Health & Fitness

The Realities of Stroke Recovery

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These days, many stroke survivors make significant recoveries thanks to physical, occupational, speech and alternative therapies. But it’s a long journey. Discover the realities of stroke recovery and learn how you can prevent the worst from occurring.

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Linda Jordan has experienced her share of health complications. For 11 years, she’s been battling cancer. First it was in her breast, then in her lungs. Now it’s in her lungs and her liver. She’s had a kidney removed. She’s been through chemotherapy and all the “fun” that goes with it. On June 14, 2018, she was looking forward to a well-deserved visit with her son in Kansas City. But on the train ride there, a throbbing headache soon became unbearable.

“I wasn’t with her – I was in Michigan,” says Everett Jordan, her husband of 15 years. “We have a summer home, so I was up there staining the deck. That’s when I got a call: ‘Something’s wrong with Mom.’”

Everett asked to speak with Linda, and even through the phone he could tell something was off.

He suspected she was having a stroke induced by medications she was taking to treat her cancer.

Unfortunately, he was correct.

“I told them, ‘You need to call 911 right now.’”

By the time Linda got to the hospital, her window of opportunity to receive tPA (tissue plasminogen activator) had already passed. The drug helps break down blood clots, but it can only be administered during a brief window of time after stroke symptoms begin. After that, there’s a risk of bleeding in the brain that outweighs the benefits of the drug.

Since Linda wasn’t eligible for tPA, her stroke recovery journey has likely been more complicated than it could have been. First, she spent five days in the ICU (intensive care unit) at Saint Luke’s Hospital of Kansas City, followed by three weeks in inpatient rehab.

After almost a month of being away, she was finally able to return to Rockford. But still, she couldn’t go straight home.

“Then, she had to spend two months – September and October – at Wesley Willows Rehab Center,” Everett says.

Linda had to work through “left side neglect,” since the stroke occurred in the right side of her brain.

“Her whole left side – arm, hand, leg – she had no control over that,” Everett says. “It was hard to get her to move in the wheelchair because she would just go in a circle without the use of her left side. Even her vision on her left side was affected.”

Linda made enough progress to finally go home for almost a month. Then, she had to face yet another setback. A fall caused her to tear ligaments in her left knee and ankle.

“That really slowed down the progression of recovery,” Everett says. “But she’s a fighter, so she hasn’t given up yet.”

If there’s one thing Everett’s learned as a caregiver, it’s that stroke isn’t an instantaneous recovery. He does everything he can to support Linda, but having a good relationship with Linda’s health care providers has been a big help.

Since having a stroke, Linda has been through extensive treatment with physical, occupational and speech therapists. Her fall especially increased her need for physical therapy.

For the past few months, she’s been seeing Becky Lesko at OSF HealthCare Saint Anthony Medical Center. As a physical therapist and neurological clinical specialist, Lesko can help Linda achieve one of her biggest goals: being able to walk again.

“Getting to work with people like Linda is such a privilege,” Lesko says. “If I get to make a small impact in her journey, that’s a huge blessing for me. The whole reason I became a PT is to glorify God and serve people.”

Lesko has worked a lot with Linda on stretching, since Linda’s muscles are tight from being in the hospital for so long.

“It’s hard, but it helps a lot,” Linda says about her stretching exercises. “I really don’t want to be in a wheelchair for the rest of my life.”

Lesko has also worked with Linda on getting in and out of bed independently. It’s crucial that Linda uses her left leg during the process, so that it can get stronger.

Now, Linda is taking a break from physical therapy to practice what she’s learned.

“We’re giving her body a chance to get stronger,” Lesko explains. “Stroke is a really long process of recovery; it’s not a quick fix. We tend to see people for a while and give them the skills they need to work on their own, as they can. And then we let them spread their wings and fly. Maybe they come back in a couple of months if needed.”

Some patients are more motivated than others, Lesko has found. She tries to figure out what’s important to her patients, so she can make each exercise more meaningful.

For Linda, gardening is a passion. Each time an exercise is hard, Lesko reminds Linda what she’s working toward.

“She has everything but the certificate for being a master gardener,” Everett says. “Our garden is full of flowers, but she’s not able to get out there. So, right now we just look at them from the window.”

But Linda has always been a motivated person. She credits her faith.

“I need to get digging out there, and I will,” she adds. “I’ll fight until it’s done.”

Recovering From a Stroke

After having a stroke, most patients have a few months to a year to make their most significant recovery gains. That’s why stroke rehabilitation typically begins right away after the patient is stabilized in the hospital.

Since stroke can change the chemistry of the brain, neurologists typically monitor stroke patients for depression on a continuous basis. It’s important to intervene if depression is detected, since it can inhibit a person’s motivation during therapy. And typically, stroke patients need to work hard in three core types of therapy: physical, occupational and speech.

Patricia Glynn, a physical therapist assistant at Beloit Memorial Hospital, primarily helps patients with anything related to mobility. She helps patients with walking, balancing, getting in and out of bed, and transferring from the bed to a wheelchair or walker.

Lauren Kolar, an occupational therapist, primarily focuses on activities of daily living. Most stroke patients have upper extremity weakness on one side, which can affect their ability to get dressed, brush their teeth, wash their face – “pretty much everything,” Kolar says.

Allison Petska, a speech language pathologist, helps patients with both the cognitive and physical aspects of speech. It’s not uncommon for stroke patients to have issues with swallowing, slurred speech, or aphasia – difficulty with understanding or producing language.

“Very seldom are we with patients all at the same time,” Glynn explains. “But if we think somebody needs inpatient rehab, they have to be able to tolerate three hours of therapies between the three disciplines. So, for that, we need to work together as a team.”

“We definitely share information,” Kolar adds. “I look at both of their notes before I go to see a patient.”

All three therapists consider a patient’s specific goals when coming up with a treatment plan. They also encourage families to be involved from the very beginning.
Most of the time, family members are welcome to be in the room during therapy sessions.

“A good support system makes a huge difference,” Petska says. “I think awareness of the patient’s deficits is really important as well.”

However, this doesn’t mean family members should rush to help out their loved ones who’ve had a stroke.

“We talk a lot about not always doing things for the patient,” Glynn adds. “They’re not going to get better unless they do things for themselves.”

“Education is huge,” Kolar adds. “For example, if someone doesn’t want to get out of bed, it helps to educate them that movement is really good for their lungs, since it helps to prevent pneumonia. We try to give patients and family members the information and the tools to help them better understand why what we’re asking is important.”

All three therapies gear patients toward functional independence. It’s a long-term process, since recovery can take weeks or even years, depending on the severity of the stroke.

But every small gain is a victory.

“I was treating a relatively young gentleman with pretty significant aphasia, so he had a hard time understanding and producing language,” Petska explains. “It was very frustrating for him because with aphasia, for the most part, people still retain their knowledge and they know what they’re trying to express, but they’re unable to do so. He had been unable to produce anything at all for a couple of days, but then he had a breakthrough and was able to sing a little bit. And we were able to get him to say his name. It was small, but his wife ended up in tears. It was a nice moment and he did end up making a pretty good recovery.”

The takeaway point for all three therapists? There’s always hope.

“It’s certainly possible to make a full or almost full recovery,” Kolar says. “There’s life after a stroke.”

Preventing and Detecting a Stroke

Stroke recovery is an uphill battle, so it’s best to avoid stroke altogether if possible. Roughly 800,000 strokes happen each year, and about 75 percent of those are new stroke patients. Though stroke is more common in older populations, it happens in people of all ages. So, what should people do to prevent stroke?

“Actually, about 80 percent of all strokes and cardiovascular disease are considered preventable by the American Heart Association,” says Dr. Shawn Wallery, a neurohospitalist and the medical director of neurovascular and stroke care at Mercyhealth. “Risk factors are important to modify no matter what specific age you are.”

He finds The American Heart Association’s Simple Seven to be an ideal guide for living a healthy life. It details how to eat healthy, stay active, lose weight, stop smoking, manage blood pressure, control cholesterol and reduce blood sugar.

“If you can do at least five of those things, the American Heart Association has found a 78 percent risk reduction for heart-related death compared to people with no ideal metrics,” Wallery says. “So, in other words, if you do five out of those seven things on a consistent basis, you have a 78 percent risk reduction for disease.

That’s really an incredible statistic because when you think about how we are growing older as a society, the only real way that we’re going to be able to fund the burden of chronic disease is if we do [the simple seven] up front.”

Wallery especially loves the concept of prescribing exercise to his patients. Instead of labeling exercise as a “recommendation,” he prescribes 150 minutes of exercise per week, which can be broken down into a daily routine.

“As physicians, we prescribe medications, but do we prescribe methodologies as a way to keep people healthy, especially after they’ve had a condition or disease? That’s not done as often,” he says.

But that’s not to say medication is unimportant.

“You would be surprised at how many people simply don’t take their medications, especially blood pressure medications,” Wallery adds. “That can help prevent and significantly reduce the risk of stroke.”

Of course, if a stroke does occur, time is critical. Everyone should be familiar with the acronym B.E.F.A.S.T., Wallery says, which stands for “balance, eyes, face, arms, speech and time.”

B. indicates a sudden loss or change in balance. E. stands for eyes – is there a sudden blindness or blurred vision in one eye? F. stands for facial weakness. Is there a droop in one side of the face? A. stands for arms – perhaps a patient can’t lift one arm as high as the other. S. stands for speech, indicating slurred speech or the inability to speak. And finally, T. stands for time. Time is of the essence during a stroke, since about 2 million brain cells are at risk each minute.

Any abrupt onset of these symptoms should be taken seriously, and an ambulance should be called immediately.

“Always assume it’s a stroke until proven otherwise,” Wallery says. “We’ll be ready for you in the emergency room.”

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