By Peter G Levine
There is a lot of frustration among stroke survivors about “the system” when it comes to stoke recovery and rehab efforts after stroke. Most of the complaints revolve around three issues:
- There’s not enough therapy.
- Clinicians are not well-trained in stroke rehab.
- Researchers don’t seem to have a clue about what drives recovery.
The following are possible explanations for these (legitimate) gripes.
1. Not Enough Therapy
No argument here – this is true. Managed care should take note. Every bit of clinical research points to a “more is better” perspective. There are some caveats, of course. For instance, rehab that is too intensive too soon after the stroke may impair recovery. So adding more therapy hours during the acute phase (approximately the first seven days) for some survivors is not necessarily a good idea.
Managed care appears to be confused on this point as they often send survivors to rehabilitation hospitals for a minimum of three hours per day of therapy during the initial acute phase. Once a patient reaches the sub-acute phase (approximately seven days to three months), three hours of therapy per day is a good rule of thumb. If done in the acute phase though, this level of intensity may worsen the prospects for recovery. In other words, managed care sometimes provides too much too soon, but not enough therapy later on when survivors would benefit more.
Stroke survivors need more therapy during the sub-acute phase. The chronic phase (approximately 3+ months) can be extraordinarily fruitful, as well. So, more therapy should be provided during the sub-acute and chronic phases.
But is it? Generally, no.
Not Enough Therapy: Solution?
So what can survivors and caregivers do? Write to the folks who make decisions. And do it like you vote: early and often.
2. Clinicians Not Well Trained For Stroke Recovery
Of course, this is not always true, but most therapists and other clinicians in rehab are trained in multiple pathologies. Not only are therapists trained in a broad swath of pathologies, they also treat an array of pathologies throughout the day. It’s rare to find a therapist who is trained specifically in stroke recovery. Clinicians who have specialized training usually reside in rehabilitation hospitals. However, having done talks to thousands of therapists across the country, these experts can be just about anywhere including nursing facilities, outpatient clinics, and even orthopedics settings.
For example, my wife is a physical therapist. She works on the “stroke team” at a rehabilitation hospital. She also works in a nursing home, and, therefore, is able to use her specialized knowledge from working on the “stroke team” in that facility. However, therapists are generally not well-trained in stroke recovery.
Clinicians Not Well-Trained For Stroke Recovery: Solution?
What can you do to find clinicians who are knowledgeable about stroke recovery?
Here are some suggestions:
Find A Dedicated Stroke-Recovery Facility
The Internet Stroke Center website has listings of all the hospitals in your area specially dedicated to stroke. Clinicians who work in these facilities are trained in cutting-edge stroke recovery options. Enter your zip code to find a center near you.
Find a Specially-Trained Therapist
If you are looking for a specially-trained therapist, visit the Saebo website. Look at the lower right corner of the page where it says “Find a Saebo Therapist.” Enter your zip and click “search.” These therapists are trained in a particular form of recovery (Saebo). Therapists trained in this way tend to be on the leading edge of technology and tend to aggressively help survivors pursue recovery.
Find a Nuerologist
If you are looking for an aggressive neurologist, check out the BOTOX for spasiticy website. At the top right of the page enter your ZIP code. As with Saebo-trained therapists, doctors who administer BOTOX tend to be better trained in stroke.
3. Researchers Don’t Seem To Have A Clue About What Drives Recovery
I’ve been involved in stroke specific research for quite some time, and I have absolutely no problem with the lament that research doesn’t know enough. I have no problem because it is true. Allow me to present some of the realities researchers contend with as they strive to unravel the mystery of stroke recovery.
There’s an old saying about brain injuries (and stroke is a brain injury). If “you’ve seen one brain injury… (wait for it)… you’ve seen one brain injury.” Each stroke survivor can be so different from the next that they may as well be considered completely different pathologies. Imagine these two imaginary stroke victims:
Joe is 47 years old with two kids, a mortgage, and a pretty good job; he’s highly motivated to recover. He was on blood thinners briefly after the stroke, but now takes no medications. Joe has some difficulty straightening his elbow and opening his hand. He used to walk with an AFO (ankle foot orthosis) and a cane, but a few months after the stroke he worked hard and managed to get rid of both.
Now meet Jane. Jane is 78 years old and she takes a total of 13 medications including beta blockers, blood thinners, diabetes medications, and pain medications. Why is she on pain medications? Four years ago, two years before her stroke, she fell and broke her hip, and it still hurts! She has diabetes, osteoarthritis, vertigo, a frozen shoulder, and a hip replacement. Her stroke left her with “dense” spastic hemiparesis, resulting in very little movement in her upper extremity. Because of the combination of the stroke and the orthopedic issues (hip, shoulder, arthritis), she fatigues easily. And because of the vertigo, she is often too frightened to walk, making her essentially wheelchair-bound. She’s also clinically depressed.
You don’t need to be a clinical researcher to see that Joe and Jane are very different. Joe may respond much better to an aggressive recovery option focusing on getting the hand “back in the game.” Because of her many medical conditions, Jane may benefit from treatment options that help reduce spasticity.
So when it comes to stroke, what should researchers focus on? Should they focus on spasticity, better movement, better balance, better motor planning, muscle fatigue, or depression? There clearly is not a one-size fits all answer. Cancer research has the same problem, as cancer is the name given to a collection of related diseases.
Researchers Don’t Seem To Have A Clue About What Drives Recovery: Solution?
On top of stroke being a very different pathology in different people, stroke is also a brain problem. As a brain problem, there is good news and bad news. The bad news is that the brain is complex and so diseases of the brain may take a bit of time to work out. The good news is that many disciplines are trying to figure the brain out including neuroscience, chemistry, and even computer science. Survivors constantly benefit from the continuously evolving knowledge of the brain.
My suggestion is to keep you ear to the ground and keep abreast of new treatment options for stroke recovery.
Source: Stroke Recovery: Problems and Solutions | Saebo