Aug 12, 2014

Dr. Miller: So you have had a stroke or a family member has had a stroke. How do you maximize your recovery? How do you get as close to normal as possible after the stroke? This is Dr. Miller and we're going to talk about that next on Scope Radio.

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Dr. Miller: Hi. I'm here with Dr. Steven Edgley. He's a member of the Department of Physical Medicine and Rehabilitation at the University of Utah. Steve, you're a physiatrist, right?

Dr. Edgley: Yes.

Dr. Miller: What does a physiatrist do?

Dr. Edgley: We work towards maximizing a patient's physical and functional potential.

Stroke Recovery

Dr. Miller: I'd like to point out that Dr. Edgley's made a successful recovery from a stroke himself and so knows well about how to treat patients post-stroke. Dr. Edgley, what sorts of things should a patient know who's had a stroke in terms of how they might maximize their recovery?

Dr. Edgley: I tell patients at the very outset that stroke recovery takes a lot of work, patience, and guidance. When I typically get involved in a patient's care, they are usually at their lowest point functionally and physically. It's just important to realize that they do have the potential to make great gains and recover to a significant extent.

Dr. Miller: So stroke recovery is also a team sport. Is that right, Steve?

Therapy for Stroke

Dr. Edgley: That's right. We employ physical therapists, occupational therapists, speech pathologists, specialized nursing staff, psychologists, and we really try to individualize the patient's care plan for the optimization of the recovery.

Dr. Miller: So there are different types of stroke that result in different types of problems. So depending on the type of stroke, you tailor the therapy for the particular patient. Is that right?

Dr. Edgley: That's right. It's really important, also, to be involved with a mature, specialized, and robust treatment program that can essentially guide you through the recovery process.

Dr. Miller: Is there proof that this team approach is better than a one-on-one with, say, just a physician or a nurse?

Dr. Edgley: That's a good question, and there is significant evidence that this is a way to maximize a stroke patient's physical and cognitive overall recovery.

Dr. Miller: Now, it sounds like this team effort is also one of cheerleading, because from what you're saying, it's a process to get better and patients have to work at that, so I'm sure there's some coaching there about keeping their spirits up and working with the team members to maximize their outcome.

Dr. Edgley: It takes a lot of individual effort from patients. They go through ups and downs. It's very important to have a team that is able to support optimally the patient's physical and emotional needs.

Stroke Recovery Process

Dr. Miller: For the patient who's had a stroke or family members, what would you say to them about doing something after the stroke? What should they expect after their stroke? They're in the hospital with the stroke or in the emergency department and then they're ready for discharge. What would be the next step in your opinion? What should they ask for or seek?

Dr. Edgley: There is a spectrum of situations that patients go through. We try to get the patients to the home environment as soon as possible. Now, often that comes after days and weeks of intense training. Sometimes the patients are able to go home right away but we still want to follow them and support them in terms of facilitating their maximum recovery. I would say they should expect a lot of work. Stroke recovery is a very active process that requires a lot of work on the patient's part, supplemented by guidance as a team.

Dr. Miller: Would you say that a patient that's had a stroke should expect a consultation from a physiatrist?

Dr. Edgley: Yes.

Dr. Miller: Is that sort of the standard now?

Dr. Edgley: Yeah, it's the standard of care at the University. Whether they go home right away or have a prolonged stay in the hospital, a rehab consult is the standard of care. We can really guide patients and family members too at the maximum recovery potential.

Dr. Miller: I know every patient is different, but are most patients that have had a stroke usually treated in rehabilitation in the hospital or out of the hospital?

Dr. Edgley: About one-third of patients are typically treated in the rehab inpatient unit. Two-thirds either go home right away or are really not to the functional level to be able to participate in a really robust rehab program at the time of discharge. We follow all types whether they come to rehab or not, so we have influence over the care of stroke patients whatever environment they end up going to.

Stroke Recovery Timeline

Dr. Miller: Is there any length of time or an average length of time that a patient would spend on a rehabilitation unit recovering from a stroke? I know, again, that's variable, but I'm just for our audience wondering if there's a ballpark figure.

Dr. Edgley: Typically the patients stay on inpatient rehab for about two and a half weeks on a regimen, but that's a figure that has wide variability.

Dr. Miller: This is quite a workout. They're receiving care from physical therapists, occupational therapists, speech therapists, and it's work, right?

Dr. Edgley: Yes.

Dr. Miller: It's very different than being in a hospital bed.

Dr. Edgley: Physical rehab from a stroke is, again, a very active process. We deliver at least three hours or more per day to those patients.

Dr. Miller: So they should not expect that this is going to be something that they passively receive treatment. They're going to be actively involved in improving their futures.

Dr. Edgley: Yes.

Stroke Treatment at Home

Dr. Miller: What about when they get home?

Dr. Edgley: We have an active outpatient clinic. We like to follow the patients for as long as they need care. On the outpatient basis, we're dealing with outpatient therapy and addressing return to driving, return to work, return to recreational activities for those patients who are appropriate candidates and really try to maximize their functional potential.

Dr. Miller: So, Steve, obviously a family plays largely into how a patient recovers. What would you say in terms of the family's benefit to the patients and how they should interact and how are they involved in the care? Are they mainly cheerleaders in the process or do they receive some training in how to improve the patient's outcome?

Dr. Edgley: Family members are extremely critical in the recovery process. I will point out a few things. One is many family members try to do too much for the patients. We are trying to facilitate active participation in activities of daily living. This is the way patients improve. The second thing is initially family members are typically counted on to provide some support at home for a period of time. That's something that requires training, education, and getting a basic comfort level with dealing with these issues.

Dr. Miller: Thank you, Dr. Edgley. That was very helpful.

Dr. Edgley: Thank you.

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