HEALTH MATTERS: Recovery and rehab following a stroke

According to the National Stroke Association, 10 per cent of stroke survivors re cover almost completely, and 25 percent recover with minor impairments.

Tuesday, May 20, 2008 1:15 PM EDT

By Carol Sonatore, M.D. Princeton HealthCare System

This column is the second of a two- part series in recognition of National Stroke Awareness Month. Last week’s Health Matters focused on stroke symptoms and prevention.



More than 5 million people in America today have survived a stroke. Many are back to leading regular lives and through rehabilitation have learned to adapt to the changes that may have occurred because of damage to the brain.

This month is National Stroke Awareness Month and provides us an opportunity not only to educate people about the signs and symptoms of stroke and how to prevent it, but to teach people that there is life after stroke.

According to the National Stroke Association, 10 percent of stroke survivors recover almost completely, and 25 percent recover with minor impairments. The majority of stroke survivors — 40 percent — experience moderate to severe impairments that require special care.

No two strokes are alike, and the physical and emotional impacts, along with the rehabilitation and recovery process, vary from person to person. Much depends on the area of the brain that is affected, the severity of the stroke and the patient’s overall health.

Patients who experience a stroke in the right hemisphere of the brain, which controls movement on the left side and controls analytical and perceptual tasks, may experience the following effects:

• Weakness or paralysis on the left side of the body.

• Trouble with spatial and perceptual abilities that may cause problems judging distance or may create challenges in guiding their hands to pick up objects or button their shirt or tie their shoes.

• Impulsive behavior and impaired judgment that often causes some stroke survivors to dangerously believe they are able to perform the same activities they could prior to the stroke, including driving a car and walking without assistance.

• Left-sided neglect. Some stroke survivors will experience left-sided neglect, which causes them to forget objects or people on their left side.

• Short-term memory loss.

Stroke survivors who experience a stroke in the left hemisphere of the brain, the part that controls movement on the right side of the body and controls speech and language abilities, often experience different effects such as:

• Weakness or paralysis on the right side of the body.

• Trouble with speech and language, known as aphasia. Aphasia can impact a person’s ability to communicate whether through speaking or writing and can affect the ability to understand words.

• A slow and cautious behavioral style that may cause a stroke survivor to require frequent instruction and feedback.

• Shortened attention spans and difficulty understanding new information.

In addition, strokes in the cerebellum of the brain may cause unsteady walking due to difficulty with balance, dizziness and nausea. Strokes in the brain stem can be especially debilitating as the brain stem controls the body’s life support functions.

While recovering from a stroke takes time — generally, anywhere from six months to two years — rehabilitation is helpful and enables many patients regain skills they possessed prior to the stroke.

Rehabilitation often requires a multi-disciplinary approach that involves physical therapy to strengthen and retrain muscles; occupational therapy to help survivors with daily living skills; speech therapy; swallow therapy, and therapeutic recreation therapy, which helps stroke survivors reintegrate socially.

Rehabilitation nursing is also an integral part of the process for close patient monitoring, education and medication teaching. The patients work with nursing staff throughout the day and night on applying skills taught during rehabilitation therapies.

The ultimate goal of inpatient rehabilitation is to provide patients with the building blocks to continue their recovery either at home with or without assistance or in a longer-term care facility.

After a loved one experiences a stroke, it is often left to family members to determine where the patient will receive treatment. Finding the best rehabilitation program, especially during a stressful and emotional time, can be an overwhelming and daunting task.

In evaluating rehabilitation programs, the National Stroke Association recommends choosing a program that is accredited by the Commission on Accreditation of Healthcare Organizations (CARF). Requirements for CARF accreditation include:

• A medical director and doctors who are board-certified in rehab-related specialties, such as physiatry or neurology.

• A team approach for patient care.

• Regular rehab team meetings to evaluate each patient’s progress.

• Involvement of family members in the program, and regular family meetings to keep them up- to-date with the progress of their loved ones.

• Patient and family education and support.

• A defined process for handling emergencies.

• Ongoing assessment of each patient’s progress in terms of abilities and level of independence in activities of daily living, such as dressing and walking.

Experiencing a stroke is a significant life change for survivors and their families, and rehabilitation and recovery take time. With patience and commitment, however, many people realize there is life after stroke.

For more information about University Medical Center at Princeton’s CARF-accredited Acute Rehabilitation Unit or to find a physician with Princeton HealthCare System, call (888) 742-7496 or visit www.princetonhcs.org. If you would like to receive a free magnet card listing the signs and symptoms of stroke to place on your refrigerator or near your phone, please call UMCP at (609) 430-7107.

Dr. Carol Sonatore is the medical director of the Acute Rehabilitation Unit at University Medical Center at Princeton and is chair ...........