OUR BRAINS!!!!! Stroke Facts READY SET.

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1 HealthSouth Rehabilitation Hospital Huntington Dr. Timothy Saxe, Medical Director READY SET. OUR BRAINS!!!!! Stroke Facts 795,000 strokes each year- 600,000 new strokes 5.5 million stroke survivors Leading cause of disability in adults Many strokes are preventable Stroke rehab works stroke

2 Stroke Prevalence per 1,000 Three Groups of Stroke Survivors % recover full independence in two weeks % have severe residual deficits % are in the middle group stroke survivors TBI Most common of serious, disabling neurologic disorders Large proportion of males younger than 30 Commonly affects people with pre-existing mental health issues Persistent effects of TBI on cognition, emotion and behavior

3 Realms Impacted Physical Cognitive Psychological Emotional Visual Perceptual Communicative Social Educational Recreational Vocational Family Structure Collateral Sprouting Collateral sprouting to reinnervate cells and circuits 8 BACK TOGETHER

4 Neural Plasticity Unmasking of other neural pathways and synapses (neural plasticity) Neural Plasticity Improvement requires the performance of functional tasks Neural plasticity can take place for years after a stroke years after stroke Neural Plasticity Neural plasticity The ability of the Central Nervous System (CNS) to adapt to injuries or environmental requirements.

5 Neurons Repair Slowly Maximize brain repair & restoration with rest. Comprehend & accept strengths & limitations. Relearn old concepts, habits, & skills. Master compensatory strategies and/or assistive technology. Make new friends. Create a new life of meaning, joy & value. COULD YOU DO THIS WITHOUT HELP? Rescue vs. Collapse Intermediate loss of connections Critical state Either lose connectivity permanently or recover Need REHAB! Rehabilitation Drives Recovery Rehabilitation (learning) can drive recovery by rehabilitation enhancing interconnections to reconfigure the neural circuits and restore function. restore function

6 Rehabilitation Aggressive rehabilitation can make a difference in how quickly one is able to return home and get back to the quality of life they deserve following an illness or injury. Rehabilitation hospitals utilize a team approach to offer a more intense regimen and higher level of care such as greater physician involvement and therapy time Principles of Rehabilitation Rehab needs to start immediately Patient-centered (family/caregiver included) Goal Oriented emphasizing abilities Team approach Education starts immediately Wellness promotion Education, Adjustment, and Change Goals of Rehabilitation To improve and Individual s Quality of Life & help him or her reach the fullest possible physical, psychological, educational, vocational and social potential. Focuses on.. ADAPTATION

7 Who are Rehab Candidates?? ANYONE with deficits & potential to recover functional, cognitive, communication, psychological, educational, or vocational RECOVERY/TREATMENTS (patient specific) Full or Partial Restorative or Compensatory Training & Education to Caregivers Rehabilitation Rehabilitation should immediately begin when the patient is. STABILIZED!!!!!! The Rehabilitation Team The Rehabilitation Treatment Team takes on a Interdisciplinary team approach to successful rehabilitation. The team members are dedicated to meeting patient s physical, psychological and social needs in an environment that promotes wellness, confidence and Independence. A team of professionals have the ability to pinpoint specific needs and set goals in order to maximize recovery.

8 The Special Teams Physiatrist Attending Physician* Physical Therapist Occupational Therapist Speech/ Language Pathologist Rehabilitation Nurse Case Manager Respiratory Therapist-as needed Clinical psychologist- as needed Nutritionist-as needed * Varies from facility to facility Physiatrists: or rehabilitation physicians, are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians are medical doctors who have completed training in the medical specialty of physical medicine and rehabilitation (PM&R).. The focus is on the development of a comprehensive program for putting the pieces of a person s life back together after injury or disease-without surgery. They provide ongoing medical management and supervision of the rehabilitation team. Roles Attending Physician: Primarily oversees the medical management of the patient. Some of their responsibilities may include the monitoring of medications, lab values, the need for further diagnostic testing. They work closely with the physiatrist and treatment team to measure the patient s progress. He or she also oversees the continuity of care from the surgical team to the PCP

9 Roles Physical Therapist: - assists in increasing overall physical mobility. The primary focus for physical therapists is on evaluating and designing a treatment program to address limitations in physical function, mobility and safety. Areas that are emphasized include: flexibility, strength, endurance, and pain management. AutoAmbulator Roles Occupational Therapist: -assists in achieving independence in activities of daily living. They design and deliver activity based therapy to promote independence in the areas of self care, home management, and community re-entry. The individualized program is tailored toward safely relearning or compensating tasks for the disabled following injury or illness.

10 Roles Speech /Language Pathologist: Assesses and treats individuals with communication and comprehension disorders, cognitive difficulties, and swallowing disorders

11 Roles Rehabilitation Nurse: Integrates rehabilitation and medical care as directed by physician. The nurses monitor the patient s physical status as well as provide emotional support, encouragement, and education on wellness and medical management. This will include bowel and bladder training, skin care, medications, wound management, and coping in a healthy productive manner. Roles Case management: Focuses on involving the family and other caregivers in the patient s rehabilitation. This includes helping the family adjust to changes brought about by the disability or illness. They are primarily responsible for discharge planning by providing appropriate equipment and or services that may be needed upon discharge. ROAD TO RECOVERY

12 Road to Recovery Emergency Services ER Acute Hospital Coma Recovery Acute Rehab Day Program Outpatient Services Subacute Rehab Transitional Living Support Family, Vocational & Community Comparing Clinical Environments Characteristic IRH SNF Attending MD Visit Usually 5-7 times a week Only required every 30 days Multidisciplinary Team Required Not required RN Oversight 24 hours/day At least 8 consecutive hours/day Nursing hours per patient day Between 6.0 and 7.5 hrs Between 2.5 and 4.0 hrs Specialty nursing/rehabilitation Yes Not required PT/OT/Speech Therapy 3 hrs/day 5 days per week minimum No minimum Recovery External factors which can affect the extent and pace of recovery Initial medical response and intervention after the accident Quality of preventative rehabilitation in ER and ICU Quality of insurance coverage Family support, knowledge of systems and advocacy Continuum of levels of service and support from hospitals and community Two individuals with identical care will not necessarily have the same outcomes, nor recover at the same pace.

13 Recovery Individual Factors that affect the extent and pace of the recovery Work Ethic Sense of Humor Unselfishness Insight Healthy Living Co-operation with medical and rehab team Pre-injury health Use of support groups Recovery Factors in Recovery PEOPLE The Individual The Family The Team BRAIN BIOLOGY Plasticity New Growth Rerouting TIME FIM Instrument FIM Measures 18 Items On a scale of 1 (most severe) to 7 (independent) Motor Items Activities of Daily Living (ADLs, e.g. feeding, grooming, bathing, dressing) Bowel and Bladder Control Mobility (transfer to bed, toilet, tub/shower) Locomotion (walking, stairs) Cognitive Items Communication Social Cognition (problem solving, memory)

14 F.I.M. Instrument Levels of (In) Dependence (0-7) No Helper 7= complete independence (safe, timely) 6= modified independence (device, slow) Helper 5= supervision ( subject 100%; helper nearby) 4= minimal assistance (subject 75%; helper 25%) 3= moderate assistance ( 50%/ 50%) 2= maximal assistance (subject 25%; helper 75%) 1= total assistance (subject <25%; helper > 75% 0= not assessed or N/A Rancho Los Amigos Scale I No response II Generalized response III Localized response IV confused and agitated V confused, inappropriate, non-agitated VI confused & appropriate VII automatic & appropriate VIII purposeful & appropriate Case Study 57 year old male presented to ER with left sided weakness, facial dropping, slurred speech and difficulty walking. Patient also complained of a pressure like headache in his right temporal area for 2 days. Medical history included; HTN, MI, CAD BMI was only 22 2 ppd Smoker Independent at home, very active

15 Case Study Home Medications included; Aspirin and Plavix Original CT scan of head No acute findings MRI of brain impression left MCA infarct Admitted to HealthSouth on Discharged on FIM Gain of 63

16 We ALL have a HAND in making sure the patient has a Successful Outcome George Eliot ( ) It is never too late to be what you might have been -Mary Ann Evans

17 Questions?

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