Episode 29: Regaining Balance After Stroke with Jenna Tucker, DPT
Have you ever heard the saying knowledge is power? When it comes to stroke, nothing is more true. Many of the risk factors for having a stroke are things you have control over--quitting smoking, a healthy diet, and exercise are just a few. In this episode, Dr. Jenna Tucker, DPT teaches us about regaining physical balance to increase mobility and rebuilding a healthy, balanced lifestyle to help prevent future harm. Recovering from a stroke is a full time job; it has the power to transform your life in very positive ways!
Covered in this episode:
Acquired brain injury: no direct impact causing trauma
Anoxic brain injury: lack of oxygen causes brain injury
Stroke: 2 mechanisms that cause stroke
Hemorrhagic: a bleed from AVM, aneurysm, or other source
Ischemic: a clot that blocks blood flow, most common type, lots of modifiable risk factors
The line can be blurry as to what gets called a stroke versus not. Clinical presentation and mechanism of injury are considered when deciding what gets called a stroke
Typical presentations are based on which artery is affected. MCA strokes are the most common
Left MCA: hemiparesis on the right side of the body (weakness), right sided sensory loss, speech and language deficits
Right MCA: hemiparesis (weakness on the left side), sensory loss, visual spatial deficits, visual impairments, cognitive impairments
ACA: higher order cognitive impairments, problem solving, behavioral challenges
PCA: visual deficits
Cerebellum: “the little brain,” center for coordination and balance: will see symptoms called ataxia which are impairments in smooth movement
There are trends depending on the areas of the brain affected but everyone presents differently
B.E. F.A.S.T.: Typical symptoms of a stroke. If you have these, get to the ER immediately!! The faster you get treatment the better the outcome
B: Balance
E: Eyes. change in vision
F: Face. facial droop
A: Arms. Arm weaness
S: Speech. Slurred speech, difficulty communicating words, not making sense or jumbling, unclear speech
T: Time: get to the emergency room immediately, best outcomes come from getting treatment as soon as possible. If you have a clot, they can give you a “clot busting” medicine but it has to be given within a few hours of the onset of symptoms. It is important for your doctor to know when the symptoms started.
In the book, My Stroke of Insight: A Brain Scientist’s Personal Journey by Jill Bolte Taylor, she explains her first hand account of how it feels to have a stroke. This book is a great read!
Patients who have had a stroke are at very high risk of having another one. Stroke survivors need to be educated on the symptoms to watch for so they can get help as soon as possible.
Rehab after stroke
“How long will my recovery take?” “How much better will I get?”
There is always room for improvement. How much? Time and effort will tell
Recovery depends on time and effort, every injury and stroke is different.
Get off to a good start with a lot of education on risk factors, stabilizing your general health, and education on reasonable expectations.
Recovery takes time--it is frustrating and overwhelming. You end up learning to live with uncertainty and patience.
The majority of physical recovery happens in the first year or two. Recovery doesn’t end after this, it just slows down. As the symptoms get better there is less improvement needed.
You may see a lot of gains and improvements early on. You get to a plateau where it is harder to see gains-- be patient with yourself as changes slow down
Education on follow through is very important. As you move on in your recovery the length of time you work with a therapist decreases. Recovery relies on you following through on your home exercise regimen. The patient and family are a huge part of the rehab team. Survivors have to be very involved and motivated.
Rehab has to be functional. Therapists rely on knowing a patient’s goals and breaking it down into actionable steps.
You can keep yourself motivated by knowing that every small step brings you closer to the larger goal. Celebrate all the small steps. I.e. when you want to lose 100 pounds you don’t say you failed because you have only lost 5 lbs so far. Each pound adds up to the final goal
If something isn’t working, you may need to change up your therapy, “pivot” and use a different approach to reach your goal
There is always room to keep improving. If you feel like you’ve hit a plateau it may be time to change it up. She gives the example of a patient who wanted to walk. He was having trouble making progress. When they talked about what he wanted to do on his walks it was that he wanted to walk his dog. They were able to incorporate canine assisted therapy to help him make gains with walking
Where is the Mango Princess? A Journey Back from Brain Injury by Cathy Crimmins: you lose a lot of independence with a stroke and it has a huge psychological component. It is important for therapists to remember that the people in recovery are people. What does functional independence mean to the patient? It may be just being able to get around the house in shorter distances versus being able to walk miles.
The goal of your recovery is based on what is important to you
It’s very important to let your therapist know what matters to you. You can work together to achieve this.
Modifiable risk factors
High blood pressure, diabetes, unhealthy eating, physical inactivity, smoking: You need to change these behaviors to prevent another stroke
You need to address what caused the stroke to prevent having another. Not only are you recovering from a stroke but you also need to work on healthy lifestyle changes
Physical inactivity is the new smoking. Lack of physical activity is detrimental to your health. You need to exercise.
Find what type of activity is pleasurable to you. You have to enjoy it to stick with it.
You need to have 40 minutes of moderate to vigorous activity, 3-4 times a week for stroke prevention and optimal level of health
Physical therapists can help you start an exercise program that is appropriate for you. They help you set your target heart rate which will tell you if you are in the moderate to vigorous range. Some people are on medications that modify the heart rate so PTs help you find your “rate of perceived exertion” to find the moderate to vigorous range.
Balance: a huge part of stroke recovery
Work closely with a physical therapist to modify exercise to a safe level for you
Balance relies on 3 main systems: vestibular, visual, and somatosensory system (ability to perceive sensation: touch--ability to feel foot on floor OR proprioception--knowing where your body is in space)
These three systems work together to send input to your motor system. Any disruption in this chain causes a problem with balance
A PT will need to diagnose where the breakdown in balance is to give exercises and strategies that will help.
PTs are very creative in finding ways to modify your activities to make them safe
When your balance is off you are at high risk for falls.
You have to address the cause of the balance issue and apply the right therapy
Vestibular: vestibular therapy
Visual: neuro-optomerty, prism glasses, strategies to help deal with visual neglect
Somatosensory: teaches ways to work around your loss
Your brain and body will compensate by relying more heavily on other systems that help with balance
PTs provide strategies to restore balance along with ways to compensate and work around the deficit. This will help reduce your risk for falls
75% of stroke patients will have a fall in their first year after stroke
Addressing fall risk
Address the cause of balance loss
Modify activities to make them as safe as possible
PTs and OTs can do home safety evals to make your home as safe as possible
Nightlighting
Removal of throw rugs and things you can trip on
Placement of furniture
Fear of falling: requires a combination approach of physical and psychological therapy
Be real with where you are today. Define today’s limitation. This won’t last forever. It requires being realistic, diligent, giving it time. Recovery is a full time job
Chris Dittrich episode: Keep Moving Forward! Every small amount is an accomplishment. Follow Chris’s on Instagram for inspiration.
Over time it takes less and less structured care and recovery as you incorporate strategies into your life and get stronger
Healthy eating
Diet culture is not sustainable, it's more about incorporating a balanced diet
The general research shows the Mediterranean Diet as being a heart and brain healthy way to eat
Lots of fruits and vegetables
Eating natural, non-processed foods foods
Live in moderation. Avoid the extremes of never eating this or always eating that--this type of dieting is hard to sustain
If you need help, consult a dietician
The more you know the better off you are. It can be very overwhelming to take all this in. If anyone takes anything away from stroke prevention it is doing things that make you feel good, get moving, eat well, and stay hydrated. It is all about coming back to the basics
Links to any resources mentioned:
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My Stroke of Insight: A Brain Scientist’s Personal Journey by Jill Bolte Taylor
Where is the Mango Princess? A Journey Back from Brain Injury by Cathy Crimmins
Connect with Jenna Tucker, DPT
Instagram: @jtuckdpt
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