Rehabilitation

Takeaways from Dr. Belagaje’s Stroke Recovery Live Chat

Stroke Recovery ChatThank you to everyone who joined us on May 28, for our live chat on Stroke Recovery. There were some great questions and we hope you found stroke neurologist, Dr. Samir Belagaje’s discussion informative. If you missed the chat, feel free to review the full chat transcript.

There was such a good response, we didn’t have time to address all of the questions you submitted during the chat, so we will answer those below:

Question: What other things can be done besides going to a recovery center?

Samir BelagajeDr. Belagaje: Certainly one can develop a home exercise/rehabilitation plan and continue to work on improving their stroke related deficits in that fashion. However, I strongly recommend that stroke recovery be completed under the guidance of a health care expert in that area or going to a stroke recovery center. They can look at medications which may be adversely affecting the recovery process, start new ones, screen/treat for depression, and provide opportunities to participate in clinical trials which would allow one to get access to latest technology and developments.

Question: Does the brain actually recover from a stroke or are you just ‘retraining’ different parts of your brain? How is it recovering?

Samir BelagajeDr. Belagaje: Great question! People recover from stroke in 3 major ways:

  • Adaptation– In this method, people just “learn to live with deficits” and find ways to adapt or get along with them. Examples would be the use of prisms in eye glasses for post-stroke visual problems or using a cane/walker to help with walking. Another example would be for a person to learn to feed themselves with their opposite hand
  • Regeneration– this involves growing new brain cells and them getting to the area of stroke and repairing that area. This is the way that stem cells and other biotherapeutics may help. It is an exciting area for stroke recovery research.
  • Rewiring– this is probably the major way of stroke recovery in the brain and the mechanism most therapy is geared towards. It is also the way that you are alluding to in your question when you talk about “retraining different parts of the brain”. Most therapy is geared towards getting those undamaged parts of the brain to rewire and take over the function of the damaged portions

Question: My dad lives in the UK and suffered a stroke. What can he do to help himself?

Samir BelagajeDr. Belagaje: Sorry to hear about your father. It really depends how long ago his stroke was and what kind of deficits he has post-stroke. In general terms, he should continue to stay as active as possible and continue to work on his deficits with therapy/rehab team. I would also encourage family and close friends to monitor for post-stroke depression symptoms and alert his health care providers if they notice depression symptoms.

Question: How do you regain normal vision after stroke?

Samir BelagajeDr. Belagaje: Admittedly, post-stroke vision deficits are challenging as we don’t have as good and effective and proven visual rehab therapy/techniques compared to some other deficits. If her stroke is greater than 6 months, I would recommend seeing a neuro-ophthalmologist for possible prisms in the glasses (this would be an adaptation technique I mentioned in an answer to another question). In addition, working with an occupational therapist (OT) may also help to improve visual field deficits and develop compensation techniques.

 

 

 

Stroke Rehabilitation Clinical Trial a Top International Trial

Rehab Clinical TrialAt Emory, clinical trials are at the core of our mission and we are proud to offer them to our patients. Groundbreaking scientific advances and medical treatments available today have been made possible because of volunteer participation in clinical trials and research.

In fact, one of the thousands of clinical trials conducted at Emory was just identified as one of the 15 top international clinical trials ever published for physical therapy and rehabilitation.

The EXCITE (Extremity Constraint-Induced Therapy Evaluation) trial, led by Emory University’s Steven Wolf, PhD, PT, professor of rehabilitation medicine at Emory University, was created to teach stroke patients to use their stroke-affected arm rather than their “good” arm. Conducted almost a decade ago, the clinical trial was found to have a significant impact in stroke rehabilitation, which set the stage for many future trials.

Each year, more than 795,000 people in the United States suffer from a stroke and many stroke survivors experience partial paralysis on one side of the body. The EXCITE trial enrolled 222 patients who had suffered a stroke, predominantly an ischemic stroke, within the previous three to nine months.

During the trial, participant’s less-impaired hand was restrained and/or immobilized by placing a mitt around the “good” arm in an effort to encourage use of the affected extremity. Participants engaged in daily repetitive tasks and behavioral therapy sessions, which included training in tasks such as opening a lock, turning a doorknob or pouring a drink. Only use of the affected arm was allowed during exercise.

“Often, stroke rehabilitation focuses on teaching patients how to better rely on their stronger limbs, even if they retain some use in the impaired limbs, creating a learned disuse,” says Wolf. “This trial was just the opposite and focused on the impaired limb, which proved to be a valuable form of rehabilitation. We are so pleased and honored that this clinical trial has been found to be a top 15 trial amongst an international jury of experts.”

Wolf, and other Emory University researchers partaking in the national trial, studied participants to determine if the intervention improved motor function, as compared to no therapy at all. Patients were evaluated using the Wolf Motor Function Test (named after Wolf), which is a measure of laboratory time, strength-based ability and quality of movement.

Research investigators found that over the course of a year from the beginning of therapy, the group undergoing constraint-induced therapy showed greater improvements than the control group in regaining function.

“Results showed that constraint-induced movement therapy produced statistically significant and clinically relevant improvements in arm motor function that persisted for at least one year at follow-up,” says Wolf. “This trial was the first large multi-center, randomized controlled trial in stroke rehabilitation that lay the ground work for many other trials to follow.”

The EXCITE trial was funded by the National Institutes of Health from 2000-2005 and the results were published in JAMA in 2006. For the past 15 years, PEDro, a database located and supported within the George Institute for Global Health in Australia, has reviewed clinical trials, guidelines and reviews of work related to rehabilitation and physical therapy. During that time period, around 28,000 trials and manuscripts dating back as far as 1929 were reviewed. The free database is used by thousands of physiotherapists and others interested in rehabilitation from more than 200 countries. Out of the 15 trials highlighted by PEDro, only two were clinical trials based in the U.S.

Click to learn more about clinical trials at Emory, or call 404-778-7777.

Related Resources

Emory Honors World Stroke Day

World Stroke DayOn this Wednesday, October 29, people all across the globe will celebrate World Stroke Day. This day was established in 2006 to raise public awareness of the warning signs of stroke. Our teams at Emory Healthcare work daily in the fight to treat and end stroke. Last year, Emory Healthcare treated over 1800 stroke patients at our hospitals, and approximately 300 patients received intensive rehabilitation care post-stroke at the Emory Rehabilitation Hospital – a total surpassing 2,000 patients.

We are passionate about stroke prevention – especially since 80% of strokes are preventable – and have created outreach teams that screen and educate members of the community throughout metro-Atlanta. To date in 2014, our teams have reached over 1,000 community members and counting.

Recognizing stroke early and getting immediate medical attention is key in reversing potential damage to your brain. Remember to ACT F.A.S.T. if you suspect that you or someone else around you is experiencing a stroke. If you notice the following signs, you should call 911 immediately:

F: Facial droop; uneven smile

A: Arm numbness or weakness

S: Slurred speech, difficulty speaking or understanding

T: Time to call 911 and get to the nearest stroke center immediately

In line with World Stroke Day, Georgia Governor Nathan Deal recently signed a proclamation declaring October 29th Georgia Stroke Awareness Day, in which he encourages all citizens to seek education on adequate prevention and recognition of signs/symptoms of stroke.

As we promote stroke prevention and timely recognition in our communities, we remind you that you have the power to end stroke – and Emory is here to help. We invite you to visit our website for further information on stroke prevention, recognition and treatment.

Lastly, we would like to thank all the teams playing a role in our efforts, and share with them this campaign as we continue our fight to end stroke.

Related Resources

A Victim No Longer

Dick TaylorToday, I write poems in ode form as a hobby. How does this peculiar habit of mine relate to the stroke I suffered September 16, 2013?

I was admitted to Emory University Midtown Hospital on September 16th to undergo a much needed hip replacement surgery. All went well, and I was scheduled for release the following day. But around midnight I was caught unaware by a stroke that affected my entire left side. I spent five more days in the hospital before I was discharged to Emory Rehabilitation Hospital to begin my recovery. I believe strongly that God sent me there.

Can you imagine hip surgery and a disabling stroke occurring on the same day? It goes without saying that coping with both became a daunting challenge for me. And, I was mad at the entire situation.

When I placed pen to paper, I intended the poem to be an upbeat, positive feel good piece with a motivational flavor. The finished product shocked me, because it reflected me in an angry light, more confused and afraid than strong and hopeful; not the outcome I was seeking.

However, upon review, I concluded that my “Ode To A Stroke” was, in the end, truthful and realistic; something fellow stroke survivors could and would embrace. I had finished the poem promoting hope, determination and perseverance; traits representing the challenges faced every day by people with stroke.

Throughout my ordeal the commitment of the nurses, doctors, and staff has been inspirational and healing. The nurturing and training administered by my physical, occupational, recreational and speech therapists over the ensuing months has given me renewed strength. Together, they saved my life…a victim no longer; and they continue their work daily to improve the lives of those afflicted by stroke.

ODE TO A STROKE or A Life Altered
 Dick Taylor, December 26, 2013
I was moving forward at a pace,
In this life called the human race,
With strength and purpose and resolve,
And little thought to how we evolve.

How simple it has been to ambulate,
My legs stride out with a steady gait,
Effortlessly in motion with no command,
To walk, to run, to sit or stand.

My arms reach and carry,
And hug and tote,
And accomplish tasks,
As if by rote.

And, oh! My hands!
They grasp and cling and digitize,
Fingers point, Aha!
As I discover and realize.

How astonishing our bodies,
Intricate machines to behold,
Easily functioning,
Without being told!

Until….that nightmarish instant,
Unforeseen, unexpected, unwarranted, unfair,
When an explosion of cranial havoc,
Renders me motionless and unaware.

I look at my lifeless arm,
I tell my hand to grip, to clasp,
And wonder why it won’t respond,
Nothing works, “my God!” I gasp!

Minutes ago I was hearty and hale,
Now I lie here, wane and pale,
Feeling alone in my solitude,
Facing uncertainty and rectitude.

But….life goes on, I will survive,
I am told to work, I am alive,
Does anyone know how angry I feel,
depressed, in pain, a long time to heal?

My life has been altered,
Run down from behind,
I could not see it coming,
So disabling and unkind.

So…..where do I go from here?
How do I rebuild my whole?
When imbalance and weakness,
And heartache assault my very soul?

God answers these fears directly,
He dispatches people who care,
Angels to push and train and
Encourage me in my physical repair.

Time and patience and persistence,
Offer recovery I am sure,
And Faith that I will mend,
Determined to find my cure!

When Life Brings New Challenges: A Rehabilitation Patient’s Story

Emory Rehabilitation HospitalPrior to April 2011, I was working as a records and document specialist for Fulton County, in addition to taking courses to become a special education teacher. I was also facing the challenge of being a single parent of two beautiful boys, a 9 year old and 6 year old.

It was in April 2011 that I was diagnosed with nonspecific encephalitis. After several weeks at another facility, I was transferred to Emory’s rehabilitation hospital. I underwent intensive rehab as an inpatient, and when I was strong enough, returned to Emory’s outpatient rehab program.

The Outpatient rehab program provides a continuity of treatment and long-term follow-up with physical, occupational and speech therapists, along with Emory’s physicians and other rehabilitation specialists. After a lot of hard work and several months of therapy, I was released in December 2011 with positive projections. However, by the end of February 2012, I had a setback and found myself in the hospital again.

A month later, the decision was made by my mother and the doctors to take me off all medications so that I could have an unobstructed brain biopsy. During this time my condition worsened and I was eventually placed on a feeding tube and became non-responsive.

Finally, I was able to have the biopsy and remained at the hospital a month because of various complications. Upon release I went into a nursing home, and after several weeks, I was able to go home and started home-based therapy. Once I was strong enough, I returned to Emory’s outpatient rehab program where the real progress began.

I improved there because of the dedication of the therapists who pushed me even when I resisted. By the time I left Emory in December I was able to bear weight on my legs and use a walker.

Since leaving Emory, I am now able to walk again independently. I do continue outpatient therapy for additional speech and physical therapy. I have had my challenges and struggles in taking care of myself and my 2 boys, but I never gave up. My boys have had to handle a lot over the past 2 years. My mom and family have been there through it all and I am very grateful.

I am also very grateful to all the Emory rehabilitation therapists, physicians and staff for not giving up on me and for their ever present encouragement.

Remember, Never Give Up!

Michaela Glover

National Rehabilitation Awareness Week: Look How Far We’ve Come

Eric GarrardWhen considering blog topics for our first Emory Rehabilitation post, I felt it would be appropriate to begin during National Rehabilitation Awareness Week. This week has been designated to educate people on the benefits and impact that rehabilitation medicine has made on the lives of patients and their families.

Part of the education includes helping people understand the history of rehabilitation and how it has progressed over time. Physical rehabilitation traces its origins back to ancient times when agents like heat, cold, water, and massage were the very first modalities used for injuries. But it really became far more recognizable as a field in the early 20th century as the benefits of rehabilitation was applied to World War I veterans, polio survivors, and others disabled by trauma or disease. In the 1930’s a small group of physicians and nurses became more and more specialized, establishing a curriculum and research trials that incorporated electrotherapy and radiotherapy. When WWII ended, the field had emerged into a comprehensive therapy that included the healing of both the physical and emotional abilities.

By the 1950’s, twenty-five hospitals nationwide had established fellowships and residencies in physical medicine and rehabilitation. In the 1960’s and 70’s, rehabilitation medicine achieved newfound respect as a vital component of patient care. This led to further specialized rehabilitation providers in physical, occupational, speech, and even recreation therapy. Rehabilitation also expanded to a number of different patient care settings, such as specialized rehabilitation hospitals (like the Emory Rehabilitation Hospital), nursing homes, outpatient centers and day programs. Today, rehabilitation professionals are sought out by patients of all ages and functional abilities. From newborns, to stroke survivors, to elite athletes, our society is benefitted daily by the contributions of these incredible professionals.

I am very proud to be part of the rehabilitation provider community, and even more so to be associated with the incredible team of rehabilitation specialists affiliated with Emory. Please join me this week in thanking all of the therapists, nurses, social workers, physicians, and others practicing now and throughout history who have dedicated their professional lives to the cause of rehabilitation. They are a very special group of people.

Happy National Rehabilitation Awareness Week!