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Stroke is commonly thought of as a condition that affects the elderly and retired. Therefore, many rehab continuums focus
on the patient who returns home and is largely homebound following a stroke. The reality, though, is that stroke can also occur in middle adulthood, from age 30 to 55.
When you factor in the large number of strokes that occur each year (it causes approximately one in 17 deaths, making it the third leading cause of death after heart disease and cancer, and is also the leading cause of serious long-term disability in the U.S.), clearly a large number of strokes occur in this younger age range.
“These tend to be patients with jobs and young families, in full career mode,” says Mark Barisa, Ph.D., ABBP, a clinical neuropsychologist at Baylor Institute for Rehabilitation (BIR). With younger patients in mind, BIR is developing continuum-of-care models that reflect younger patients’ realities, which may include a job and the care of young children. “We want to follow stroke patients from the acute phase to the transition back to home, then back to work,” Barisa says.
Baylor is equipped to handle acute strokes. Medical care for acute strokes begins with stabilizing the patient’s condition and efforts to stop or reverse the effects of stroke. Inpatient rehab is a key part of this early acute medical stage, with early intervention—physical therapy, occupational therapy and speech therapy—being key to successful recovery, Barisa says. After patients are discharged from the hospital, many enter acute rehab centers where they receive daily interventions, including physical, occupational and speech therapy services with additional interventions provided by neuropsychology, social work and therapeutic recreation professionals. Afterward, the next step depends on the patient’s needs, Barisa says. One option is the Day Neuro Rehab Program, which Barisa describes as an “intense” day, where patients are involved in therapeutic interventions from about 9 a.m. to 3 p.m. An advantage is that these patients receive rigorous therapy but still live at home. “Patients can try something out [at home], then come back to a safe place at day neuro, where therapy can be tailored to meet each patient’s individual needs.” Some patients do therapy two or three days per week, while others do three, four or even five days per week.
Day neuro and outpatient rehab usually involve strengthening muscle, sensory or high-level cognitive function in the wake of medical recovery and increasing day-to-day functioning. “In rehabilitation, we look at various functions of the brain, including physical and cognitive abilities, and compare to pre-stroke levels,” Barisa says. Where possible a rehabilitation team works to remediate or eliminate the deficit. When that’s not possible, some patients receive training to compensate for deficits in their daily lives. For example, someone with a vision impairment may use glasses to “compensate” for their acuity deficits. Others may receive LASIK surgery to eliminate or “remediate” the vision problem.
Younger patients in their 40s or 50s differ from older patients in their key roles and responsibilities, such as going to work or getting kids off to school each day. “We help patients develop the skills to be successful performing these tasks,” Barisa says, emphasizing the team approach. As part of the continuum of care, each patient at BIR has access to physical therapists, occupational therapists, speech therapists, therapeutic recreation therapists, physical medicine providers, optometrists and neuropsychologists from the hospital to the home. This team approach allows the patient to receive the right care at the right time with the right professional.