Ask an Expert: How Long Will it Take to Recover From a Stroke and When Should I Start Therapy?

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Question: How long will it take to recover from a stroke and when should I start therapy?

Answer: Every stroke is different, just as every person is different. Generally, you will see the most improvement or recovery within six months to a year. After a year, recovery and improvements are still possible, however, the rate of recovery tends to slow down.

To minimize disability and improve your recovery, therapies should begin as soon as possible. It is common for patients to think they need to rest after a stroke, but research shows greater improvements if you start therapy 24-48 hours post stroke.

There are various factors that may affect your rate of recovery including:

  • Severity of stroke regarding physical and cognitive aspects
  • Emotional factors that affect mood and motivation
  • Social environment and support of family/friends

It is normal to experience a wide range of difficulties or “bumps” along the way that could impede or slow progress including other medical complications. Once you have a stroke, you are at a higher risk to have a another stroke. It is important to continue to monitor blood pressure, blood sugar and heart rate, take all prescribed medications, follow up with doctors, and continue with therapies.

Erica Howard, PT, DPT

Ask an Expert: Why Do I Need Speech Therapy If I Can Talk Fine?

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Question: Why do I need speech therapy if I can talk fine?

Answer: Though our title of Speech-Language Pathologist suggests we focus on speech only, our scope of practice is much broader!

In addition to speech and language, SLPs assess and treat swallowing disorders and cognitive-linguistic impairments. Swallowing treatment addresses difficulty chewing and swallowing, and can include instruction in exercise, diet texture analysis, and training for compensatory techniques. Cognitive-linguistic treatment addresses changes in cognitive function and may include training in techniques to enhance memory, orientation, problem solving, and executive function skills.

Lisa Pinnell, CCC-SLP

Ask an Expert: Can PT Relieve My Pelvic Pain?

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Question: Can physical therapy relieve my pelvic pain?

Answer: Yes! A pelvic health physical therapist is trained to evaluate and treat the possible causes of abdominal and pelvic pain to include muscle tightness, joint dysfunction, irritation of nerves, weakness, and scar tissue.

After the evaluation is complete the therapist will design a plan of care that may focus on manual therapy to address scar management or tenderness, stretching for muscle tension to improve flexibility and strengthening for added stability for daily tasks. Other treatments may include the use of modalities such as TENs for pain management, biofeedback to gain awareness of muscle tension, pelvic floor relaxation exercises and posture retraining.

Every plan of care is individualized for each patient to assist them with relieving their pelvic pain in order to return to all desired daily activities.

 

Amy Hauerstein, PT, CAPP-Pelvic

Easy Steps to Keep Your Bladder Healthy

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Good bladder habits can improve bladder control whereas poor bladder habits can lead to poor bladder control. Here are four steps to keep your bladder healthy!

Step 1 — Use Good Toilet Habits

  • It is normal to go to the toilet four to six times per day (approximately every 3 ½ to 4 hours).
  • You shouldn’t get up to go to the toilet more than once a night.
  • Don’t get into the habit of going to the toilet “just in case.” Try to go to the toilet only when your bladder is full. Going to the toilet just before you go to bed is fine.
  • Women should sit down to go to the toilet. Do not hover over the toilet seat.
  • Take your time, relax when you are on the toilet. This helps your bladder to empty out fully. If you rush, you may not empty your bladder fully and over time can result in a bladder infection.  You may even need to rock your body while on the toilet and then relax again for a second urination. This is called the double void technique.

Step 2 — Look After Your Pelvic Floor Muscles

  • Keep your pelvic floor muscles strong with pelvic floor muscle training.
  • Practice your Kegels after every bathroom trip (for example, while washing your hands), when you sit at a stoplight, check your watch, or wait on tv commercials. Contact a pelvic physical therapist to make sure you are doing Kegels correctly.
  • Return to physical therapy if you feel you are regressing in any significant way. Remember, you will have “good days and bad days,” but you should feel like you are in control of your bladder for the most part.

Step 3 — Keep Good Bowel Habits

  • Avoid constipation.
  • Do not strain when using your bowels. This puts extra load onto your pelvic floor muscles and may weaken the muscles. The pelvic floor muscles help with bladder and bowel control.
  • Eat two pieces of fruit and five servings of vegetables daily.
  • Keep active. Physical activity helps to keep your bowels regular.

Step 4 — Drink Fluid Every Day

  • Fluid is everything you drink. Fluid includes milk, juice, and even soup, but the best fluid to drink is water.
  • Cut down on how much caffeine and alcohol you drink, as these may upset your bladder. There is caffeine in chocolate, coffee, and tea. Avoid fizzy drinks which contain caffeine, including cola and sports drinks.

Christie DeCraene, PT is an outpatient Physical Therapist who has over 25 years of experience treating not only Women’s Health issues but also orthopedic and neurological deficits. Christie uses a variety of treatment approaches with an emphasis on education, function-based therapeutic exercises, and manual-based treatments.

Rehabilitation for Stroke Survivors: Speech and Motor Recovery

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May is National Better Speech & Hearing Awareness Month, and we thank all Tx:Team Speech-Language Pathologists for their continued dedication to their patient, their community, and to Tx:Team. During this month, we want to raise awareness about hearing and speech problems, and to encourage people to think about their own speech and hearing and seek assistance through a Speech-Language Pathologist.

You may wonder, what does a Speech-Language Pathologist do?

A Speech-Language Pathologist provides skilled therapy services to stroke survivors in the areas of dysphagia, communication and/or cognitive impairments. As we know, seeking medical services immediately while experiencing signs/symptoms of stroke is critical because, “Time lost is brain lost. Every minute counts.”

Therapy services should be implemented as soon as the patient is able to participate, as early intensive therapy may lead to better outcomes. Depending on the location and severity of the stroke as well as impact on functioning, a patient may participate in skilled services while in the hospital and subacute rehab with home health or in the outpatient setting.

Impairments treated by a Speech-Language Pathologist are varied secondary to location of the stroke and may include the following:

A swallowing disorder known as Dysphagia may demonstrate impairments in oropharyngeal functioning. A patient may have an objective swallow study completed such as a Modified Barium Swallow Study (MBSS) or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) to assess oropharyngeal functioning, rule out risk of aspiration, and recommend an appropriate diet texture/liquid consistency that may need to be modified. The objective swallow study will also drive the Speech Therapy plan of care to provide appropriate swallow rehabilitation including recommendations, exercises, and strategies to facilitate safe intake of least restrictive diet to maintain nutrition/hydration orally.

Communication impairments include motor speech (Dysarthria or Apraxia) with deficits in articulation, respiration, and resonance via reduced coordination and strength as well as motor planning. Receptive and/or expressive language deficits (Aphasia) to understand communication (verbal and written) as well as being able to express wants, needs, thoughts, etc. to familiar and unfamiliar communication partners. A stroke survivor may also experience Dysphonia, which is a voice disorder with deficits affecting vocal quality and vocal functioning. A Speech-Language Pathologist will provide rehabilitation services as well as educating and developing appropriate compensatory strategies to enhance a patient’s ability to communicate independently without fear, frustration, or embarrassment.

Cognitive impairments may include deficits in memory and attention skills, which can directly impact their ability to communicate in addition to impaired safety awareness impacting a patient’s ability to maintain a level of independence.

It is important to recognize that a Speech-Language Pathologist will be a part of a Stroke Survivor’s multidisciplinary team. Research indicates, “Screening for dysphagia (within 24 hours) and communication impairment (within 48 hours) is critical in working toward optimal outcomes for stroke survivors,” indicating the need for immediate medical attention if someone demonstrates the signs or symptoms of a stroke.

 

Johanna Ebbs, MS, CCC-SLP is an outpatient Speech-Language Pathologist who specializes in a wide variety of speech-language & cognitive abilities. She has extensive experience treating the adult neuro population and is LSVT LOUD® Certified. Johanna also treats patients undergoing/following treatment for head and neck cancer.

 

References:  

1. CDC. (2022, November 2). About Stroke | cdc.gov. Centers for Disease Control and Prevention. https://www.cdc.gov/stroke/about.htm#print 

2. Dilworth, C. (2008). The role of the speech language pathologist in acute stroke. Annals of Indian Academy of Neurology, 11(Suppl 1), S108–S118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9204112/ 

 

Debunking Speech-Language Pathology Myths

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In honor of National Speech-Language-Hearing Month, we’re dispelling some misconceptions to highlight the vital role of speech therapy.

Myth #1: Speech therapy is only for those with lisps or stutters.

While addressing lisps and stutters is indeed a common aspect of speech therapy, it encompasses a far broader spectrum of issues, including problems with expression, sound production, comprehension, speech clarity, hearing, cognition, swallowing, and memory.

Myth #2: Speech therapy is only for children.

Contrary to popular belief, the benefits of speech therapy extend across the entire lifespan. From the earliest stages of development to the golden years of adulthood, individuals of all ages can reap its rewards. Speech-Language Pathology focuses on motor speech function, cognitive-language abilities, voice, and swallowing to help each patient reach their highest level of function and independence. Even in adulthood, tailored speech therapy programs are available to address the needs of those affected by disease, traumatic injury, or disorders of the nervous system, aiming to enhance functionality and elevate overall quality of life.

Myth #3: Speech therapy is only for talking.

Beyond speech, therapy plays a crucial role in addressing various challenges beyond verbal expression. Through targeted exercises and techniques, speech therapists help patients enhance cognitive abilities, memory retention, and improve swallowing function, thereby enhancing overall communication and quality of life.

Speech therapy encompasses interventions for memory, cognition, and swallowing issues, commonly associated with conditions like stroke, brain injury, Parkinson’s Disease, Multiple Sclerosis, and Alzheimer’s Disease, among others. Furthermore, individuals affected by cancer in the mouth, throat, or esophagus, as well as those recovering from head and neck injuries or surgeries, may also benefit from speech therapy interventions.

By dispelling these misconceptions and highlighting the multifaceted nature of speech therapy, we hope to foster a deeper understanding and appreciation for the invaluable contributions of speech-language pathologists in enhancing communication and quality of life for individuals across diverse backgrounds and circumstances.

We thank our Tx:Team Speech-Language Pathologists for the invaluable work they do every single day in improving the lives of their patients.

Ask an Expert: Can Occupational Therapy Help Me?

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Q: Can Occupational Therapy help me with shoulder pain and weakness even though I had surgery over 10 years ago? 

A: Absolutely! Whether or not you had therapy following your surgery, your condition has probably changed since that time. Arthritis, joint degeneration, soft tissue overuse/damage, impingement, and joint positioning are some of the causes of inflammation and joint limitations resulting with pain and weakness.

Occupational Therapists assist in recovering from injuries and regaining functional abilities. Occupational Therapy is often referred by a doctor to address these issues for improved pain management and functional mobility of your shoulder.

 

Kelly van Vliet graduated from Towson State University in Maryland with an Occupational Therapy degree. She has over 30 years of experience and specializes in treating upper body limitations related to orthopedic and neurological deficits. She provides a range of other OT evaluations and treatments including pet care capability, power mobility operation, low vision needs, continence improvement, and cognitive care. Kelly is certified in LSVT BIG® to treat clients with Parkinson’s Disease.

Ask an Expert: Can OT Help My Mom Feed Herself?

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Question: My mom has dementia and seems to have forgotten how to use her silverware to feed herself. Can OT help?

Answer: Yes! Sometimes, as dementia progresses, people can have more difficulty feeding themselves. OTs can figure out what’s getting in the way of self-feeding and provide the best amount of support that helps the client maintain their skills for as long as possible.

Your OT can recommend changes in things like the type of dishes used, the kind of food offered and how it is presented, distraction level, and adjusting routines and schedules. OTs train caregivers in offering the right kind of cueing and support. OTs also take into consideration other factors outside of dementia that may be impairing self-feeding.

 

Stephanie Grunklee, MOT, graduated from Maryville University of St. Louis with a Master of Occupational Therapy degree. Stephanie is a champion of the Wound Care Program. She is passionate about geriatric rehabilitation and understands the importance of an interdisciplinary team-based approach to help patients reach their goals.

OT Solutions: Adaptive Equipment

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Adaptive Equipment (AE) are pieces of equipment to compensate for a physical limitation, promote safety, and promote independence. They are used to facilitate completion of daily activities such as dressing, feeding, bathing, grooming, and functional mobility. One may also hear the term “assistive device;” these terms are often used interchangeably.

Pieces of adaptive equipment include, but are not limited to:

  • Dressing: long-handled shoehorn, sock aid, button hook and reacher
  • Bathing: long-handled sponge
  • Feeding: plate guards, cup adaptors, and built-up handles on utensils
  • Home management: ergonomic knives and adapted cutting board with side rails and prongs to stabilize foods
  • Additional pieces include: universal cuffs, doorknob extensions, and bed transfer devices.

Some patients may require the use of AE due to precautions put in place after an injury or surgery. For example, a sock aid, reacher, and long handled shoe horn are provided to individuals after a hip replacement to allow for increased independence with lower body dressing.

Pieces of AE are used in energy conservation and safety. For individuals with decreased balance, trunk stability, dizziness, or poor vision, a reacher is beneficial to eliminate the need to reach outside of their base of support to retrieve an item.  Additionally, too much bending and reaching can cause fatigue and shortness of breath. Utilizing pieces of AE can eliminate the need to bend/reach, and therefore allow for energy conservation during dressing tasks.

Adaptive equipment may also be used in conjunction with mobility devices, such as adding platform crutches and/or enlarged grips on walkers to comply with a non-weightbearing status or prevent further stress on joints.

Occupational therapists will carefully assess performance and collaborate which pieces may likely benefit an individual’s participation in their daily tasks. It may take lots of practice, patience, and trial and error as an individual learns to use a piece of adaptive equipment.

Occupational therapists will educate patients on how to use equipment with strategies and techniques based off of an individual’s needs and learning style. An occupational therapist will also collaborate with a patient’s interprofessional team, families, and/or guardians to allow for best follow through for use of the equipment.

Maggie Webber, OTD, OTR/L is an Occupational Therapist in the Senior Living setting but has experience with clients of all ages, from pediatric to geriatric. Her area of expertise are in General Occupational Therapy, Cardiac Critical Care Unit, Neurology & Neurotrauma ICU, Trauma & Trauma ICU Colorectal Surgery, Infectious Diseases, Dementia, and Parkinson’s Disease. Maggie believes in building positive, lasting relationships with her patients to help them reach their goals.

Debunking Occupational Therapy Myths

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In celebration of Occupational Therapy Month this April, we want to debunk some common misconceptions about this vital profession.

Myth #1: Occupational Therapy and Physical Therapy are Interchangeable

While both Occupational Therapists (OTs) and Physical Therapists (PTs) utilize their expertise in health science to administer therapeutic exercises and hands-on care for similar conditions, it’s crucial to recognize their distinct objectives. A commonly used analogy highlights the difference between the two disciplines: physical therapy helps you walk to the door, while occupational therapy helps you open the door. PT aims to enhance mobility, focusing on aspects such as range of motion, coordination, muscle strength, and pain management. OT helps you “open the door” by focusing on skills development and environmental adaptations for activities of daily living.

Myth #2: Occupational Therapists Only Help with Employment

While OTs can help a person use ergonomics at work to avoid injury, occupational therapy extends far beyond employment-related concerns. The field revolves around the concept of “occupations,” which encompasses a broad spectrum of activities essential to daily life. Whether it’s parenting, socializing, pursuing hobbies, or managing household tasks, OT helps individuals regain, maintain, or adapt essential skills. Occupations form the fabric of an individual’s existence and occupational therapy intervenes when disruptions occur due to injury, illness, or disability.

Myth #3: Occupational Therapy is Only for Certain Age Groups

Another misconception surrounding OT is its purported limitation to certain age demographics. In reality, OT intervention spans the entire lifespan, catering to individuals from infancy to old age. Pediatric OTs play a crucial role in fostering early development, assisting infants in bonding, exploration, and acquiring foundational skills critical for future growth. Geriatric OTs provide invaluable support to seniors grappling with age-related challenges such as vision impairment or cognitive decline, enabling them to maintain independence and quality of life.

Moreover, occupational therapy extends its reach beyond individual therapy sessions, with practitioners actively engaging in community-based initiatives targeting diverse populations and societal issues. These initiatives encompass promoting healthy behaviors, facilitating community transitions, addressing homelessness, supporting mental health, and tackling addiction, underscoring the breadth and versatility of OT’s impact across various age groups and societal contexts.

Myth #4: Occupational Therapy Only Occurs in Medical Settings

Occupational therapy services are available in a multitude of settings, including clients’ homes, community venues like community centers and shelters, hospitals, nursing homes, outpatient clinics, schools, and more. These services are adaptable and can be delivered wherever individuals engage in their daily activities, ensuring accessibility and support across different environments.

OT practitioners also serve as consultants and experts in diverse fields such as health information technology, human-centered design, community health initiatives, education (including schools and higher education), health promotion programs, driving rehabilitation, and beyond.

This month, Tx:Team celebrates the remarkable dedication and tireless efforts of our OTs and COTAs who strive to make profound and lasting differences in the lives of their patients every single day, all year round. Your unwavering commitment to enhancing the quality of life for those you serve fills us with profound gratitude. Thank you for being the driving force behind positive change and for embodying the true essence of compassionate care!

Source: American Occupational Therapy Association (aota.org)