Early Rehabilitation Is Key to Stroke Recovery: Q&A with Dr. Jeffery W. Williams

More than 795,000 people have strokes in the U.S. each year, causing varying degrees of motor control, speech and cognitive issues. The impact of a stroke is unique for each individual. However, receiving rehabilitation care as soon as possible following a stroke is imperative for every patient to regain function and independence.

Good Shepherd Rehabilitation’s Stroke Program provides specialized inpatient and outpatient care to treat the physical and cognitive effects of a stroke. Good Shepherd’s stroke recovery is supported by a team of experts that includes: physiatrists (doctors who specialize in physical medicine and rehabilitation); rehabilitation nurse; neuropsychologists; physical therapists (PTs); occupational therapists (OTs); speech-language pathologists (SLPs); respiratory therapists; recreational therapy; dietitians; social workers; chaplains; and care managers.

Leading the Good Shepherd team is Jeffery W. Williams, MD, Medical Director of Good Shepherd’s Stroke Program. Dr. Williams explains stroke, the causes and the critical role of stroke rehabilitation in helping patients regain the highest level of function and independence possible post-stroke.

Q: What is a stroke?

Dr. Williams: A stroke involves damage to the brain from an interruption of its blood supply — which may be blocked or reduced blood supply — or due to sudden bleeding in the brain. There are two types of strokes. An ischemic stroke is the result of the blood supply to part of the brain being blocked or reduced, preventing oxygen and nutrients from reaching brain tissue. About 87% of strokes are ischemic. Hemorrhagic stroke occurs when a blood vessel bursts or leaks in the brain, causing blood to put pressure on brain cells and damage them.

High blood pressure is the leading cause of ischemic and hemorrhagic stroke. HTN (hypertension) is the single most importantly modifiable risk factor of ischemic strokes.

Q: What are common physical and cognitive impairments resulting from a stroke?

Dr. Williams: The physical symptoms include weakness on one side of the body, lack of sensation or abnormal sensation on the affected side of the body, facial droop, balance and walking problems, coordination issues, difficulty swallowing and speaking, bladder issues, pain, fatigue, visual deficits, and difficulty with self-care.

A stroke may impact comprehension, attention, memory, language (slurred speech) and orientation. Emotional symptoms include depression, anxiety, mood swings and emotional outbursts.

Every person’s stroke is unique and may include just a few or many symptoms.

Q: What causes a stroke?

Dr. Williams:  High blood pressure is the leading cause of ischemic and hemorrhagic stroke.Other top causes of strokes are diabetes, obesity, high cholesterol, smoking, carotid artery disease and atrial fibrillation and other heart damage.

A sedentary lifestyle, poor diet and alcohol consumption may contribute to issues like high blood pressure, obesity and diabetes. In fact, there is evidence that up to 50% of stroke patients have prediabetes.

Q: How vital is it to receive rehabilitation immediately following a stroke?

Dr. Williams: Rehabilitation should begin as soon as possible – within 24 to 48 hours, if possible – to improve the ability to regain lost function and independence. The sooner rehabilitation care begins, the better the outlook for regaining lost abilities or improving them as best as possible.

Stroke rehabilitation takes time, but the rate of recovery is greatest in the weeks and months after a stroke. I find the greatest gains happen in the first three months, followed by the next three to six months. However, there is evidence that gains can be made 12 to 18 months after a stroke.

Q: What does rehabilitation for a stroke involve?

Dr. Williams: Each person’s stroke rehabilitation is different, depending on the severity of the physical and cognitive deficits from the stroke. That’s why a comprehensive, focused stroke rehabilitation program and the skill of the care team are so important.

Good Shepherd’s interdisciplinary stroke team works to take each patient to the highest level of independence possible. The physiatrist is the “quarterback” of the team, directing the patient’s care, handling medical issues, prescribing medicine and tailoring therapies to individual needs. The physiatrist conducts an evaluation and creates an individualized rehabilitation plan in coordination with the other medical team members.

At Good Shepherd Rehabilitation Hospital, we manage an entire floor of 30 beds dedicated primarily to stroke patients, which is different than most hospitals that that combine patients with various diagnoses such as spinal cord injury (SCI), brain injury, orthopedic and medically complex all on the same floor. We here at Good Shepherd have a separate floor that focuses on SCI and yet another floor that focuses on brain injury rehabilitation. This enables us to focus on the particular needs of the stroke patients, modifying medications, orthotics, equipment needs, nutrition needs, the environment, therapies and modalities. Our team of doctors, nurses, PTs, OTs, speech therapists and dietitians specialize in stroke rehabilitation.

Motivation and mood can impact a patient’s recovery. That’s why our inpatient hospital team goes beyond physicians and therapists to include neuropsychologists and pastoral care for each patient’s emotional needs.

A neuropsychologist provides cognitive testing, evaluates depression and anxiety, and provides supportive care for agitation or patients with dementia.

The support of family and friends also impacts stroke recovery. For instance, will the patient need help with managing urinary incontinence once home? What if the patient becomes agitated and angry at home?

We communicate closely with a patient’s loved ones, who may take over care at home, to educate them and provide the tools to handle various situations. Our care managers and social workers address barriers to returning home and coordinate resources to lessen the burden on loved ones so that the patient’s functional gains continue past the inpatient hospital stay.

The transition from inpatient care may include ongoing rehabilitation (PT, OT, speech) in an outpatient setting. Good Shepherd offers stroke rehabilitation at our collection of outpatient sites throughout eastern Pennsylvania.

We also offer a Transitional Care Management Program led by a nurse practitioner, who follows up with the patient for 30 days. Plus, our team communicates ongoing medical and rehabilitation plans and information with the patient’s other physician specialists.

Q: What rehabilitation technology does Good Shepherd use with stroke patients?

Dr. Williams: Good Shepherd utilizes technology in many of its care plans, in combination with functional movement therapy. For example, if a patient has one-sided weakness or needs to improve hand strength, functional neuromuscular electrostimulation may be part of rehabilitation sessions.

Good Shepherd offers rehabilitation technologies that help with vision, strength, balance and overall functional movement.

Another example is for patients who need help walking: Good Shepherd is a worldwide leader in using the Ekso Bionics exoskeleton, a wearable suit that enables patients with lower extremity weakness to stand and walk through the use of robotics.

Q: What are the most effective health and wellness approaches for people to prevent stroke?

Dr. Williams: It’s what we all hear over and over: Eat right, get moving and have regular checkups with your doctor.

Dietary changes should focus on low-fat, low-cholesterol food choices. Regular exercise can help control prediabetes, diabetes and high blood pressure. Be sure to stay on prescribed medications for conditions like high blood pressure and high cholesterol.

It’s important to discuss your family history and stroke risk with your family physician to coordinate and monitor appropriate lifestyle changes, weight loss plans and medication use.

Learn more about Good Shepherd’s Stroke Rehabilitation Program or call 1.888.44.REHAB (73422).