And welcome back to Family Health Matters.

I’m Shelley Irwin.

With me today, Stephanie DeKryger, occupational therapist at Mary Free Bed.

Thanks for being here.

Sarah Battjes, Sarah Battjes, physical therapist at Mary Free Bed.

I bet you two know each other.

And Dr.

Umar Farooq, Vascular neurologist at Trinity Health.

Good day to you in the neurology department, you spend much of your day.

Tell me more.

Oh, thank you.

Thank you,Shelley for the opportunity.

Good to be back.

So I’m a vascular stroke neurologist and my daily varies, you know so much, depending upon where I am, depending inpatient service, outpatient clinic.

So I see patients in ER, right there, when the patient come with acute stroke.

We receive patient in the ambulance bay, take their patient to the CT scanner and decide what to do next.

And I also see the patient on the floor.

Around in the hospital, like in our Hospital service we have, I have a wonderful team there.

And when the patient is discharged from the hospital, I see those patients in the clinic So whole spectrum from inpatient to outpatient and we worked very closely with our colleagues at Mary Free Bed, and I am very actively involved in stroke research.

So we have a wonderful stroke team and research team and we are involved in clinical trials, like with the stroke net with which is like national like a stroke research program, in collaboration with the University of Michigan.

Right.

We’ll need to discuss in these next few minutes.

Talk to me a little bit about you, Stephanie.

I’m an occupational therapist at Mary Free Bed.

I work in the inpatient unit there.

So I’m working with patients that have come from the acute care hospital, like Trinity Health, or Corewell, and then we’re working on getting back to those activities of daily living and so working on getting yourself dressed again, you know, managing your transfers and ambulation throughout the home environment and things like that.

I also spend part of my time as the OT Fellowship coordinator at Mary Free Bed.

We have the only neurologic, accredited OT fellowship in the state.

We’ one of 14 in the country.

So I managed to improve program development and management of that in the after afternoon.

So a little bit of twofold there.

Wonderful.

Sarah, your job?

I’m a physical therapist at Mary Free Bed in the inpatient rehab setting as well, so I work closely with our team, including people like Stephanie working with patients every day to get them up and moving and learning how to navigate in their environment again after they’ve had a stroke or a brain injury, working with their caregivers on the ways to help support their loved ones and help just reach their goals in order to help get home.

How important is the family?

Extremely important.

Support is everything in the recovery.

We’ll get to that.

What is a stroke?

Good question.

So, a stroke basically is lack of blood supply to the brain, as simple it is.

So there are two types of stroke.

One ischemic stroke and hemorrhagic stroke.

Ischemic stroke is when there is blockage of the blood vessel to the brain and hemorrhagic stroke is when there is a rupture of the blood vessel.

A majority of these strokes are ischemic stroke, a problem approximately 85 to 87% and approximately like 10 to 12% or 13% strokes are hemorrhagic stroke.

And there are two main categories of hemorrhagic stroke.

One is intarcerebral hemorrhage, when there is bleeding inside the brain, and the other is subarachnar hemorrhage, when there is a rupture of the blood vessel in the subarachnar space, because of the aneurysm rupture or can be other vascular or malf formation, like AVM or fistulas.

So these are two main categories.

Yes.

Stephanie, who would be at risk for stroke?

Anyone, unfortunately.

It is the risk increases as you get older, but it is not to say that you won’t get a stroke if you’re younger.

We’ve seen lots of different age ranges that Marry Free Bed, that have had a stroke.

Some are even in utero, the babies can have strokes as well.

And can one recover from a stroke?

Yes.

That’s what we’d like to hear.

Yep.

It takes good hard work.

Are there, You mentioned you involved in the emergency services.

How important is early detection, early treatment?

Shelley, this is a very important question.. This is the most important thing in stroke care.

sooner it’s better.

As soon as somebody is having stroke like symptoms should call 911, that is the message we need to convey to everyone.

This is our job to create awareness in the community.

Somebody is having a stroke, always call 911 because every single second count.

So let me explain to you like how it is, you know, going to impact, you know, if we don’t do anything participation.

So in one minute, approximately 2 million neurons, we can lose if we don’t take care of this patient in timely fashion.

So very important to take care of this because we can give clot busting medication, TNK,to these patients.

And nowadays, doctors can go from their wrist or the groin and take the catheter to the brain and remove the clot mechanically.

So all these things can be done for these patient if they come early.

So time is time is brain, basically.

Yes, yes.

Obviously, a question for all of you, what would be a first sign or symptom, please?

: Absolutely.

So they like to use the acronym F.A.S.T.

So that F letter stands for face.

So if you notice in an individual or a loved one, it’s kind of acting funny and you ask them to smile.

If they’re unableable to raise one side of their mouth or it seems droopy, and there’s like extra skin on that side, that could be a sign of a stroke.

Yes.

As well as A stands for arm.

So if you ask them to raise one arm, if one arm drifts to the side or has difficulty staying in an upright position or they’re unable to raise their arm at all, that’s what the A stands for.

S stands for speech.

So, you know, if you notice that they’re talking, like, they don’t make sense, right?

Like they’re saying things that just don’t go well together or they’re really slurred difficulty with clear speech, that could also be a sign.

And then then time.

Anything that, you know, like Dr.

Farooq was mentioning, time is brain.

So if you notice these things, are they just feeling off or they have a, you know, their balance is poor, call 911, get to the emergency room right away.

Sarah, when does physical therapy enter this diagnosis?

Pretty quickly after, they’re medically stable.

Once they’re at the acute care hospital, you know the acute care therapists are coming in and just even trying to mobilize these patients, it’s incredibly important after a stroke to kind of get up and get moving again to help with aiding in that recovery.

Dr.

Farooq more on the broad picture.

Hence, you’ve stabilized the patient, then what happens.

Do you start the referral processes?

Yes, very good question.

Just to add also very small point here because of the interior circulation, these are very good things to look for Sometimes this can be a clot in the back of the brain.

So sometimes we can pick up those patients so quickly in ER so we can miss those easily.

So acronym, like from fast, is now we use like B.E.

F.A.S.T.

So B is for balance.

As we know, I guess somebody suddenly lose balance.

It can be like a sign of stroke and also eyes.

So if somebody has certain loss of visions or somebody has a certain onset of double vision.

So that can be a sign of like stroke as well.

So just to add a very small point.

Yes, but getting things taken care of would be important.

So you’ll begin possibly the referral process to PT and OT, where it would be your job here.

So occupational therapy, we work on a lot of different things, and that’s what I love about it.

So it’s all about what’s important to the patient.

But in the inpatient setting, we’ll work on those activities of daily living getting back to taking care of themselves again.

Excuse me, because a stroke can affect someone very differently.

They could have double vision, their vision loss, vision cut.

balance could be off, they could have a very weak side that they have to learn to move their body again when only one side is working.

So we’ll work on dressing techniques.

We’ll also work in like our clinic space spaces and do some, we call it neuromuscular reeducation, where we’re working on that brain and body connection again So working on strengthening, we’re working on sensory reintegration.

And then following through to outpatient care.

So you’re working more on return to school, return to work.

How do you access your community again?

How do you get back to that volunteer job that you love to do?

So OT is working through every part of that.

Physical therapy?

we work a lot on kind of their mobility and put a big focus on patients getting up and getting walking and moving again.

You know, at Mary Free Bed, we have harnessed systems that we use and we have rehab techs that we coordinate with to really try and get these patients mobilized and get up and moving, because oftentimes, you know, a big goal for a lot of patients is, I want to walk again.

So, you know, to really give them that jump and work at a high enough intensity that we’re really you know, working on that neuromuscular reeducation, like Stephanie said, to help drive some of that motor recovery is a big part of what we do.

And then just including caregivers in order to help, you be prepared and feel ready to take their loved ones home and help support them as they continue through their therapy too.

Yes.

Before we talk more about the rehab team, Dr.

Farooq are we still talking, are TIAs still out there?

I mean, other other, I don’t want to say smaller issues, but talk to me about this.

Yeah, a very good question.

Thank you for mentioning that.

Because TIA is like a transient ischemic attack.

So the definition of TIA actually is, if somebody has symptoms, like weakness, numbness difficulty with speech, visual impairment, and these symptoms come on very quickly and they go away within a few minutes, and there is no damage to the brain.

And when we do the MRI of the brain and there is no stroke, which we can see on MRI, that is TIA.

However, the management of TIA and stroke is more or less the same The tricky part in stroke here is there is no pain.

Most of the patient, they don’t have any pain.

So, for example, somebody has heart attack, right?

They have a chest pain, they are in a hurry, they come to ER right away.

In stroke, sometimes you have symptoms, but you don’t come to ER.

So that is the reason there’s some delay.

patient don’t come.

They have like TIA or a strokelike symptom, they wait at home and they are outside the treatment window, but we can do anything for those patients.

So we should take TIA and stroke the same, approximately.

There is no big difference.

The management is the same.

The most important thing to know is the mechanism.

Why is somebody is having a stroke?

If we know the mechanism, then we can prevent.

Yes, we’ll get into preventions as applicable.

Is there if one is saying,"Doctor, how long will it take me to recover?"

What’s your answer for that?

Good question.

It varies, depending upon this size of stroke, and the way the stroke is.

Based on the deficit.

So it can take a couple of days, to weeks, to months.

Yes, yes.

Sarah, talk to me about other parts of the team and how you all are working together Yeah, it’s a huge interdisciplinary team.

You have the physician, you have the nurses, you have the speech therapists, physical therapists, occupational therapists.

Mary Free Bed, we’re fortunate enough to have music therapy, recreational therapy, a lot of supportive therapies, and you know, we’ll coreat together if it’s appropriate for the patients to really help address their needs and their goals.

We have weekly meetings formally to discuss the patients and their progress and their care, but there’s a lot of communication throughout the whole team, throughout that patient’s length of stay and how they’re progressing and what their needs are and what all we’re working on to help them accomplish those goals.

Stephanie, how important is it to bring in the psychology part of your treatment, knowing that you will most likely recover to your best?

How does that brought in to your daily treatment?

Absolutely.

So we do have psychology on staff as well that come and see everyone who comes to the hospital because it’s a life change You wake up one morning, you have this event, and all of a sudden, everything is different.

So a lot of people are like, well, I’m just going to grit and I’m going to go through it.

But it’s nice to address that.

Like, okay, this is different, this is affects you, it affects your family.

Roles might have to change for a little bit when someone’s going through recovery.

So someone who owned their own business and was ready to, you know, get going and always was the leader in their family, might need a little bit more support from family members.

So it’s a really nice learning opportunity and an ability for education, for family and patients to go through that together with psychology, because it changes everything.

And when do you bring the caregiver in?

As soon as possible.

Yep, and we kind of start concluding them on day one, you know, what’s the patient’ goals?

What are the family’s goals?

And how can they best support them, you know, even while they’re still at the hospital You know, can they help them move around in their room?

Can they do exercises with them?

Are there certain strategies that we can start teaching them about, you know, encouraging their loved ones to swallow in a certain way or look a certain direction or help cue them and how to learn how to navigate in their environment, so that they’re practicing it here with us in the setting, so it just helps them feel a little bit more comfortable and a little more ready to go home.

I know, Dr.

Farooq, there is a team, but do you start incorporating nutrition at this point or other lifestyle changes as we start to look for discharge?

Right, absolutely.

So early intervention is better.

So we work very closely, use our colleagues at Mary Free Bed.

So you do an amazing job, so thank you.

So early therapy makes a huge difference.

So this is the thing we encourage to the patient if they start early nutrition plus like PT or OT speech makes a big difference down the road.

Yes.

What’s unique about Mary Free Bed in your therapy?

Mary Free Bed’s one of a kind.

So we have that interdisciplinary team approach, like Sarah mentioned, we have lots of technologies to help best support the patient and their goals.

It’s definitely the culture there is all about welcoming education and supporting the patient and meeting them where they are and what their needs are It’s not a big fish in a huge ocean, we are a big fish in a very structured supportive pond in a way.

Everyone makes an effort to know your name and support you through those goals.

and then you have the support of your team members.

We’re there.

I always say, you’re on the team with us, right?

We work with you and for you, and we’re going to get you back to home the best way that we can.

Sarah, do you see other patients promoting good, you know, you got this in other patients?

Is that teen comradery?

It is to make positive.

Yeah, it is, absolutely.

You know, we have our gym spaces or even people that are working out in the hallways.

You know, there’s individuals that are there that are cheering each other on or family members or, you know, man, when we got here last week, you know, you’re doing so much better.

And so there’s a lot of that positive encouragement from staff and from, you know, other patients and family members that are around there as well.

Yes.

What’s the latest on research?

There are a lot of things happening.

It’s like a stroke of prevention, and also for the acute treatment.

So now at least we can do so many things for our stroke patients.

So in good old days, there were not many options.

So now, as I mentioned, the window the treatment is extended up till 24 hours or even beyond So I remember like, we used to feel like kind of like helpless, you know, you cannot do anything far for these patients.

Now we can go into the vessels with the catheters and remove the cloth until 24 hours.

or even after that.

So last week at we treated a patient like we very young, 46 year old and has significant deficit.

And one of our new interventionalist Dr.

Scott, took care of that patient and helped that patient and when patient left, hospital had minimal deficit.

So these treatments are making a huge difference how we treat these patient.

And also a lot of things happening for the stroke prevention standpoint, and also for the neuro protection.

So we used to joke, like if you are rat, you know, these therapies work.

But now we are seeing some more response in human trials and a lot of things happening and new treatments coming for these patients, which we can treat right now, options are limited, but many things are in progress.

In the therapy world, are there we still using adaptive devices, perhaps more in the initial stage and then promoting without post?

Yes.

Absolutely.

So we use adaptive equipment quite a bit for the occupational therapy world, for dressing.

So there’s like a reacher, a long handle shoehorn, things like that.

But we also modify things.

We modify the environment, We can use splintty material to make a better handle for someone to be able to open their cabinets at home.

We can modify like a book bag strap.

If somebody is an upper extremity amputee and they need help kind of putting their bag on to go to school and things like that.

So everything can be modified and adapted to help evasion.

So, what’s the latest with PT?

You mentioned the harness Yeah, so intensity matters is kind of the big thing with driving with stroke recovery.

So when you’re coming, you’re going to come and you’re going to work hard.

And we have heart rate monitors that we put on people to kind of monitor where they’re at when they’re working within that intensity, too.

But kind of the biggest thing is just getting them up and getting them mobilized, you know, as far as adaptive equipment, introducing it as appropriate.

But if somebody wasn’t using it before, we’re kind of minimally trying to bring it in right now, as we’re kind of training them in physical therapy, if they needed an occupational therapy or working in the room with nursing, certainly but it’s a good challenge for their balance in just kind of that intensity and repetition is really important keys.

Dr.

Farooq also mentioned clinical trials tell us about this.

So there are a lot of trials, like we are participating, for example, like a sleep smart study.

So patient who have like stroke, and they also have sleep apnea.

So sleep apnea is a risk factor for stroke.

So now we are trying to figure out how much it is contributing and what we can do for these patients So we are actually a part of this national trial and this patient who have a stroke, and then we randomize these patient, like standard of care versus, you know, they get screened for sleep apnea.

And those things really makes a difference in the prognosis and the long term outcome because sleep apnea is also associated with abnormal heart rhythm, afib.

So abnormal heart rhythm is one of the other important stroke risk factors.

If the heart goes in afib, then clot can form in the heart can go to the brain.

So this is one of the important trials we’re participating.

And also we’re trying some other chemicals which we can use in these patients early on within the first like eight hours or so, and how we can help in the prognosis and recovery for our huge stroke patients.

You mentioned risk factors share a couple of more?

Oh, yes, for sure.

A very important point It’s really important to know that 80% of the strokes we can prevent.

So it’s important to know the risk factors, right?

If we know the respector, then we can treat.

If we don’t, then we can, right?

Now, so high blood pressure, high cholesterol, diabetes, as I mentioned, sleep apnea, abnormal heart rhythm, And what we are seeing now, obesity, other risk factors like use of any drugs, like cocaine or some, you know, marijuana, like smoking, all these things are important risk factors.

They have two main categories.

Basically the risk factor which we can prevent, the other which we cannot, right?

Age, we have no control.

Our sex, gender, you know, we have no control.

But other things we can control.

So if we properly control these risk factors aggressively, 80% of the stroke we can prevent.

Yes, or add to the prevention.

Yeah, I mean, activity is a big thing as well.

You know, staying up to current recommendations with your primary care provider taking the medications that are prescribed to you.

It’s a big education piece when we’re working with patients as well, when they’re coming in.

They say, how do I keep this from happening again?

How do I move forward from this?

So that’s a big piece of education that we’ll provide with patients as well.

is here’s the things that you can control, you know, your diet, your activity, your medication, you stay on top with your primary medical team too.

So a lot of that education is done with patients to try and help give them that some of that education, and then just reinforcing like, you, here’s the symptoms, right?

If you notice these things again, get back into the hospital, call 911.

What are the chances of having a recurring stroke?

I mean, there’s a chance.

I mean, having a previous stroke is a risk factor for having a second stroke.

Yes.

Add to that, if you would, Stephanie, as far as prevention.

Absolutely.

A lot of it, you know, we hear it all the time, like Sarah said, healthy lifestyle.

That’s so important.

And just to, you know, listen to your body as well, and know, like, okay, do you have a family history of stroke?

That’s another one.

And then just making sure that you’re going to that primary care appointment every year and you’re talking with your doctor and having a good relationship and saying, this is a concern of mine, where you mentioned I now have afib.

You know, what is something that I can continue to manage this outside of these visits so that I can keep myself helping in the future.

Dr.

Farooq, more on prevention and DNA.

If a parent or a grandparent has suffered the strokes and or the hearts, how does one stay?

stay the course, even though that’s something I can’t control?

Right, that’s very true.

So basically controlling all these factors, which I mentioned, like high blood pressure, high pressureol diabetes, it really makes a difference.

There are some genetic disrorders, but the percentage of patients who have stroke because of the genetic factors is very small.

However, we can, you know, have look for those things, and like, for example, Fabry’s disease.

It’s very rare disease.

It’s like a disorder.

And by chance, I have so many patient at least I see in my clinic, almost like 15, 20 patients.

And this is a genetic factor, you know, heart stroke.

So basically, we cannot do much for those except there are a few new treatments, like for, for example, Fabry’s, there are new treatments out there.

We can treat their underlying disorder and that can help to prevent this stroke also from that standpoint.

Yes.. Discharge, Sarah, A, what’s it like for the patient?

And do you usually set up a pretty extensive home program?

And I trust you would go from inpatient to outpatient to ultimate home?

Yeah, the whole team works collaboratively, especially with the social worker driving a lot of the setting things up for the patient as well, based off of the team’s recommendations but discharge going through what equipment they may need, what recommendations we may have for setting up their home to set them up for success, maybe what things to expect, really working with them, about, you know, if we have recommendations about someone being there to help support them, is that set up, and how are you going to get to your appointments?

So a lot of those trying to help patients think about what’s the next step with all of this We do set them up with the home program as well.

Here’s exercises that you need to continue to work on, when they’re with us.

inpatient rehab, they’re getting therapy five days a week, at least three hours a day.

When you go home and you go to outpatient, that might not be as frequent as what you’re getting, and you don’t have that therapist coming into your room and saying, all right, it’s time to get up and go.

So keeping that patient motivated on, here’s the progress you’re making and you’re going to continue to work on this with your next level of therapy, whether that’s starting with a brief course of in-home therapy and then transitioning to outpatient or going directly to outpatient therapy.

Yes.

to that, Stephanie.

Absolutely.

So we also are big proponents of family training and caregiver training because, you know, we’re in it together And as I mentioned before, roles change.

So we try to have them in at least once, twice, three times it’s whatever it takes.

So that way they get to see the DME, the durable medical equipment that we’re recommending, they get to try it, and then they’re doing hands on assist for the patient if the patient needs that.

They’re providing the cues, if the patient needs a little bit of hints, like, okay, make sure you’re looking left because they have some visual changes since the stroke And then it just offers an opportunity for the caregiver to increase their confidence.

They feel like, yep, we can do this together.

We’re definitely a team, or you know, that felt a little uncomfortable.

I’d like to try that again.

And then the therapists are partnered with them and with the patient to make sure that they’re set up the best for home.

What do you leave us with on behalf of the world of occupational therapy and stroke?

Absolutely.

So the big thing, I think it’s just, you know, we say stay active, but do things that are important to you.

Do things that the things that are meaningful to you.

If you have changes in your medical history or things that are new to you, and you feel like, okay, I can’t do the things that I’d like to do before, speak up about that.

Those are things that can be, you know, maybe the environment can be changed a little bit.

Maybe we can modify some of your activities so you can still participate in those things that bring you joy and then, you know, make you, you know, happy in your overall wellbeing and improved.

And then just, yeah, let’s stay active.

Get out, do things, you know, Winter months are coming here, you know, but you want to make sure that you’re still doing the things that bringing you joy.

Nice.

What resource do you have for us?

So, you know, the American Health Association is a great one to go to.

Mary Free Bed has a wonderful website with lots of different programs.

We do have like caregivers sessions or a stroke.

We have a stroke support group, outpatient and inpatient that previous patients, current patients, community members can be a part of.

We have adaptive wheelchair sports, so things that, you know, we have activities.

If you used to love to snowboard or, you know, go kayaking and you have some physical deficits since having a stroke, you can still do those things.

So definitely check out our website That’s a great resource.

Great.

Thank you for your service.

Sarah, what do you leave us with on behalf of PT.

Yeah, you know, stay active, stay motivated.

You know, go with the recommendations from your whole medical team with things, Stay involved with your loved ones and family members.

Keep going with therapy and just, you know, what are those things that are important to you and drive you to continue to have that success?

You know, recovery looks different for everyone but it’s kind of finding, yeah, what’s that those things that bring me joy right now?

Yeah.

Definitely a caring profession, isn’t it?

Yes.. You got to be smart, but you have to care for people as well.

Is there a resource to add from you?

Yes, Stephanie hit a lot of them.

You know, I just really emphasize support groups.

American Heart Association, American Stroke Association, have a lot of good resources.

You know, we have a booklet that we give to families as well, that have a lot of good resources listed in it as well.

So I know the big PR was Ask for Mary, but Ask for Sarah and Ask for Stephanie.

That’s what I’m going to put on my list.

I give you a couple minutes to bring us us down from this topic of stroke and leaving us with positive thoughts.

Thank you, Shelly.

So just to recover, Sarah and Stephanie mentioned, you know, lifestyle is very important, right?

So active lifestyle, watching what you eat, what you do makes a huge difference.

So as I mentioned before, 80% of the strokes we can prevent.

So this is the only way to know your risk factors, you know, Watch for your blood pressure, your cholesterol, your blood glucose.

Many times, patients have no idea, you know, they have not checked their blood pressure for many years.

But it goes up when we walk in your office.

Yeah.

I tell my pat, you know, you should have a blood pressure machine at home, right?

That is more important.

So how your blood pressure is.

So I encourage them to check blood pressure every day, make a log, and make sure, you know, call your PCP if it is high.

It’s like an ISI patient yesterday, very young patient in 30s, and she has a LDL was 169. and she was not doing anything.

So this is one of those things we need to be proactive and watching for those things.

Somebody’s snoring.

They need to reach out to their PCP and get the CP machine.

Somebody’s having palpitations, right?

So they might have AI.

and AFBib is so common that we don’t direct realize it is a major respect of our stroke.

How do we find out more information from you?

We have a lot of resources.

Give me two.

Oh, That’s not good.

Yeah, So one, at least is our website, TTHalth.org and stroke page, so you can go there.

You will get a lot of good information about the stroke and what to do and how to reach other out to us and get the appointment with us.

If you have any questions, we’ love to see you.

We have wonderful world-class like stroke team mnity Health.

We are so proud of us, you know, what we do.

So we take like three really pride in our care, especially the acute strocases when we see in ER.

So we have the best time in the state of Michigan, to need a time what we call.

Wonderful.

I do have to say goodbye.

Thank you all for helping us.

Yeah,’s these days of stroke.

Take care of you.

And as always, take care of you.

Thank you for watching.