Let's Talk Stroke

Optimizing Therapy Outcomes in Stroke Rehabilitation

curtschulz — Wed, 31 Aug 2022 00:57:16 +0000

In order to maximize your stroke recovery efforts, it’s important to get the right care at the right time. You should also closely follow the guidance of your stroke rehabilitation provider team and be diligent about doing the work needed on your own as well.

Timeline of stroke recovery

Anticipating a reasonable stroke recovery timeline can help you to manage your expectations throughout your stroke rehabilitations process. While there is some variation from stroke survivor to stroke survivor, your doctor can give you a rough estimate of what to expect. Regardless of the overall expected stroke recovery timeframe, the brain has the most effective neuroplasticity and produces the most significant gains in the three months immediately following a stroke. That’s why stroke survivors should begin stroke rehabilitation as soon as possible.

Your Stroke Rehabilitation Treatment Plan

Different disciplines will play a role in stroke rehabilitation. The providers on your team may include:

Physical therapist
Occupational therapist
Speech therapist
Nurse
Social worker

Your team will collaborate closely with each other, communicating regularly about your case in order to deliver the most effective care possible. Don’t hesitate to ask any questions that you may have to any of these providers.

Importance of Independent Patient Practice

If you initially begin your stroke recovery in an inpatient setting, your activities will be closely supervised and monitored. However, when you transition back to your home or an outpatient setting, you’ll take on more of the responsibility for your recovery. That means that you must do the work in between therapy sessions in order to see continued progress. Your PT and OT will give you detailed instructions regarding frequency and repetitions of your exercise regimen.You may want to enlist a caregiver or another accountability partner to check in with regularly and help you stay on track. Taking full advantage of all of the resources available to you during the stroke recovery process will set the stage for success. If you are committed to the process and follow your health care team’s directions closely, you will be able to maximize your potential functioning moving forward.

Stroke Survivor Jerry Wald (Me) Will Be Sharing My Experience With The Staff At Myomo

curtschulz — Tue, 30 Aug 2022 17:19:45 +0000

The MyoPro is the only device that, sensing an individuals EMG signals through non-invasive sensors on the arm, can help the patient improve their arms and hands so that they participate in activities of dally living.

In this video I share my experiences with the Staff at Myomo.

Stroke Rehabilitation Settings

curtschulz — Mon, 29 Aug 2022 17:26:03 +0000

Different stroke survivors will receive care in different settings, with some offering more intensive services than others. You and your health care team will collaborate to determine which environments will be most effective in meeting your stroke rehabilitation needs.

Options For Stroke Rehabilitation

Stroke rehabilitation services, including physical, occupational and speech therapy, along with medical care may be provided in:

Acute Rehabilitation Center: Intensive services for patients with the greatest impairments and the most significant needs
Skilled Nursing Facility: Closely supervised services for patients with significant needs, but not as intensive as those provided in acute rehabilitation facilities
Home Health: Therapies and other services delivered in the stroke survivor’s home setting
Outpatient: Services provided in an outpatient clinic, which may include therapy or ongoing medical care

Most stroke survivors will transition from inpatient to home health to outpatient settings over the course of their stroke rehabilitation. However, patients who are appropriate for an inpatient level of care typically will be in either acute rehabilitation or skilled nursing, not both, depending on the initial effects of the stroke.

Which Setting Is Right For Me?

The setting that will be most appropriate and effective for each patient is determined by the treating physician and is based on severity of the stroke’s effects, along with the patient’s care needs. Not all stroke survivors necessarily need to receive care in an inpatient setting, and some may actually do better in familiar home environments where they feel more relaxed. Your health insurance provider can also play a role in determining the most appropriate level of care for you. This may be dictated by certain clinical measures of impairment. If you feel that your health insurance provider is standing in the way of your getting needed care, work with your doctor to navigate the appeals process. Getting the right level of post-stroke care in the right environment makes all of the difference in stroke recovery outcomes. Look to your providers for direction on which rehabilitation settings make sense at different points in your post-stroke journey.

How Caregivers for Stroke Survivors Can Avoid Burnout

curtschulz — Mon, 29 Aug 2022 14:41:05 +0000

Taking care of a stroke survivor is hard work. As such, caregivers are at risk of burnout from performing that role. Knowing the signs of burnout is crucial, so that you can take care of yourself and continue to be effective in taking care of the stroke survivor.

Be Aware Of Burnout

In order to be able to implement your self-care strategies, you need to know when it’s time to do so. Ideally,this will happen every day, but that’s not realistic for many caregivers. At the very least, monitor yourself for signs of burnout so that you will be aware that you need to engage in self-care. A few of the most common burnout signs include:

Irritability
Apathy
Sadness or depression
Impatience
Feelings of overwhelm and helplessness

If you start to notice any of these warning signs in yourself, it’s definitely time to implement your self-care plan.

Self-care Tools And Tips

Self-care techniques will look different for different people. These are just a few suggestions:

Take care of your own physical health: Eat as well as possible and exercise when your schedule allows. It can be helpful to have a few ideas for quick and simple healthy meals that you can make regularly. Even 10-minute bursts of exercises can go a long way if you spread them throughout your day.
Build a support system. Consider joining a group specifically designed for caregivers or enlist a few friends who you can vent to. Working with a professional therapist may also be helpful.
Journaling can help you process your feelings about being a caregiver and better manage associated stress.
Coordinate respite care, such as a friend or family member or a professional who can take care of the stroke survivor for an afternoon or a week or more and give you the time you need to recharge.
Practice self-compassion. You are human, and you will experience normal human emotions which are totally reasonable responses to your circumstances even though they are unpleasant. Remember that you’re doing the best that you can in a difficult situation.

Just like they tell you on the airplane, you need to put on your own oxygen mask first. Be sure that you’re taking care of yourself and reducing your risk of burnout so that you can continue to take care of your loved one.

How Stroke Can Affect Your Career and Your Finances

curtschulz — Mon, 29 Aug 2022 14:06:06 +0000

People who return to the workforce after stroke rehabilitation may find that their capacity for their previous positions has changed. You can still enjoy a rewarding career after a stroke, although it may require your employer to make accommodations and adaptations for you.

For those stroke survivors who are unable to resume their careers, the financial challenges can seem overwhelming. Resources are available to help, though, so make sure that you are taking advantage of all of the forms of assistance that are out there.

Making The Workplace Work For You

Some stroke survivors may be able to return to their careers without missing a beat, while others may need to make significant changes to their work routines, responsibilities or environment. As you move forward in your stroke recovery, your professional activities can involve:

Returning to your previous job, with or without accommodations. Under the Americans with Disabilities Act, your employer is required by law to make reasonable accommodations that are needed for you to perform your job.
Finding a new career path – Depending on the severity of your post-stroke symptoms and the nature of the work you did before your stroke, accommodations may not be feasible, and it may be necessary to consider a career change.
Engaging in meaningful volunteer work – If you are unable to return to paid work, you may want to identify volunteer opportunities that give you purpose.

Work with your care team to develop a plan for resuming professional activities in a way that makes sense for you.

Finding Financial Resources to Help

Increased medical costs in combination with reduced income can put a major dent in a stroke survivor’s financial situation. As such, stroke survivors may want to consider financial assistance programs that can help to defray expenses or supplement income

Prescription assistance programs
Caregiver assistance programs
Private resources, such as grants or GoFundMe campaigns
Social Security Disability – if denied initially, can work with a law firm or other advocate to assist.
Previously purchased short-term or long-term disability insurance policies

A social worker or case manager who works with your medical providers or insurance company. can help you identify sources of assistance. Patient advocates (www.patientadvocate.org) can also help to navigate health care billing and other financial aspects of stroke rehabilitation and services. Additionally, the American Stroke Association has published a helpful guide that covers post-stroke financial concerns. Many stroke survivors feel uncomfortable about asking for the help they need, whether that help involves adjustments to their work duties or financial assistance programs. Don’t be shy in accessing the resources that will help you lead a full life again.

The Importance of Getting Good Sleep After Your Stroke

curtschulz — Mon, 29 Aug 2022 13:54:22 +0000

Poor sleep can negatively affect your physical and mental well-being, and sleep disorders are fairly common among stroke survivors. It’s important to know the signs of a sleep disorder so that you can pursue treatment options if they are warranted.

Post-stroke sleep disorders

There are a range of sleep disorders that can affect stroke survivors, with different characteristics. They are:

Insomnia – According to a 2021 study published in the journal Stroke, more than one-third of stroke survivors experienced insomnia (difficulty falling or staying asleep) three months after the stroke.
Sleep disordered breathing – Northwestern Medicine reports that nearly two-thirds of stroke survivors experience this issue when breathing is disrupted during sleep.
Sleep-wake cycle disorders – According to statistics from Northwestern Medicine, 20-40 percent of stroke survivors may find that their circadian rhythms get off track, meaning that their sleep schedules are no longer dictated by day and night.

Consequences of poor sleep

Why is it important to get good quality sleep? If you don’t, your mind and body will suffer. These are just a few of the consequences of poor sleep:

Mood issues
Memory issues
Reduced neuroplasticity that prolongs the stroke recovery process
Increased risk of another stroke, along with other health issues
Systemic inflammation

Managing post-stroke sleep disorders

If you suspect that you have developed a sleep disorder after experiencing your stroke, it’s important to address the issue in order to reduce the effects of the consequences listed above. Consult with your doctor to learn about treatment options. The following approaches may be used to help patients overcome sleep disorders:

Sleep hygiene – reserve your bed only for sleep and sex, establish a bedtime routine, sleep in a dark cool room and turn off screens at least one hour before bedtime.
Lifestyle changes – lose weight, cut back on alcohol and smoking, and limit caffeine use to early in the day.
Medication – over-the-counter or prescription Sleep apnea treatment – wearing an oral appliance or a CPAP mask
Bright light therapy for sleep-wake cycle disorders – Looking at a light box early in the day to reset your circadian rhythms

Your stroke recovery and your overall health depend on getting a good night’s sleep. If something is presenting an obstacle to quality sleep, talk to your doctor to learn how you can address it.

Post-stroke Dietary Changes

curtschulz — Mon, 29 Aug 2022 13:43:36 +0000

It may not be one of the first considerations that comes to mind, but your diet can change significantly after you experience a stroke. For example, physical changes resulting from the stroke can affect your chewing capacity, and you may decide to pursue a healthier diet as a stroke prevention tool.

How Stroke Impairments Affect Nutrition

Stroke survivors can experience dysphagia, which affects their ability to swallow properly. This condition can lead to serious concerns like aspiration, in which food enters the lungs. Impairments to the chewing muscles can exacerbate this problem by limiting the stroke survivor’s ability to process food thoroughly before swallowing. As such, dietary accommodations for any chewing or swallowing limitations may be needed for stroke survivors. These accommodations might include:

Incorporating softer foods, such as cooked vegetables vs. fresh
Drinking thickened liquids to reduce the risk of aspiration
Using adaptive utensils that make up for impairments.

Stroke survivors can work with a speech therapist to regain chewing and/or swallowing function, and this therapy will be important part of your stroke rehabilitation if you have experienced this effect of stroke.

Revamping Your Diet After A Stroke

The foods that you eat can either increase or reduce your risk of subsequent strokes, so you may want to do a post-stroke reset on your diet. Start by making healthy additions of nutritious foods that support stroke recovery and general overall health, such as:

Omega-3 fats (high in salmon and walnuts)
Fiber (plentiful in fruits, veggies and whole grains)
Magnesium (high in pumpkin seeds, cashews and spinach)
Potassium (found in bananas, oranges and apples, sweet potatoes, spinach)
Micronutrients, such as the polyphenols and antioxidants found in berries

Additionally, inflammation plays a role in stroke risk, so stroke survivors should reduce their intake of inflammatory foods, like highly processed foods, sweets and alcohol. Connecting with a nutritionist who specializes in working with stroke survivors can help you to make sure that you are getting all of the nutrients your body needs to be as healthy as possible. Talk to your doctor to see what resources might be available to you.

How Stroke Can Affect Your Mobility

curtschulz — Sun, 28 Aug 2022 14:48:34 +0000

Mobility impairments, such as paralysis and spasticity, are among the most noteworthy effects of a stroke. Effective stroke rehabilitation can limit these effects, and stroke survivors can also explore adaptive equipment to improve their ability to perform their daily activities despite limitations that may remain.

Paralysis and Spasticity

Strokes may interfere with communication between your brain and your muscles. This situation can result in paralysis for a stroke survivor. Paralysis, or the inability to move muscles voluntarily, can be as mild as foot drop to as severe as full limb paralysis and can be a significant obstacle to resuming normal activities post-stroke. Spasticity is another common effect of stroke It results in rigidity or stiffness in the muscles. Symptoms may include:

Muscle spasms
Decreased functioning in the affected muscles
Overactive reflexes
Bent elbow pressed against the chest with curled fingers
Curled toes

Paralysis And Spasticity Treatment Options

Treatment options for paralysis and spasticity will depend on the severity of the issue. For paralysis, interventions may include

Passive exercises that a physical or occupational therapist performs on the stroke survivor
Electrical stimulation that re-establishes the communication channels between your brain and your muscles
Visualizating stroke rehabilitation exercises, which can trick your brain into thinking you’re moving your own muscles

Targeted treatments for spasticity may include:

Specialized exercises and stretching to reduce muscle shortening
Botox injections to block the affected nerves
Oral medications to relax the nerves
Electrical stimulation
Braces, which are typically only used for mild to moderate elbow or wrist spasticity
Surgery that targets the damaged nerves causing spasticity
Baclofen pump to relax the nerves, which may be used for patients who were unable to tolerate other treatments

As with all stroke rehabilitation, the goal is to leverage neuroplasticity and rewire the brain to restore maximum functioning. Also, as in all stroke cases, it’s essential to begin your stroke rehabilitation to reverse paralysis and/or spasticity as quickly as possible in order to get the best results.

How To Manage Paralysis And Spasticity

While you are going through stroke rehabilitation specifically for paralysis or spasticity, you may need to identify interim solutions to help you manage daily activities as you make progress in your therapy. This may involve adaptive equipment, such as:

Stroke orthotics or braces to increase strength and movement
Walkers or wheelchairs for mobility aids
Home modification equipment, such as shower grab bars or raised toilet seats to assist with activities of daily living

You may also need to consider pacing your activities to make them more manageable or getting assistance from others. These solutions often are temporary until you achieve your therapy goals. Physical and occupational therapy and adaptive equipment can help to overcome any post-stroke mobility impairments. Consult with your care team to see what techniques, tools and strategies might be most beneficial to you.

Insurance Basics for Stroke Survivors

curtschulz — Sun, 28 Aug 2022 14:36:22 +0000

Having a stroke is expensive, potentially costing tens of thousands of dollars for acute care and stroke rehabilitation services. Your health insurance can decrease your out-of-pocket costs drastically, so it’s worth your time to get familiar with your coverage and learn how to advocate for yourself to maximize your benefits.

Knowledge Is Power: What Benefits Should You Get?

When you know what your insurance will pay for, you can avoid unpleasant surprises later on in the process. Spending a few hours reviewing your health insurance coverage is a valuable investment of time for a stroke survivor. Policies vary, but your health insurance may offer partial or full coverage for the following stroke rehabilitation care :

Inpatient care and associated therapies
Home health nursing, therapies and social work
Outpatient physical, occupational and speech therapy
Medication
Stroke orthotics (e.g. arm, leg or ankle braces that help to restore functioning to affected body parts)
Some mobility equipment

Most health insurance plans cover at least a portion of the costs associated with stroke rehabilitation and adaptive equipment, but patients can expect to share some financial responsibility as well. You’ll want to become familiar with the following insurance terms that you may encounter in this process:

Deductible – a set amount of money that patients are responsible for before insurance coverage kicks in.
Co-pays – A set dollar amount that patients pay per office visit or service received after the deductible has been met.
Co-insurance – A percentage of the billable amount that is the patient’s responsibility, after deductible has been met.
Out-of-pocket (OOP) maximum – The highest amount of money that the patient is expected to pay for care in a one-year period.
Lifetime coverage limits – These are rare, but your insurance policy may place a limit on the total dollar amount that it will pay out for stroke-related care.

Advocate For Yourself To Get Your Entitled Benefits

Unfortunately, errors by both providers and insurers can cause unnecessary stress as you are trying to focus your energy on your recovery. If you do encounter one of the issues listed above, you can advocate for yourself or enlist help as needed. Get acquainted with the Patient’s Bill of Rights (https://www.stroke.org/en/life-after-stroke/recovery/managing-your-stroke/finances-insurance-and-assistance/patients-bill-of-rights) so that you know the coverage you should have. If you don’t get the response that you want from your insurer despite your best efforts, consider consulting a professional for further assistance. The following resources can be helpful in this effort.

Patient Advocate Foundation – https://www.patientadvocate.org/
Medical social workers
Social workers or case managers employed by health insurance companies
Private pay care managers

When you’re recovering from a stroke, you want to focus your energy on stroke rehabilitation, not fighting with your insurance company. Be a strong advocate for yourself, and tap into professional assistance as needed to help you navigate this complex system.

Reducing Fall Risk Among Stroke Survivors

curtschulz — Sun, 28 Aug 2022 14:33:25 +0000

Falls can compound the effects of a stroke, and specific characteristics of stroke survivors make this population more susceptible to falls. Therefore, implementing fall prevention strategies in your environment is essential to your long-term health and well-being.

Higher Fall Risks For Stroke Survivors

As many as 75 percent of stroke survivors will suffer a fall during their first year of stroke recovery. Several factors specific to stroke survivors influence this risk, including:

Balance and coordination issues
Mobility impairments and gait changes
Medication side effects of dizziness or drowsiness
Cognitive changes
Depression

With stroke survivors facing all of these risk factors, it’s clear that fall prevention should be a priority for this population.

Falls: The Consequences

Falls are a major underlying reason for serious short-term and long-term disability, especially in older adults. The following negative outcomes may be associated with a fall in stroke survivors:

Possible fractures (especially in stroke survivors who also have osteoporosis)
Potential of suffering additional brain trauma
Subsequent hospitalization and rehab
Increased medical costs

Obviously, avoiding these serious consequences offers a compelling reason to create a fall prevention plan.

Your Plan For Preventing Falls

With some thought and attention, you can make your environment safer and eliminate tripping hazards. Incorporate the following steps into your fall prevention plan:

Secure or remove throw rugs that could present tripping hazards
Keep walkways free of clutter
Practice exercises to improve your posture
Use adaptive mobility equipment as needed.
Monitor for depression symptoms and seek treatment as needed.
Get your vitamin D levels checked, because some research suggests that low vitamin D levels are associated with a higher fall risk

You can work with a physical or occupational therapist to develop your fall prevention plan. Ideally this professional will be providing treatment in your home and can tailor their recommendations to your environment. However, PTs and OTs in an outpatient setting can offer guidance, as well. Are you are doing everything possible to reduce your fall risk and the negative consequences associated with falls? Check in with your care team to see if they have any suggestions of ways that you can make your environment safer.