Today, I received 3 phone calls. All from individuals who had their stroke less than 6 months ago. They were worried because they had been discharged from Physical and Occupational Therapy. The therapists told them that “they had reached her goals”. Problem is, they had not yet reached their own goals!! So, three different calls, three different people, all asking if their was any chance that they could continue to improve from their stroke. The answer: YES.
I talk a lot about this in my book.
“Highs, Lows, and Plateaus: a path to recovery from stroke.”
I often think about why some health care professionals are so negative. They say things like, “he will never walk again”, “that patient is non-compliant and never does their home exercises”, “the family is just wasting money on rehab”.
I believe in offering hope through education. Maybe that patient can’t walk today, but we do not know what kind of technological advances the future holds. It is important to continue to exercise to maintain bone density, muscle mass, muscle and joint range of motion. I have a client who spent 11 years in his wheelchair. But, he continued to exercise at the Adaptive Physical Education program at the local college and he continued to go to pool therapy every week. Last spring, he walked across the Golden Gate Bridge! At last, technology had provided a tool for him.
I think that people want to be compliant with their home exercise program. But sometimes, they do not have the thought processes that enable them to be independent in initiating and completing exercises. Sometimes the home environment is so full of other stresses and worries that exercises is the last thing on their list. Once, I had a client who NEVER did his home program. He did go to the gym, but did not do the exercises correctly. After much frustration, we decided to have him get a Neuro-psych eval. His stroke had affected his ability to initiate and follow-through on tasks. Physical rehab was put on hold while he worked on his cognitive rehab!! Everything in the proper order.
Money, somehow it always seems to get spent. How it is spent is a personal decision. A rehabilitation professional has an obligation to present their patient/client with options. It is the survivors decision how to use their money toward those options. Many years ago, I worked with a family who insisted on a particular piece of equipment for the mom in the family. I thought it was too expensive and her prognosis was not good. She had a tumor. Insurance denied payment, so the family decided to pay out of pocket. They never regretted that decision, because it provided freedom and independence and allowed her to be engaged with her family for several months.
I have started telling people to find a doctor /therapist/ trainer who believes in them! It is OK to change doctors, change therapists… Also, we know that individuals and their families need to stay proactive and continue to look for new devices, new therapies and changes in rehab. Neurological rehab is VERY dynamic right now. Things are changing quickly.
My video talks a little bit about this. Would love to hear what you think or tools that you have used.
Earlier this week, I received a phone message from a client I haven’t seen for years because I moved away from that area. His message was “Today, was the first day that I woke up and didn’t feel paralyzed.” WOW! It has been several years, but he is still changing, still making small improvements, still recovering.
Sometimes recovery from stroke is defined by very small improvements that make a huge change in someone’s life. I cannot tell you how many times I have heard statements such as “You know, he doesn’t really need his left hand. He does fine with his right.” OR ” Your daughter will never walk again. You will have to push her in a wheelchair the rest of her life.” I think to myself…”Oh my gosh!”. By denying the need for recovery, one denies the potential for recovery.”
Sometimes it is the small improvements that make a huge difference. Being able to feel your hand after years of nothing, being able to hold the car keys in your left hand while opening the car door with the right, being able to hold your baby in two arms, being able to go to the toilet by yourself…
We know that the brain is always changing! This ability to change and to learn, this neuroplasticity, is true of the young brain, the old brain and the damaged brain. Change takes longer in the damaged brain, but research has repeatedly demonstrated the power of neuroplasticity.
Is it possible to have a full and total and complete recovery after stroke. Maybe not. But it is possible to have a gradual continuum of small improvements that add up over time.
Dr. Anne Burleigh Jacobs 