A Closer Look: Physical Therapist Neera Prabhakar on Stroke Rehabilitation
Meet a physical therapist at MossRehab who specializes in the kind of therapy Patty received.
Stroke is caused by an interruption of blood flow to the brain because of a blocked blood vessel or bleeding in the brain. Some of the most common signs of a stroke include sudden severe headache, weakness, numbness, vision problems, confusion, trouble walking or talking, dizziness and slurred speech etc. In general, most of the cognitive and motor skills required to functional normally in our everyday life are partially or severally affected.
According to CDC, stroke is the fifth leading cause of partial or permanent disability and one of the top causes of death in the U.S. Effects after a stroke can include muscle weakness or paralysis, speech difficulties, vision deficits, impaired balance, and cognitive difficulties. Due to the wide range of effects stroke can have, the treatment and recovery process for each patient must be tailored individually. Even though, not all patients have same effects or experiences. Their lives change, leaving them frightened and with feelings of uncertainty and helplessness.
“The patients are in a very vulnerable state when they are in the inpatient rehab setting,” says Neera Prabhakar, PT, DPT, NCS, who specializes in inpatient stroke rehabilitation. “These patients were used to doing most of their daily tasks independently. After suffering from a stroke, they are in a state where they must rely on other people to help them accomplish these tasks like eating, bathing, dressing, and walking. All this can be very intimidating and challenging for them. At MossRehab, our goal is to provide patient-centered care, working towards the patient’s stated goals. It is so important to address this from the very beginning, providing them with a sense of control over their rehabilitation. If their goals are not addressed, then we are not providing them with an opportunity to take the lead.”
Prabhakar’s job, and that of other members of a dedicated team of experts at MossRehab—including doctors; rehabilitation nurses; neuropsychologists; and physical, occupational, speech and recreational therapists—is to provide inpatient therapy that begins the process of moving patients who have suffered a stroke toward recovery and greater independence. That means ensuring they are at a level where it is safe for a loved one or caregiver to continue care in the home and back in the community, although for some it can also mean moving on to a short-term skilled nursing facility before going back home. (In the most recent year measured, 66 percent of MossRehab stroke patients were released to their home, two percentage points higher than the national average.)
Every stroke patient is unique and so are their treatment plans. Patients are thoroughly evaluated to determine what abilities have been affected because of the stroke and gain an understanding of what they can and cannot do. “From the very beginning, we work to identify the main areas that are impacting the patient, affecting their performance to the point where they cannot perform things independently. It is really important to prioritize what those problem areas are, so they can be attended to first,” says Prabhakar.
Therapy can take a variety of avenues from performing a ball toss while standing on a balance pad or walking a serpentine course to practicing challenges they will face in everyday life, such as walking up and down stairs or unloading clothes from the washer to the dryer. The physical therapy gym is not a perfect substitute for the real environment the patient will face, but the skills required are the same. “If we’re bending down to reach for an object, this will help you in those instances where you have dropped something on the ground at home, or if we’re standing on a surface that challenges your balance reactions, this is going to help your balance when you are walking on flat indoor surfaces or outside on the grass,” Prabhakar tells patients.
In the inpatient setting, patients often make gains that perhaps they might not have expected. Prabhakar and team also lets them know that for many, it can be just the beginning of a long road. Therapy can continue at a home level of care for a short period of time with a transition to outpatient, or patients may transition right to outpatient, with therapy lasting anywhere from a few months to a couple of years. This new reality can be daunting, and challenging on an emotional level. Prabhakar and colleagues place a lot of emphasis on that side of recovery as well.
“We try to encourage them to see that there is still a light at the end of the tunnel, that with continued therapy, as long as they continue to take charge of their recovery, continue to work with their loved ones and therapists, they can achieve goals and get to a point where they are living a life they can enjoy. It might not be the exact life that they used to live, but they can still have a great quality of life.”
(Photo by Wes Hilton)