Family Plays Critical Role in Stroke Recovery

Many high profile Americans have experienced stroke episodes—actors Kirk Douglas, Robert Guillaume, and Patricia Neal; entertainers Quincy Jones and Gene Kelly; Hugh Hefner; and writer Ray Bradbury. Quick medical intervention and rigorous rehabilitation helped these people and many more to return to their chosen professions.

For the 700,000 Americans who experience strokes each year, time is of the essence when it comes to treatment—so much so that health practitioners are now referring to strokes as "brain attacks" to emphasize the importance of getting medical help right away. Recent research has shown that quick intervention dramatically improves a patient’s recovery.

But equally important in a stroke patient’s recovery is early rehabilitation and a complete understanding of and commitment to the rehabilitation process. Ideally, this means working with a physical medicine and rehabilitation (PM&R) physician, also called a physiatrist, to design an individualized recovery program.

Early Rehabilitation

"Stroke recovery begins immediately and takes place over a long time—not just during a hospital stay or physical rehabilitation session," says Dr. Steven Flanagan, vice chairman, department of rehabilitation medicine at The Mount Sinai School of Medicine. "It is extremely important for people to begin as soon as possible and to then continue exercising beyond their rehabilitation stay."

After patients are treated for a stroke, their typical initial rehabilitation program will last 2-3 weeks depending on how severely the stroke disabled them. This program is critical to the patient’s long-term recovery and well being.

A PM&R physician will evaluate not only the negative effects of the stroke but also the patient’s pre-attack status taking into account their physical abilities, emotional state, family support, education and even spiritual resources. This in-depth personal understanding allows the PM&R physician to create a comprehensive recovery program with physical therapists, speech therapists, psychologists, and social workers.

"PM&R specialists provide the overview. Rehabilitation is a team sport with the patient and family included first and foremost. The team may also include physical, occupational, and recreational therapists, speech language pathologists, psychologists and social workers. The physiatrist has the responsibility to direct and coordinate the team," says Dr. Charles E. Levy, system chief of physical medicine and rehabilitation services for the North Florida/South Georgia Veterans Health System. "In this active partnership we strive to find out what motivates the patient and how we can use this to his or her benefit."

Different Strokes

Flanagan stresses that every stroke patient is unique as is every brain attack and the resulting deficits that occur. Therefore every recovery is unique. Typically, after a PM&R physician evaluates a patient, the goal is to help clear as many of the obstacles as possible to his or her recovery so the patient can focus on returning to the daily activities that he or she is able to perform.

"Stroke happens. That’s the bad news," says Levy who is also an assistant professor in the department of orthopaedics and rehabilitation at the University of Florida College of Medicine. "The good news is there is great potential for the brain to recover from stroke. With diligent rehabilitation, those prospects improve."

Family Support

Both specialists quickly point out that one of the most critical elements in a patient’s rehabilitation from stroke is the strength and commitment of their primary support system—usually their family.

"Stroke often threatens our definition of ourselves by forcing us to rely on others to complete everyday activities. Family acceptance is crucial in helping a person understand that just because he or she needs assistance is no reason to feel ashamed or unworthy. If we live long enough, all of us can expect that our skills will diminish. Ultimately it is who we are, not what we can do that is important," explains Levy.

According to Levy, family members can be particularly helpful when it comes to identifying the best ways to psychologically motivate the patient. Family members may also be particularly adept at interpreting communications and signs when speech impairments are present. "Family members know the patient better than we ever can. We try to involve them as much as possible. Their commitment often makes a world of difference in terms of recovery."

A Helping Hand

Since the vast majority of people recovering from stroke will be cared for by family or loved ones, part of the rehabilitation program requires educating those caregivers on how to assist with necessary tasks, such as:

• Transfers - from bed to wheelchair, wheelchair to car, etc.

• Rehabilitation exercises to strengthen and stretch weakened muscles

• Organizational strategies – such as laying clothes out in order

• Empowerment tips – such as verbal cues, a gentle inquiry rather than an order

• Food Preparation – because swallowing problems are common

Depression is more common in patients recovering from a stroke than many other diseases with similar deficits, although it is not completely clear why this happens. Depression can rob a person of their willingness to work towards recovery. This can be very damaging. Motivation and a positive attitude are key to obtaining an optimal level of recovery. "Obviously family are a great resource," reports Levy. "It is not uncommon for the patient to report that everything is fine only to have the spouse vigorously nod her head ‘No!’ It may the spouse who alerts us to the real problems at home. Together we can begin to address the physical, medical, thinking and emotional problems so common to those living with the effects of stroke."

Brighter Future

"This is a very exciting time for us—five to ten years ago the consensus was not much could be done to influence the limited natural recovery from stroke," says Levy. "Now we’re making enormous strides in helping more and more people enjoy normal daily living." For example, one of the new treatments being investigated is constraint induced movement therapy where intensive training of the weak side (5-6 hours per day for two weeks,) can result in dramatic recovery of arm and hand skills. Investigations of different medicines to encourage recovery is under way. New imaging techniques are allowing us to see how the brain reorganizes after a stroke to regain lost abilities. Promising new strategies using body-supported treadmill training are helping to restore walking.