest things about our new building is that we have in that building five ceiling lifts for clinical care to have a ceiling lift in a room that would allow nursing to be able to turn patients who are totally dependent to be able to allow therapists to stand patients at the bedside and to actually ambulate them in the room or work with them on upright activities that's that that's that getting in as soon as possible to Reese emulate that process so these are things that we are going to have access to we have access to this now and this device here is a lighter version of a walking frame that also has an overhead support so these are things that just make our job as therapists much easier and the job of clinicians much easier biofeedback this is the same concept that some of the games are but biofeedback is more about using a more simplified method it's it's getting patients to actually it basically rewards them with sound to know that they're moving in the right direction sometimes patients don't know and if a patient may not understand verbally what you're trying to teach them they may be able to understand the tone that they hear so as a person is firing certain muscles they're increasing the tone and as the tone increases they notice their hand can move more that's what biofeedback does is it gives them that immediate for a task that's done correctly or it helps you to start to work on developing those techniques okay now switch therapy this is one of the most difficult areas because speech as we talked about in a Sinise covered speech is an area where it is there are so many things that can happen and is it it does require that constant focus that constant input the types of aphasia that patients can experience global aphasia is their difficulty of reading and writing the this is very pronounced early on you can have patients who initially can have trouble comprehending or trouble being able to to verbalize what their needs are Broca's aphasia speech can be reduced and patients may not be able to verbalize what they want to say so they may understand what we tell them but the words that come out are not matching what we what they're trying to express and mix nonfluent aphasia it's similar to Broca's but the patient can remain limited in their speech for a longer period of time Wernicke's aphasia is difficulty understanding but they actually can speak clearly so a person may understand what you're telling them and you may tell them I want you to scratch your head and they may say Apple Apple you know and it has nothing to do with anything but their their ability to express the words or what they're trying to get across it's not coming through clearly anomia this I was just having this discussion with a speech therapist anomia is sort of a smaller version of Broca's aphasia so it can improve over time and so when someone has anomia they they can over time start to redevelop some of those techniques and become better at being able to express what they're trying to say other right are there varieties Alexia the term Alexia is difficulty writing and agraphia is dif their difficulty reading and agraphia is difficulty writing other disorders that you may have heard of and these can relate to speech or they can relate to physical dysfunction apraxia is difficulty with movements so that can be facial movement that can be your limbs that can be in speech but the difficulty in directing the arm a person may want to reach for something but they may be entirely off target dysarthria is the physical component of speech so someone may have difficulty with air intake when they try to talk so instead of being able to say ah because they can blow that air out and get the vocal cords to vibrate it may come across as because they physically can't generate the air to push through the vocal cords so articulation breathing the physical use of the tongue those are all things that stroke kind of can impact the the factors that we want you to remember about stroke patients in general and especially with a phasic stroke patients is we have to continue to treat patients as adults there's a tendency to talk to patients as if they're a child and they're not especially our 80 year old stroke patients it would be very easy to look at someone's age and discount them but we shouldn't because that person has just as much of a story to tell just as much of a life to lead just because they've made it to 80 doesn't mean they're done and especially if they were active before they deserve every right to be active again so we need to make sure we don't do that we can't talk down to people because again the engineer who is very independent and all of a sudden has had a debilitating stroke there's still that engineer brain so we have to make sure that they understand that it's helpful when you're working with patients with stroke to minimize the background noise sometimes you have to shut the TV off you have to close a door you have to I unfortunately I've had to ask family members to leave the room I don't like to do that but if it's interfering if a side conversation is interfering with a patient's ability to concentrate and you can't recognize that that's interfering you have to leave the room because it's not helping the patient of focus that has to happen in the home that has to happen in therapy that has to happen in a lot of places where patients have the opportunity to gather their thoughts okay make sure that you have a person's attention because again if the TV is on or if the phone's ringing or if they're on a video device playing that those things need to go away they need to be focused and listening you constant praise constant encouragement positive gestures these are all things that help a patient and know that they're on the right track so as much as we can help them to understand any bit that they are getting or any bit that they're moving in a direction that you want them to go that constant praise just helps to get across you know what what they're doing is actually you know a good thing and you think about communicating with someone whose language you don't speak we use nonverbal communication all the time and sometimes we have to use that with our patients as well caregiver statistics I went through and kind of pulled some similar information to Denise so I won't spend too much time on this stuff but I thought this was very interesting that primary caregivers can fall in this thirty to sixty four degree range I thought it was very interesting that 37% of caregivers had some sort of technical or college training I think it's known that many caregivers are have other jobs you can see that over 50% of women who are caregivers have jobs 48% of men we see that women are full-time caregivers more so than men but the number of paid and unpaid caregivers 66% of caregivers are unpaid so that is a lot of people who are providing care to dependent patients for family on average people spend about 20 hours a week this was back in 2009 so with the advances that we've made in medicine patients do live longer and they can survive these events but they survive these events with deficits and so that's where the family becomes caregivers the 42% of patients are big people are caring for their mothers 14% for their fathers and 13% of people for their spouse you can see that 65 million people provide care and that is 29 percent of the u.s. population is a caregiver in some capacity so if that doesn't emphasize that a third of the population you're not alone okay there's other people out there that understand what you're going through the stress that can go along with it 42 percent have felt stress with a spouse that's that's needed care or 35 percent have had stress with their children of people that are employed 16 percent I have been diagnosed with depression and 37 percent of people with depression caregivers with depression are unemployed you can see at 6 of 10 of 6 out of 10 family caregivers were employed in 2010 I thought this was also a very telling statistic 44% of people have to reduce their hours and 20% of people had to waylay opportunities in their professions to be able to provide care for someone the difficulty that people encounter I think that across-the-board caregiving is a difficult role to be placed in for family earnings you can see that the amount of money that people earn per year and as the amount of money that someone earns goes lower you can see that the caregiver amount of caregiving goes higher so people with less money have to provide care for their families so for caregivers we have to make sure that you are taking care of yourselves having support groups having the time just to bring in other people I think that you know we don't we don't employ our resources enough because we take a lot on people give and give and give and give and they don't take care of themselves and you have to because again I think Denise put it very well you if you don't have a full well you have nothing to give to someone else now switching gears a little bit some of the apps that are out there for stroke rehab these are apps these are apps that help with physical and mental coordination vision speech they can be things like reminders alarms this was a study that just came out I have a good friend who's the executive director of the Alzheimer's Association at down in San Diego this year's national conference focused on the fact that activity was increased in the brain with things that help to provoke decision-making and memory so they showed a direct correlation in helping to decrease dementia and these are factors that can be applied to stroke rehab the apps that I brought up earlier another app is called brain headquarters these are online things that you can access to play memory games play physical games things that you don't need to be up and mobile active but sometimes just being able to give someone a device that they can operate themselves helps to stimulate them I'm gonna plug in an app called clock yourself now this is for a higher level patient so this is someone this is for someone who is physically more physically capable but I've used this app with patients before there we go got it alright so the clock yourself app what it does is it allows patients to be able to practice stepping activities so for example I'm gonna put myself out here because I'm actually going to do this in front of you so this could be a win or a failure we'll find out how this goes but you imagine a clock so 12 o'clock 6 o'clock 9 o'clock 3 o'clock and a patient can step to the they can step to a beat that allows them to be able to pick and choose so for example I can change the time I can change what side of the clock for this one I'm going to use the whole clock face and so okay so I've set this very slow so my clock is forward have to think about where nine was okay so think about someone who doesn't have very good standing balance if I had a stroke I've got to stand on my hammie paretic side to take a step okay so that's someone who may need the practice and standing so imagine if you had a grab bar that you could hold on to while you did your stepping okay and it's the physical input that helps patients to stimulate a side okay one other thing I'm going to show you is this is so adjustable that let's say that I want to adjust this for someone who is trying to exercise their upper extremity and so I'm going to use the top half of the clock so from 9:00 to 3:00 and I'm going to just do punches with my arm okay so then I'm reaching to try to touch those numbers on the clock okay if someone has a shoulder disabled disablement they can at least start to emulate that movement and if they can't reach at least they can slide you can start on a table you can go to upright you can set a clock on a wall so that they can practice they can visually see this is an app that costs $0.99 many of us have smartphones many of us have old smartphones that you can set up for just this activity many of us might have access to an old tablet that we can set up just for this activity so this is something that doesn't cost anything but it's rehab and again it's something better than someone sitting in front of a television watching something that doesn't stimulate their brain remember positive things stimulate positive behavior negative things stimulate negative so we want to facilitate positive neural input okay does that make sense to everybody all right constant therapy I talked about this a little bit the thing I love about this is actually this is free to therapists so therapists can access this for free and that of course drew me right in because free is good okay for patients patients actually have to pay for a subscription but the subscription is reasonable it's I believe for a year subscription it's about I wanted to say eight dollars I think it's eight dollars a month or twelve dollars a month something like that so it's a really reasonable subscription but you can coordinate this with a person's therapists so that they're practicing some of the tasks that their therapists want them to perform in the clinic so this is something that has carryover therapy is not us doing things to people alone therapy is us giving people something to do when we're not around that's what the best therapy is okay now I want to bring up Adisa Hernandez ad Saul have you come up hello everyone this is Adisa Hernandez she is a wonderful wonderful person and Adisa has worked it wash once you tell your story you've worked at Washington I've worked at to act early tomorrow it's my 28th year at Washington often graduation August 8 1990 1990 okay and I have little my title this office coordinator of food and nutrition and I've worked here 28 wonderful years and I had perfect attendance she had perfect attendance until my stroke I was I went to Vegas to attend the wedding and there I suffered a hemorrhagic stroke okay how long ago was that that was 2015 March 20th 2015 okay I was there to attend the happy occasion and ended up with surprising yes surprising you know situation but he was he was very challenging to b2b and scary to be in that situation luckily I was very blessed and lucky that my sister was with me and she took care of me and never never ever left my side and she did not let you know I wanted to go home to our hotel but she said no we we just want to check that but she said she was sitting across the table and she said she saw my left side drooping already but I still refused I said no I think I just need to rest and no she said let's go to the hospital if nothing's wrong with you we'll go home but she I saw her running when we parked in ER I saw her running in and I think he told the doctor look my sister is in the car and I think she's have a stroke so they there they call code white and in 20 minutes they did a CT scan everything you know I was in ICU for three days and I they they they what you call this they brought me to a higher level of care the next two days but all I've told them was I wanted to go home he said oh you wanna you wanna have your rehab you know I'm gonna have my rehab but Fremont after Washington hospital I said so it was scary yeah how did it feel to be a patient you're in the place where you work well scary and you know to see familiar play faces it was hard because they see you they saw me as somebody very active very active and then seeing me here in a wheelchair or in a walker was kind of kind of embarrassing for me but there was no time for me to get embarrassed because my goal was to go back to work that was my goal I had a goal that you know I wanted to go back to work but it was also hard because when they evaluated me they said I only had like 30 percent mental my mental capacity was only 38 percent so I said my god it's devastating but I asked my occupational therapist how I can improve and she said okay do this exercises it was not easy you know because you stop and think how will I go do better I have a job waiting for me but I never stopped I always just move forward sometimes you know it was slower than others some days are slower than others but I just keep going on and on till I got my goal my goal was to go back to work in six months I went back to work in nine months yeah nine months I started part-time again like three days a week and then January of 2016 I became full-time nice so how did you deal with the depression well it was hard it was hard but I felt I have to overcome it first I didn't want my family members my mom my sister to know I was depressed I had to keep it within me so what I did is when I was well enough to you know go to church I went to church because I felt like you know that was what I missed when I was working a lot is I fail to go to church I was just drowned I drowned myself working working working no time for family no time for church or night so what I did when I was well enough to go to church I went to church and I felt like from within I healed and that helped me heal better and faster so I think a father Jeff was the father Jeff was part of the Washington Hospital team was there and I think sometimes these people that was there for my recovery were like heaven sent like I never sent my god to to make my healing faster and support me to have to go back to my passion which was working yeah and what would were your next steps so tell me what's your plan my plans are next year I'll turn 65 so I'm retiring I'm going to enjoy my life and travel that's what I'm that's my goal and I met with our benefits coordinator last week and I told her my plans were and actually yesterday I spoke to my director and told her what my plans were and they're all supportive I'm not supportive of no I really really want to enjoy the things I missed before and I think what I can advise or advise the my the stroke victims are stroke patients like me is never give up you know you and the knees are right never give up there's no time to give up you just always move forward move forward and don't let anybody tell you you cannot do it because you know yourself better than anybody else so that's what I do when somebody tells me I can do it I'll just look like like I like crafting and before I used to do like crafts like you know it was nothing but now I have you know it's more challenging for me but I look at that you know I look at that project and I said how can I do it the most simplest way I'm possible and I'm able to do it right I won't stop I won't stop till I'm able to do what I want to do yeah I think my stubbornness helped me to in my recorder sunburn because I won't no one can tell me I can't do the stuff that's right yeah and I said no you were gonna fall no I said my doctor told me don't walk without a cane I walked without looking within limits within limits yeah as long as I'm safe I know I'm safe I because I know I can be you know slips and falls can hold me back issues yes yeah absolutely yeah everything else really thing it's a stroke is a beginning of a better life for us you know like me no time to say what I did wrong but it's only learning learnings about a better life for us thank you very much all right so with that I would just emphasize the following things this is a work in progress and strokes are different for every single person so you know every person is not going to be Adisa every person is not going to be the most debilitated but the recovery is an ongoing process it becomes your new job and even if you can accomplish one task that is one task more everyday it's hard to see where you are when you're in the thick of it so sometimes you have to step back and say okay where am I this week compared to last week where am i this month compared to last month because if you have some markers that show you that you're making progress stroke recovery is a is a marathon it's not a sprint and so everything that that people can do is it helps to facilitate more and more recovery what people do away from therapists we can teach people so much but we can't do it for people we would love to be able to do it for people but we can't and so what people do away from the therapists is what's going to help them to retain what they learn making sure that we give patients some sort of accountability and some sort of responsibility I think that it's inherent in every person to be a caretaker and to try to make things easier but making things easier isn't always the best way sometimes we have to challenge patients even though we think that they're fragile you know that's the hardest part of my job is to walk into a room of a patient who's had a stroke and thinks that they can't do anything and to make them sit up on the side of the bed to make them sit up in a chair when they don't want to do it because they don't feel like they have that energy it's my job to see and teach them that they do it takes a village to do this and as caregivers the caregivers have to find that support there are so many groups out now and there's so many opportunities it's become very popular to find a support group online and I encourage people to look sometimes the support group that you find may not be the right one and you may find another group but there are people out there who are experiencing what you're experiencing they know how you feel they know what you're going through they know how difficult it is and to be able to talk through your emotions and your feelings and your frustrations and the the good times and the bad times that's what helps to keep you as caregivers whole in-person support groups at our stroke support group is wonderful Tasha Rivas is our stroke group coordinator and I know that I've gone and spoken to the stroke group as well but I would emphasize you know just surround yourself with someone that whatever way that you can you are not alone in this process the Washington Hospital outpatient rehab department we see outpatient neuro in Washington hospital on the ground floor we have a fantastic team of physical therapists occupational therapists and speech therapists who are willing and able to see you sometimes people have been out of therapy of organized therapy for a long time and maybe they've started to make some improvements there's nothing wrong with going to your doctor and asking for a referral for outpatient physical therapy if someone is showing some improvement or someone is showing a new commitment you know that's what we want we just want someone who's going to carry over the things that we want to teach you but again we can teach you we can show you we can help you we can facilitate it the one thing we can't do is do it for you so people have to be willing to do things okay resources there's resources there and I'm willing to definitely give you any of the resources that you've seen and I have brought a list of the different apps and so I can can those out if you're interested if I run out please feel free to send me an email and this is printed in your packet I've just put stroke resources and just shoot me an email about what you're looking for and I'm always willing to help you find information just to help facilitate that thank you everyone [Applause] [Music]

Channel: InHealth: A Washington Hospital Channel

Views: 5,669

Rating: 4.8857141 out of 5

Keywords: Stroke, Recovery, Patient Guide, Stroke Recovery, WHHS, Fremont, Newark, Union City, Alisa Curry, Denise Lynch, Rehab, Rehabilitation, Stroke Rehab, Stroke Program

Id: 0S0OcsjsrNU

Length: 93min 27sec (5607 seconds)

Published: Thu Aug 30 2018