By Dr. Patricia Knott
From Tchaikovsky's The Nutcracker to Shakespeare's A Midsummer's Night Dream to Michelangelo's Sistine Chapel, we have much to please the senses and are grateful to the artists who shared their talents in such magnificent and beautiful ways. These works inspire many other would-be artists to invest in their gifts. Many spend vast amounts of energy, time, money, and hope to perfect the skills they have been blessed with.
Just as artists invest a monumental amount of their resources to bring us pleasure and satisfaction in the world we live in, families generally invest in one another to become the best that they can be. Often, sacrifices are made for one particular member who will eventually provide a warm safe home for the family and, hopefully, enough financial support to take advantage of the works of Mozart, Shakespeare, and Andrew Lloyd Webber.
An unfortunate occurrence, however, sometimes stays the hand of the artist, robs the writer of his words, disorganizes the expression of the musician, stills the foot of the dancer, and renders helpless the primary provider for the family. A cerebral vascular accident (CVA) - or stroke - can wreak havoc upon individuals and families.
A stroke is a brain attack caused by a bleed or a blockage of blood flow to the brain which can manifest itself by weakness to one side of the body, numbness to the extremities, decreased balance, nausea/vomiting, double vision, slurred speech, difficulty swallowing, memory deficits, or any combination of these symptoms. All of these affect your ability to perform activities of daily living and/or remain mobile. We are seeing this happen in younger and younger members of society.
When I was a child, a stroke was pretty much the end of active participation in the family's affairs and the end of independence. I remember seeing the elderly person sitting in a wheelchair in the corner, a woolen blanket covering the atrophied limb of this stroke victim. When I trained in Physical Medicine and Rehabilitation, I realized that with the proper care, more than 80% of those wheelchair-bound people could very well have stood to their feet and walked out of the room.
Rehabilitation offers a second chance on life-to be a dancer, a painter, a teacher, a banker, a janitor, or a caregiver. A team of people work diligently to ensure it happens. This team generally consists of a physician, Physical Therapist, Occupational Therapist, Speech Therapist, nurse, social worker, and sometimes a Psychologist.
Each of these specialists contributes an expertise to the goal of independence for this stroke victim. The Physical Therapist (PT) works with the patient to strengthen lower extremities, increase balance, improve bed mobility, and increase safety with ambulation and bed/car transfers. The Occupational Therapist (OT) teaches the patient upper extremity exercises, fine motor skills such as writing, feeding, grooming, bathing, dressing, toileting, and toilet transfer. The OT can also perform driving evaluations and job site evaluations in preparation for return to work. The Speech Therapist (ST) concerns herself/himself with the ability of the patient to communicate, which includes speech intelligibility and comprehension/expression of the spoken and written language, and also works to increase the cognitive abilities of the patient. One very important job of the Speech Therapist is to help improve swallow.
The stroke patient has various options to choose from for rehabilitation - inpatients units, in hospitals or free-standing, where the patient receives three hours of therapy per day and a physician rounds 3-6 times per week; Skilled Nursing Facilities, usually located in nursing homes, where patients receive 30 minutes to 2.5 hours of therapy per day and the physician rounds once per week; outpatient therapy allows the patient to go home each day but get 2 - 3 hours of therapy at an outpatient facility usually three times per week; Home Health provides these services in the home usually three times per week and the patient follows up with his physician.
I have often been asked by colleagues if the work in my specialty is depressing since I often see the catastrophic elements of healthcare after the surgeon or internist has done all that he/she can do. My answer is always "No" because I get to see these 'hopeless' cases turn around and reenter society - most of them walking.
If you or someone in your family suffers a stroke, ask the physician about a referral to rehab. A stroke should not conjure up visions of the wheelchair in the corner with the prerequisite shawl and lap blanket. With the hope that rehab offers, a stroke is not necessarily the loss of a dream, career, position in the family, or even the defeat of artistic creation.