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Stroke Rehabilitation: Regaining Independence and Improving Quality of Life After a Stroke

Dr. Sara Padalik shares when stroke rehabilitation will begin, the types of treatments offered, if a patient will fully recover, and some of the challenges a stroke patient may face.
Stroke Rehabilitation: Regaining Independence and Improving Quality of Life After a Stroke
Featured Speaker:
Sara Padalik, DO
Sara Padalik, DO Primary Specialty is Physical Medicine and Rehabilitation.


Transcription:

Melanie Cole, MS (Host): If you or a loved one has suffered a stroke, you may wonder what life will be like after that stroke. What would you be able to do? My guest is Dr. Sara Padalik. She’s a physical medicine and rehabilitation physician at Marianjoy Rehabilitation Hospital, part of Northwestern Medicine. Dr. Padalik, I’m so glad to have you here. Tell us about some of the challenges a stroke patient may be facing after their stroke?

Sara Padalik, DO (Guest): There is a different amount of challenges a stroke patient can endure. You know, again, it depends on their severity of stroke, but it affects all domains. Especially, your physical health, your mental health, your emotional health, and even your cognitive health. So, many different areas are affected by having a stroke.

Host: When does stroke rehab begin? Tell us a little bit about what happens after they’ve gone to the emergency room, tPA, whether its mechanical thrombectomy, whatever the treatments are. Then when does the rehab and the building back up part start?

Dr. Padalik: Stroke rehab begins immediately once that patient has been cleared off of bedrest. If they’re in the ICU and they’ve been cleared, it’s important that the therapies get in there and start that process by mobilizing the patient, challenging how they’re thinking, evaluating their swallowing. Getting in there and starting early is very essential to begin that process.

Host: Doctor, can a stroke patient recover fully? Tell us a little bit about what you’ve seen as far as how long it takes to recover and what things that they do get to recover?

Dr. Padalik: The brain can heal itself and patients can fully recover. Again, the degree of recovery does depend on many factors. Some can include the severity of the stroke, the location of stroke. But recovery can take up to days, weeks, months, and even years. I have seen recovery after years of people learning how to walk better, their balance is improving. So really, the sky is the limit as far as rehab goes. It’s really important to remember that right after you have a stroke, your brain is just starting that healing process. So, it’s hard to say when that end point will be as long as you continue to challenge the brain to make those new pathways.

Host: So, it’s so interesting that you said the brain can heal itself after stroke. I know that, as you say, it can take quite a while. Tell us about the Tellabs Center for Neurorehabilitation and Neuroplasticity. While you’re doing that doctor, tell us what is neuroplasticity?

Dr. Padalik: So, neuroplasticity is when the brain has the ability to redevelop these pathways that have been injured and reorganize itself to allow some of these other areas to pick up the slack of those damaged areas, and in the process learning their function. So, learning how to walk again, learning how to swallow again, learning how to dress yourself, that’s a whole part of neuroplasticity. We’re really lucky here at Marianjoy to have this Tellabs Center because it does contain a lot of robotics and it uses virtual reality and other devices. That can help with this neuroplasticity. You know, Marianjoy is one of the only providers in Illinois to offer the ArmeoPower, which is a device that helps improve hand and arm function.

We’re actually a center of excellence by Ekso Bionic, which is a battery-operated device that helps those with lower extremity weakness or paralysis to learn how to stand and walk and improve their gait. There’s a whole slew of other robotics that we do use specifically for stroke patients but also other type of patients as well. So, you know, we’re very lucky to have that and to provide these types of services and resources for patients to continue to build those pathways to get better.

Host: Isn’t that so cool, the technology that’s available today to work with these types of patients. So, what are some steps that you take to help stroke patients work towards independence because I would think that that’s really one of the main goals?

Dr. Padalik: Absolutely. To be honest the first thing that is the most essential thing is to really ask the patient what is their goal? Get to know them and understand what their goal is to get better on and to assess what their needs are. Every person has a different background and has different goals. So we need to learn one on one what exactly do they want to get out of this rehab program or in rehab in general. So, communication clearly with them is essential to begin that process. But also along the way updating the patient, having that clear communication on how they’re improving, how they’re progressing, how we are working towards their goals, and addressing their needs. In addition, just not physically, I’m also speaking about, you know, fears they may have about emotional distress and fear to have another stroke and returning to your daily living activities, returning to work or driving. These are all huge in incorporation and important to assess in a rehab program with your recovery.

Host: Well, I’m glad you brought up the psychosocial and emotional aspect of stroke, doctor, because that is a big part of that rehab. Why does it sometimes make people agitated, frustrated, or even aggressive?

Dr. Padalik: Depending on where your stroke can occur, that can affect those areas that control that. Also the degree of deficits a patient may be having can be frustrating. You know, if you cannot communicate clearly, you have a hard time controlling yourself. Mobility wise, you’re weaker than you used to be. That can be frustrating in itself and can lead to depression and anxiety. That kind of snowballs and definitely effects your mental health, which is essential in addressing in stroke rehab because that is just as important as the physical aspect. That often can be overlooked. That’s why it is essential to be working hand in hand not just with physical therapy and occupational therapy or speech therapy, but also that neuropsychology piece to add to that comprehensive team approach.

Host: What about families, doctor? Should families help their loved ones? Should they let them do things by themselves? Do families get involved in stroke rehab?

Dr. Padalik: Yes, they do and that is also very, very essential in recovery. You know, at Marianjoy here we do offer the patient’s families to come in for training more than once if they would like. Working hand in hand with not only their loved one but also with the therapy team so that their loved one can show them how well they’re doing, but where are areas they may still need help in. That’s where your therapist will come in and educate the family and patients to say, “Maybe you can do it this way. It’s a little bit safer. Or maybe hold off, they can do it.” So, it’s the education piece that does start once their loved one is admitted. Day one begins that education process that continues to build throughout their stay. So, yes, they should come in and they usually do to have that training and have their questions and concerns also addressed during that time period.

Host: It is such an interesting topic. Doctor, tell us what you would like patients, loved ones, people who have suffered stroke to know about Marianjoy and the Tellabs Center for Neurorehabilitation and Neuroplasticity and really just stroke rehab. What would you like the main message to be? What hope can you give them?

Dr. Padalik: There’s a lot of evidence out there that does show the earlier you work with therapy, the better outcomes there will be. So, starting early, right away, is essential, especially in that acute care hospital. But transitioning to an acute rehab facility, such as Marianjoy, does give you that opportunity to even emphasize even more that therapy piece as we will be working up to about three hours of therapy a day. Specifically, with your physical therapist, your occupational therapist, your speech therapist, your neuropsychologist, recreational therapist, a physician, and also the nursing piece. So, we do take that comprehensive approach to improving that patient’s life, improving their quality of life, addressing their concerns and their needs, and ultimately what we want to do is maximize this patient’s independence. We want everybody to go home, if that’s possible, and get back to doing what they want to do.

Host: What a great segment. Great information and so informative. Thank you so much Dr. Padalik for being with us today. You’re listening to Northwestern Medicine Pod Talk. For more information on the latest advances in medicine, please visit nm.org. I’m Melanie Cole. Thanks so much for listening.