ischemic stroke recovery process

[charlesavenue1]

My mom had an ischemic stroke this past August that damaged her middle cerebral artery. She is 70 and this is her second stroke in 19 years. The first stroke damaged the right side of her brain, but she recovered well enough to go back to work and live a productive life. This second stroke was more damaging.

She is alert, and only stares to the left. I'm not sure if her vision is clear. Her right arm and leg are limp, and she doesn't move them. Her left leg, neck and arm are paralyzed, with her left arm bent against her chest. She cannot speak, she only grunts sometimes. She does smile and chuckle with her mouth closed, when someone tells her a funny story. She also has a feeding tube to her stomach, since she cannot control her swallowing. She only shallows by reflex.

She has been in a nursing home for about a month now, and the CNAs do passive-range-of-motion exercises with her legs, arms and neck once per day. I do the same exercises with her once in the evening. This is the only recovery therapy that she has received. The Director of Physical Therapy says that nothing else can be done for her, because she is unresponsive. Is this normal procedure? I would think that a Speech Therapist would come in and try some sort of exercises with her. I'd appreciate any information. Thanks.

[oc1dean]

Sorry about your mom but you have entered the medical know nothing zone. As Sargeant Schultz used to say,"I know nuthin." Stroke knowledge and rehabilitation answers are impossible to find. Ask your doctor to show you a three dimensional map of the affected area of her brain and especially the penumbra. Ask what those areas controlled and what therapy would be effective. Do not take , we can't do anything for her. A speech therapist should have been assigned to determine her level of attention; ie. Can she hear and understand commands, or does she need written instructions, or does she need pictoral instructions. There are many things that can be done even with no movement; Mirror-box therapy, thermal stimulation therapy, music therapy, mental imagery, passive movement, bilateral movement. As numerous people on these sites have been told that they will not recover and immediatetly another survivor answers,"Don't listen to your doctor, he doesn't know anything, I was told I wouldn't recover and I am doing just fine." Read the book, Stronger after Stroke by Peter Levine and you will know more than any of the medical staff.Start researching neuroplasticity, it is the basis for most recovery after the initial spontaneous recovery.
Good luck, Sorry about being negative but every survivor is  basically on their own to find the treatments necessary.
Dean

[charlesavenue1]

Thank you for this very helpful response. Your not negative at all, but honest. I will look into these recovery options.

[charlesavenue1]

Just to give an update. Yesterday the PT asked if she could place a soft cast on my mother's left arm for a couple of hours, to help reduce the paralysis. I think this is a step in the right direction on the nursing home's part. I'll keep posting my mom's progress. We have a long road ahead of us.

[oc1dean]

Interesting response. A soft cast on the paralyzed arm does nothing to reduce paralysis. What casts are for is to prevent contractures(shortening of the muscles and tendons). Once contractures set in free movement of the arm becomes impossible. The cast is meant to stop the spasticity causing the arm to curl against the chest. The issue with that is that the PT needs to tell you exactly what else they are doing to stop spasticity. The cast doesn't stop the spasticity. If your Mom could talk she would say that the arm is still trying to bend inside the cast. Spasticity is a major problem for lots of survivors except that researchers do not believe that working on spasticity helps. See William  M. Landau articles: Spasticity After Stroke : Why Bother? Ask your PT about Brunstroms 6 stages of recovery. If she can't discuss it without looking it up she should be replaced.
Dean

[charlesavenue1]

Speaking of talking, my mom is now opening her mouth when she trys to speak. Of course we can't understand what she's saying, but this is a great improvement from grunting. I showed mom's nurse, so that she could document this improvement in my mom's medical assessment chart. I'm hoping she will be ready for speech therapy soon.

I had already read the article by M. Landau. I don't think that this nursing facility holds to his point of view. His view also goes against what I've been reading in the book "Stronger after Stroke".  I found the Brunnstrom 6 stages of Recovery online, and printed them out for my own reference. I will ask mom's PT if he uses this method.

In my opinion, as long as a person is alive, why not try to make the quality of their life better. My mom could live for 10 more years. Those 10 years are going to go by, regardless of whether she's lying in a bed all day, rolling around in a wheel chair or walking with a cane. It's better to try and fail than not to try at all.

Thank you so much for your advice. I really appreciate it. I hope others are benefiting from it as well. I'll keep you posted on her progress.

[charlesavenue1]

Here's an update on my mom.

The arm splint has been successful in straighten her arm down to her side. However, she is still unable to move it. Mom is also having a splint placed on her left hand to straighten out her risk.  She is receiving passive range of motion exercises 3 times a day. She is supposed to start some sort of speech therapy next week.

I would like for a neurologist to access her progress, but her doctor has not yet to give his approval for this request.

Overall, I'm coming to the conclusion that this nursing home staff doesn’t have the necessary skill set to give my mother the best chance of recovery. I've been reading about all of these cutting edge stroke rehabilitate techniques, that aren’t accessible to people like my mom. I think the staff here is wasting the precious time that my mom could be using for more aggressive rehabilitative therapy.

[oc1dean]

I used to believe that there were two types of survivors, young fighters who keep trying to recover and older people who just give up because it is such hard work. Now I think the ones who give up do so because the medical establishment has nothing positive to give them some hope.

[charlesavenue1]

I'm looking into getting rehabilatative help for my mom outside of the nursing home. Even if my family and I have to pay out-of-pocket. There is a stroke center here in my city that sounds pretty good. I'll call them for more details on their services. Even if the nursing home is just doing the "basics" I'm not going to settle for that. My mom will try if she's encouraged to do so, and that's exactly what I will continue to do. You were right, we have to do so much on our own.

[oc1dean]

Questions to ask the new facility:
How many patients has he/she seen fully recovered and what did they do to recover? This is not the ADL recovery.
What has been done and still needs to be done to prevent another stroke?
What area of the brain was disabled by the stroke? What functions did they cover?
What type, clot or bleed?
How big was the penumbra? What areas did it affect?
What clinical trials are going on right now that the patient would be a good candidate for?
What treatment options have been discovered in the last 5-10 years for stroke rehabilitation?  Of these options which ones are available in your clinic?  This is to determine if he/she is up-to-date or if you will have to do all this research yourself.
Who are the best therapists working in your clinic for stroke rehabilitation and why do you consider them to be the best?
Who do I work with if depression takes hold?
What books on stroke recovery do you recommend?
What stroke related magazines do you recommend?
What internet sites do you recommend about stroke? There are at least 15 stroke forums out there.
If they are not willing to answer these questions or do not know anything. Time to find another site.

[charlesavenue1]

Thanks for the information.

[charlesavenue1]

Mom has reached the 3-month mark of her stroke recovery. She is still in a nursing home, doing well with her speech therapy. She is able to slowly lift her neck, and slowly turn her head from the left to the middle. She is alert and talks with slurred speech, since she is still unable to completely control her tongue. She can, however, clearly say "yes, no and hi"

On the negative side, she is still unable to move any of her limbs. Her left arm has contracted close to her chest. The physical therapy she is receiving is not aggressive enough. She only gets one to two passive ranges of motion exercises sessions per day, and she wears a hand and arm splint all day. However, in the past two weeks, she hasn't been wearing any splints at all.

To top it all off, the CNAs – not the physical therapist – performs the PROM exercises on my mom, and places the splints on her left arm. The director of nurses doesn't want the CNA s to do this, but I guess the director of physical therapy has the final word.

I have set up consultation with a physiatrist, this week, to see if he can prescribe a more aggressive physical therapy plan for my mom. If he does prescribe a physical therapy plan for my mom, I'm not sure if mom will have to go to another physical therapist, or work with the physical therapists at the nursing home. The physical therapist at this nursing home, don't seem to be very interested in doing much with my mom. Like I noted before, the director of PT is ordering the CNA's to do all of mom's therapy.

On a positive note, I got my mom's left leg to bend 4 times, during her PROM exercises. It was stiff and unable to bend for the past 2 1/2 months.

[charlesavenue1]

Major set back for my mom. She was rushed to the hospital from the nursing home with pneumonia and a severe uti that had spread to her blood stream. At this time, she is in an ICU fighting for her life.