Life after stroke
Physiatrist Angelica Soberon-Cassar, MD, explains how rehab can help with recovery after a stroke and offered tips for caregivers.
Caitlyn Whyte: Having a stroke is a life-changing event. So what happens after you have one may is stroke awareness month. So to help guide us through life post-stroke, we are talking to Dr. Angela Soberon-Cassar, an outpatient and inpatient physiatrist at Roger C Peace inpatient rehab hospital.
This is Flourish, a podcast brought to you by Prisma Health. I’m Caitlyn Whyte. So doctor, thank you so much for being with us today to start us off. Just tell us a bit about yourself.
Dr. Angela Soberon-Cassar: Yes. Good morning. My name is Dr. Angela Soberon-Cassar and I am a board certified outpatient and inpatient physiatrist. I specialize in psychiatry, which is physical medicine and rehabilitation.
I’m board certified also in brain injury medicine, which encompasses stroke. I currently work at Prisma Health in Greenville at our Roger C Peace facility. It is an inpatient rehabilitation facility. And my role is to see and take care of the patients as an inpatient, but also follow up after they leave Roger C Peace and also from the community and our outpatient location as well.
Caitlyn Whyte: Now our topic today is life after stroke. Now, what are the effects of a stroke?
Dr. Angela Soberon-Cassar: So that’s a great question. As, as a population, stroke is actually the number five killer and number one cause of disability within the United States. We see, as far as disability, not just the physical that most people can see with a cognitive and emotional effects on the person themselves, but also with their families. So, I’ve been asked to go through the signs and symptoms, which again is very crucial because time is brain. We say we want to get the person, the treatment as early as those symptoms again. So any changes in speech? So having some slurring of the speech, drooping in the actual face, changes in your vision, difficulty getting words out, weakness on one side or the other, it can even be a severe headache.
Caitlyn Whyte: All of these can be signs of stroke. Now for someone who’s experienced a stroke, what are some of the short and longer term goals of rehab?
Dr. Angela Soberon-Cassar: On the short term, we want to focus on independence. So in the acute care side, we have physical therapists, occupational therapists, speech therapists, and of course nursing and so forth that will look at how the person can function and what they can do on their own versus how much assistance they need.
So this is crucial in that transition home and how much assistance you have in the home. So we have case managers who also work closely with the patients and their families to make that safe transition. So really looking at what the person’s need and their functional need and safety. So can they swallow safely? Are they able to do regular diet or do they need a specialized diet? So that’s where the speech therapist looks at in the short term. And of course, do they need equipment, mainly that transition for safety? Long-term though, we also look at recovery in itself. And with a short term, making that transition to the right level of care.
We, we use that term as, do they need rehab? Do they need my kind of rehab? I got inpatient, acute inpatient rehab facility doing. More intensive therapy, but needing more medical needs or can they go to a nursing facility to do rehab or do they just need home health and that’s sufficient. And that they transitioned with their family doing the other help.
Or outpatient services or maybe none at all. Um, just really identifying what the patient needs at that time. Then long-term, of course, is what people ask about is can they walk, will they be able to cook? Will they be able to move their hand, their speech, memory? All of those things would be more of a long-term goal.
Many people do transition to get living independently. It really depends on how they are. So within the first few days, you can see some changes that, well, if they’re very weak on one side or another, if they can’t safely move from, let’s say the bed to the chair without falling and they need that physical assistance.
They’ll need that someone with them. We look at the first six weeks and then transition to even six months out. And I do have many patients that are able to live independently and others that, unfortunately, do still need help driving is another question I get quite a bit when the person can drive after stroke, we have therapists that actually do a formal driving evaluation if it’s warranted. And it will also depend on if the person has had complications from the stroke, such as seizures and their cognition, sometimes even playing a larger role than the actual physical limitation that usually we don’t look at for at least a few weeks out of the stroke. And it really is a case-by-case situation there.
Caitlyn Whyte: Now looking more at rehabilitation what different environments can it take place in?
Dr. Angela Soberon-Cassar: We have a patient has many faces. There’s in the acute care facility like Greenville Memorial Hospital and Richland and various acute care hospitals. It’s the therapy evaluations by the acute care therapist and some treatments there. And that really will help us make the basis for further recommendations.
So after they will we say post-acute that post-acute services. Look like again, acute inpatient rehabilitation, which in those cases, the patients have more medical acuity, more medical need as far as needing to be seen more frequently by a doctor, maybe some tweaks and blood pressure, diabetes, you name it, just having their needs a little bit, a little bit higher than other folks.
And then they’ll need to tolerate. Three hours of therapy on average, a day, 15 hours a week. That’s actually a criteria that we don’t come up with. It’s actually how we’re accredited as an acute inpatient rehabilitation facility. And then our subacutes also do rehabilitation of PT, OT, speech, all those different services at a lower level of care and not requiring the same medical acuity.
Okay. The home health therapy therapists go out to the home. There are, the patients would need, they don’t have a 24/7 nurse, like at a skilled facility or an. An inpatient rehab, so that usually will fall to the family to assist them then. And those patients, it varies on their level of need as far as physical assistance.
And so their therapist will come out about two to three times a week, depending on the goals that are set by those therapists. And then lastly, you have outpatient therapy. Those you see several centers throughout different areas and you would be at home transitioning there two to three times for a week and going to the clinic to work with a therapist independently in that setting.
Caitlyn Whyte: So what does an average recovery team look like? How many people are involved?
Dr. Angela Soberon-Cassar: Quite a few. I’ve already mentioned, you know, physical therapist. We have the speech therapist, occupational therapist, and we really strive to involve the patient as part of the team and their family. You can never forget those two components are the foremost and most important because you have to have that.
Focus from within to recover and then also the right support system. And the family engagement is quite crucial. And then also for some individuals there’s nursing needs, they may have other complications that warrants a nurse and also in the other facilities as well. But. I have patients in the home setting.
I have a home health nurse or an aide as well as a nursing assistant or another paid caregiver could be a part of the team as well. You have recreational therapists, we have adaptive sports and so forth. That there’s a lot, a lot to the team. And then of course the physiatrist and the physicians, we actively engage the primary care physicians.
We love for our stroke patients to go to their primary care physicians and. Really follow up with our blood pressure and diabetes and all those risk factors that are PCPs are so crucial and managing with them. The neurology team does a great job as far as stroke clinic, following up with the patients that I’ve seen.
And then of course, if, as I trust, a lot of us will work on the rehab plan, but not every, every stroke patient has a need for a physiatrist because they have primary or the neurologist who work on that.
Caitlyn Whyte: So how can caregivers at home helped in their loved one’s recovery? What are some tips for managing at home after a stroke?
Dr. Angela Soberon-Cassar: So as far as caregivers, it’s very loaded question because you have some folks that really only require for someone to just supervise and maybe make a meal for them and just be there for support. Maybe they’re fatigued and so forth and lower emotional support, and just helping them maybe go drive them to therapy, those kinds of things. And then you have other patients who really require a significant physical assistance and needing someone to carry them, lift them into the, to the chair.
Um, some of my patients have. Significant changes in their personalities or their emotions, which can be burdensome as well on the caregiver. So taking care of themselves, reaching out the caregivers can reach out to support groups prior to COVID. We had. Phaser support group and so forth. There are still groups, virtually and resources that they need to also take care of themselves in order to be there and mentally for their loved one.
So I always, we do allow a family member to come back with our stroke patients at clinic. That is one of the topics we talk about is reducing caregiver burden and how it’s impacting the caregiver as well, because they’ve obviously been through a different type of trauma as far as emotionally and seeing their loved one, go through all of this.
So definitely taking care of themselves as part of it and having a backup, not doing it all a hundred percent by themselves. It’s crucial. So I’ve had the caregivers could be spouses, children, church, family, pretty much anybody. Um, I’ve see different combinations over the years and enlisting some other help having a backup.
So you could go out and do something for yourself. If it’s going to the grocery store or. Anything, just a short window that you at least can get that respite is important. And then really, as far as helping their loved one in every single way, just sometimes it is physical, emotional, and driving. There’s just a lot to that.
Caitlyn Whyte: And wrapping up here, what makes stroke rehabilitation at Prisma health so different?
Dr. Angela Soberon-Cassar: We thankfully at Fresno health has several, all the post-acute services that I mentioned before through Prisma health, as well as the level of cares with rehab outpatient center, we are CARF accredited, which is a rehabilitation accreditation in the stroke.
And we actually have a brain injury and young stroke. Program in downtown Greenville for outpatient stroke services that has PT, OT speech, as well as a neuropsychologist involved. Cause I did not mention this earlier, but cognitive testing for some stroke victims is actually very appropriate. Not everyone needs it again.
Yeah. So some of those individuals do need that neuro-psychological component to work with them on their transition, maybe back to work, but goals are also dependent on how the person was doing before their stroke as if it was a working individual versus. Someone who maybe had some deficits before. So what makes it different is that we really do have thankfully all the services and we can kind of plug you in to what’s most appropriate.
Caitlyn Whyte: Well, thank you so much for your care and for your information today, doctor. That was Dr. Angela Soberon-Cassar an outpatient and inpatient physiatrist at Roger C Peace inpatient rehab hospital. For more information and other podcasts, just like this one, head on over to Podcast.PrismaHealth.org. This has been Flourish, a podcast brought to you by Prisma Health. I’m Caitlyn Whyte. Stay well.Read More
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