These days, many stroke survivors make significant recoveries thanks to physical, occupational, speech and alternative therapies. Discover what resources are available in our region.
Everyone knows stroke is debilitating, but not everyone knows – or fully understands – that there’s hope of recovery. The inpatient and outpatient stroke services available in our region are more encompassing, holistic and beneficial than even one year ago.
From diligent inpatient care to unique outpatient services like art therapy, there is much possibility for stroke survivors to overcome deficits and flourish.
After experiencing a stroke, most patients spend about two weeks recovering in inpatient rehab, where they’re attended to 24/7 by doctors, nurses and therapists.
“If there’s a reason to justify it – if they’re making big gains – we might keep them longer,” says Dr. Rahul Sharma, medical director of Northwest Community Hospital’s Acute Inpatient Rehab Unit, in Arlington Heights.
In addition to cognitive issues, stroke patients typically face complications such as weakness on one side of the body, difficulty talking, eating or swallowing, and vision and sensory problems. After assessing the patient, Sharma and his team of physical, occupational and speech therapists begin treatment right away.
“Once they’re in the rehab unit, our focus is on functional activities,” Sharma says. “That includes activities of daily living. So, being able to dress and bathe yourself, getting your socks on and off, being able to clean yourself after you go to the bathroom, or just being able to go to the bathroom. Being able to eventually walk. Just gaining your independence back.”
Treatment is specifically tailored to a patient and what their needs are. Psychologists are also involved to assess for depression, which can be a result of stroke due to neurochemical changes in the brain, or the shock of a new reality.
“It’s a very hard reality – they’ve lost their independence and it’s a difficult thing to get over,” Sharma says. “For us, it’s about reinforcement and helping them to see the gains they’re making.”
A patient’s family members are always welcome to be in the inpatient unit, Sharma says, as long as they don’t interfere with therapy. Not only does their presence help motivate patients, but it allows family caregivers to learn more about how the stroke has affected their loved ones.
“It’s always scary when it’s time to go home, so I think it’s nice to have family members involved so they’re more aware of what’s going on,” Sharma says.
Sometimes, patients will “graduate” from the inpatient unit without needing further care. But’s that’s not typically the case.
After the inpatient unit, patients usually attend day rehab or have a home health plan for continued care. Sometimes, if the patient doesn’t progress, they’ll need to go to a nursing home.
“I think a person’s emotional buy-in is huge,” Sharma says. “We’ve had folks who we thought would do well, but at some point they decided they’ve had a good life and they’re done. That’s hard for us. Going to a nursing home isn’t a loss, but it’s another step to getting your life back.”
But fortunately, the majority of stroke patients make enough gains to go home. Some patients even make exceptional recoveries, Sharma adds. “I just had a gentleman who had a stroke and came to us from the [intensive care unit], and they thought he would go to a nursing home. He ended up walking out without an assisted device. I’m always amazed by those kinds of people.”
“It’s a joy to see people get their lives back. We have people who go back to work, back to driving – the majority do exceedingly well,” Sharma says.
Beginning Outpatient Care
Once a doctor deems a stroke patient medically stable to begin outpatient treatment, there’s typically much physical, occupational and speech therapy still needed.
Amy Michalak, an occupational therapist at Mercyhealth Woodstock, focuses on helping patients accomplish basic day-to-day tasks such as getting dressed or using silverware to eat a meal. Depending on where the stroke occurred in the brain, a patient can have a wide range of deficits.
Someone who experiences a mild stroke or a TIA [transient ischemic attack] – a stroke that lasts only a few minutes – might need just a couple weeks of therapy. Those with more severe deficits may need a year or more of therapy treatment.
Usually the first year or so is when the biggest recovery occurs, Michalak says, but people can still have recovery gains past that.
“The more internally motivated people are, the better they usually do,” she says. “But, there are really high incidences of depression after a stroke, so sometimes a person just can’t push themselves. Oftentimes, we talk to the patient’s neurologist and it’s not uncommon for them to put the patient on anti-depressants. It just helps them to be able to do more stuff stronger and faster.”
In addition to communicating with a patient’s neurologist, Michalak works concurrently with speech and physical therapists to provide the patient with interdisciplinary care.
“Everybody’s a little different in what they want back first, so we make a plan with the patient to get them back into doing what’s important to them,” she says.
“It can vary greatly, but one of the biggest things people always say is they want to be able to walk. I think psychologically, the inability to be mobile is hard on people, so having that mobility and that freedom is a big deal. Once they have that, then other stuff becomes more important.”
Michalak’s physical therapist colleagues typically help patients with re-learning how to walk. But as far as day-to-day living is concerned, Michalak takes the lead.
“We actually sit with them during a meal and work on ways they can move a fork up and down, or whatever it is they’re struggling with,” she says. “We’ll actually give them a shirt to put on and take off, so they can learn how to do that task again.”
Michalak urges her patients’ families and caregivers to be involved, but only to an extent. It’s great to say words of encouragement to your loved one who suffered a stroke, but it’s also important to allow them to attempt their own tasks.
“I think the hardest part on any family member is seeing their loved one struggle to do something,” Michalak says. “Your instinct is just to go and do it for them. But sometimes, stepping back is the best thing you can do for your loved one, so they can recover. It’s really hard to do, but so important.”
Michalak finds great joy in seeing her patients make strides in recovery.
“I mean, to finally see that smile on their face when they do something they’ve been trying to do over and over – we feel their joy right with them,” she says.
It’s never too late to seek outpatient care after experiencing a stroke. Northwestern Medicine’s Neuro-Rehabilitation Services in Crystal Lake offer the trifecta of physical, occupational and speech therapy, in addition to social work services and case management services. There’s also a driver rehabilitation program to get stroke survivors back behind the wheel.
“We look at everything the patient needs and treat them holistically,” says Barb Wasilk, program manager and speech language pathologist. “We’re definitely in growth mode, since there’s a tremendous need for our services.”
When a new patient requires day rehab services for stroke, the first step is to meet with a case manager who gathers background information on the diagnosis. Then, the patient will meet with the occupational, speech and physical therapists individually.
“All treatment is one-on-one,” Wasilk reiterates. “But we do work together as a team to figure out a customized treatment plan for the patient.”
The goal of treatment is to get the patient more independent and active. But the patient’s personal goals are also considered.
Pete Zmich, who had a stroke and received care at Northwestern Medicine, had lofty goals when he began day rehab. He entered in a wheelchair but wanted to leave on his feet in only three weeks.
“I had to get out of that wheelchair because I was going to a wedding,” he says. “I told them if I won’t be able to dance, it’ll tick me off!”
He also wanted to quickly return to driving and working at his job in sales.
“Pete received all levels of therapy – he started in acute, then inpatient rehab, and then came here,” says Andrea Sept, a speech language pathologist. “He was highly engaged in the therapy process and he always brought his sense of humor into the clinic. I think his atmosphere of positivity helped the other patients as well.”
Not only has Zmich reached all of his goals, but he’s also set new ones.
“My next goal is to be ready for golf season,” he says. “I’m driving, making sales calls – I work about 20 hours a week – and that’s not bad for a guy who’s 76 years old. I’ve always been a Type A, so I’ve got to keep moving.”
One of the toughest problems Zmich overcame was speech clarity. At first, he slurred his words and had weakness in his tongue. Sept worked with him to slow down his words and regain motor ability.
“My speech sounded like a drunk,” Zmich recalls. “So they gave me exercises, like pressing on the top of my palette 25 times. It all really helped.”
He now has clear, articulate speech. “In rehab, we retrain the brain to utilize different pathways,” Sept explains. “The neurons are firing and there’s a road block because of the stroke. So now we’re going to slow you down and reorganize your thinking to create alternate pathways for those neurons. It’s going to be slow, but the more you do it, the stronger these new pathways get.”
While Zmich has almost made a full physical recovery from his stroke, he still experiences emotional complications. He has the inability to inhibit his emotions, which is a common side effect of stroke.
“Normally, a person may feel choked up a bit or emotionally touched by something that’s meaningful, but you inhibit that response,” Sept says. “A stroke patient might just burst into tears, or even start giggling. It can be a big social obstacle for people.”
Zmich knows he’ll eventually overcome this, but for now, he’s not embarrassed.
“I was an emotional guy to start with,” he explains. “Now, if you hit me with the right thought, I’m gone.”
He oftentimes tears up when thinking about his wife.
“I have to give all the credit to Sandra, my wife,” he says. “We’ve been married for 43 years and she’s been by my side the whole time.”
Zmich is discharged from therapy, but maybe someday he’ll go back for a “tune-up.”
“We can always find new ways to challenge a patient or help them to function in their life,” Sept says. “It’s never too late after having a stroke to come in for therapy or support.”
Art Therapy, Pet Therapy, Yoga, Journaling
Physical, occupational and speech therapy are all extremely important for stroke recovery. But post-discharge services are just as important.
“Stroke can be very isolating,” says Laurie Sabas, an advanced nurse practitioner who helped to pioneer unique programs for stroke survivors at AMITA Health Resurrection Medical Center Chicago. “People feel like they can’t go out to dinner because they can’t swallow well, or they can’t socialize because their speech is slurred. So, we wanted something to bring patients back together among their peers and among people who can support them.”
Three years ago, Sabas helped start an art therapy program in partnership with The Art Institute of Chicago. The partnership allows art therapy interns who are in need of clinical hours to work with stroke patients in both inpatient and outpatient settings.
“Art therapy is a form of counseling that uses different art strategies in order to help people express what they’re going through,” Sabas explains. “A lot of our patients have aphasia, where they lose language capability. So they can hear, they know exactly what’s being said, they know what they want to say, but they can’t get it out because of the injury from the stroke. So, art therapy actually allows people to use art media to communicate in ways other than just verbal speech.”
Participants can paint, mold clay, or use other tools to express themselves. Typically, there’s a specific topic or theme for each session. Participants don’t need to be good at art; the purpose is to process what you’re going through.
Dian and Harold Hoyem have been participating in AMITA’s art therapy program since it began. After Harold’s stroke in 2009, he found great comfort in support groups in general. As Harold’s primary caregiver, Dian has also benefitted from these groups.
“They’ve helped a lot,” Dian says. “Everybody has different problems, and it helps to hear what other people go through.”
At a recent art therapy session, Dian and Harold had the assignment to draw how the world sees them versus how they see themselves. They were given the outline of a head to color in.
“We do the project and talk about it afterwards,” Dian says. “You learn about yourself when you talk about why you drew what you drew. And as a caregiver, it helps me to just learn more about stroke.”
The outpatient art therapy group meets every other Wednesday at 5:30 p.m. It’s free and open to all stroke survivors, their caregivers and their families.
AMITA also utilizes Rainbow Animal-Assisted Therapy for stroke patients who are in the hospital.
“It’s been absolutely phenomenal and has brought us to tears on numerous occasions,” Sabas says.
Patients aren’t always readily willing to start therapy after a stroke. However, sometimes patients are more willing to do things for animals than doctors.
“I can think of a patient right off the bat who hadn’t spoken or moved in three days, and when we brought a dog in, he started moving his weaker arm trying to get the dog’s attention. For the first time in three days, he spoke and said “Here!” trying to get the dog’s attention. This actually happens on several occasions.”
Like art therapy, the animal-assisted therapy is free to patients and run by volunteers.
Last year, AMITA also introduced a yoga program for stroke patients. Oftentimes, stroke survivors need to increase their physical activity levels, but face obstacles of “bad hips and bad knees” in addition to their stroke complications. Stroke yoga is geared toward people facing such obstacles.
“We can find movement for everybody,” Sabas says. “If you can get on the floor, great; if you can’t, no problem. We offer this on a weekly basis with rotating times. It’s a free service, as well.”
Dian and Harold are frequent participants in AMITA’s stroke yoga program.
“Harold’s left leg and arm aren’t 100 percent, so there are some things he can’t do,” Dian says. “But they give you chairs to sit on and to hold onto. I sit in the chair, too, because I have an arthritic knee. The exercises really help to strengthen everyone, and the breathing helps with the brain.”
Soon, AMITA will also offer journaling groups for stroke survivors. The idea is to document changes as time goes by so patients have a tangible record of where they were versus where they progress.
All of the stroke support programs are free, but Sabas encourages participants to call in advance so therapists can ensure enough supplies are available.
“Everyone recovers from stroke to some extent,” Sabas says. “Art, music, animals – there’s a lot of research out there that shows people who engage in these alternative therapies have much better outcomes than people who don’t. We’ve had phenomenal feedback.”