Common Medical Conditions

Mr. R. was at a fireworks display and when he decided to leave, he was unable to stand. He seemed to have lost his sense of balance and his friends were very concerned. He thought he was experiencing a hemorrhagic stroke in which a blood vessel bursts and bleeds into the brain. It was the first of 7 strokes for him.

Another time, I walked into a client home and the caregiver, 32, was telling me that she had numbness down her left arm. She was encouraged to go to the Emergency Room but refused. Since I had other errands in the area, I suggested that she call me if she changed her mind. Ten minutes later she called. While I tended to the client, she went to the ER and discovered that she had a blood clot (ischemic stroke) inches from her heart. Her condition turned out to be genetic.

Research is now indicating that mini-strokes are an indication that a major stroke could be on its way. If you experience a momentary loss of consciousness, you may be having a mini-stroke.

Signs of a Stroke include:
 Numbness on one side of the body
 Paralyzed face muscles
 Slurred speech
 Blurry vision
 Loss of memory
 Difficulty moving
 Sudden dizziness, weakness, difficulty walking, loss of coordination and balance.
 Severe headache for no known reason

Anyone can help perform a quick test for stroke by asking the person to:

1. SMILE
2. Speak A Simple Sentence
3. Ask them to raise both arms.
4. Ask them to stick out their tongue. If it is crooked, they are having a stroke.

What should be done when someone is having a stroke? Call 9-1-1 or emergency services in your area. It is critical that the person be seen in the hospital within 1-3 hours (sometimes called the Golden Hours) in order to reverse the damage. Beyond that, the damage may be permanent.

What are the effects of a stroke? It depends on the person and the type of stroke they have. It also depends on other health conditions they may be experiencing and what part of the brain has been affected. Some patients are paralyzed on one side; some experience aphasia, a speech impediment in which the patient is trying to communicate but it comes out scrambled and unintelligible. Strokes often affect balance and coordination.

Are you at risk? You may be if you have high blood pressure, smoke, have diabetes, and/or high blood cholesterol. Being overweight and not exercising puts you at risk. If you have been told you have heart or artery disease, have experienced mini-strokes (TIA) or have abnormal heart rhythms, be aware that you are more likely to have a stroke.

Mr. R. had been trained as a chiropractor. He understood what was happening. He began to rehabilitate himself by working on his balance. He would place himself in a hall that was clear of obstacles. Then he would try to stand with his eyes closed. He next attempted to touch his nose. In the beginning that was difficult. Then he practiced walking with his eyes closed.

To work both left and right brain, he utilized a Super Yoga technique in which he placed his left hand on his right ear lobe and then he placed his right hand on his left ear lobe. With his eyes closed, he slowly bent his knees and lowered his body a little and then slowly came back to starting position. He repeated that, eventually working from 1-5 minutes at a time. This technique works both left, right brain and balance.

With his particular strokes, he experienced fatigue; inability to carry through on tasks; sensitivity to any stress; and nerve damage in his arms. Initially, he was very intolerant to hot and cold temperatures. Slowly the nerves began to revitalize themselves. He now has more feeling in his arms. He began to eat a whole food diet and stopped smoking and drinking. He still has good days and bad days but he is functional and enjoying life. Each day is now more precious.

Stroke Rehabilitation today has come a long way. According to Jennifer Gamble, Stroke Program
Coordinator of the Rehabilitation Institute of St. Louis, every stroke and every patient is different. Rehab technology may utilize different equipment to stabilize different conditions. Some current therapies include:

1. Auto ambulator – This equipment has robotic legs that are strapped to the patients’ legs to help with the motion of walking. Research has shown that by practicing the patient’s normal gait pattern, it retrains the neuropathways in the brain and rebuilds muscles.
2. REO – Occupational Therapists use REO equipment to aid patients to regain range of motion. Either the machine can guide the patient or the patient can use the robotic arm to touch the screen to move the machine.> > >
3. Experia – Utilizes vital stem (electrical stimulation) and has a biofeedback component to strengthen throat muscles. Many stroke patients lose their ability to swallow and have to rebuild those muscles.
4. Augmentative Communication devices include: a. I pad b. Touch screen c. Computer screen.
   Depending on their level of impairment, patients may be able to use a laser like pointer to tell the computer what they want to say. The touch screen device allows the patient to indicate what phrase they want to say and it says it for them.
5. Free water protocol – Trials are being conducted that are yielding good results in helping patients to swallow again. They have to be on ‘No food or water’ status.
6. Aquatic Therapy – A patient must be continent and have no open sores to use aquatic therapy but it yields great results as muscles are strengthened.
7. Bioness- This equipment is used on either the foot/ankle or the hand/wrist as a vital stim for those muscles to facilitate motor return.

Ms. Gamble says that she has seen amazing success with some patients. A patient may come into the Rehab Center with a tube for water and food, bed ridden or can’t sit up, and then later walk out on their own.

Medicare as of June, 2011 pays for in-patient rehab. The length of stay is dependent on the patient’s diagnosis and how much assistance they need in the first three days after they are admitted. They use FIM scores to indicate how much assistance is needed. Other co-morbidities may influence how long Medicare will pay. Two to three weeks is a typical stay for acute stroke rehab although the rehab process can take months, even years.

As has been mentioned previously, the sooner a person gets in to be seen, the better. Technology will break clots in many instances. If it happened over- night, they may not be able to undo damage.

Medicare also pays for home health therapies. Once patients are discharged, they will continue to be seen by an occupational, physical therapist or speech therapist dependent on their impairments for up to 6 weeks to ensure continued progress.

The final thought I would like to add is that I have seen patients who had a severe stroke make a comeback. As prevention, eat a low fat diet; exercise both body and brain and stay socially active. These factors will improve your chances for staying functional and experiencing a higher quality of life.

For more information about the Rehabilitation Institute of St. Louis, go to http://www.rehabinstitutestl.com..