The role of physical rehabilitation in health care is expanding as research reveals new ways to help the body recover from major traumatic events such as strokes and accidents, says Dr. Lewis Hargett, a practicing physiatrist (physical rehabilitation doctor) in Louisville. More physiatrists are being trained to treat an aging population, and thanks to advancing technology, there are more options than ever before to help persons who have a specific rehabilitation need.
Helping Patients Recover from Strokes and Injuries
“Rehab medicine covers a whole sundry of different diagnoses,” Hargett says. One common affliction is stroke, where blood supply is cut off from the brain and the tissue in that part of the brain dies, permanently. Hargett explains that a stroke differs from what is called a transient ischemic attack (TIA), which presents stroke-like symptoms that resolve within 24 hours. Whether a person has had a stroke or a TIA, getting to the hospital quickly is absolutely essential.
“You’re assessed in the ER if it’s in a timely fashion, they have neurologists on call in addition to being seen by the emergency room physician,” he says. The medical team will often give the patient what is called “clot busting” medication – thrombolytic therapy that breaks down the blood clot and restores flow through the arteries and veins. “Within that time frame, if you can get that clot buster administered, you can actually go in and, with great success, either alleviating that evolving stroke that you’re about to have or minimizing the results from the stroke,” Hargett says.
For persons who have suffered permanent brain damage due to a stroke, the services of a physiatrist are soon required. Hargett will consult with the stroke patient in the hospital soon after he or she is treated by the ER team and neurologist and perform a full-body assessment. “Your goal is to find out, from top to bottom the extent of his or her deficits with regards to the stroke itself,” he says.
“Then what you want to do is formulate a treatment plan and get that initiated there when the patient is in the acute care hospital,” he continues. “Mobilization is key, and mobilization is done by therapists.”
Mobilization goals are specific to each patient – “the key is that you want to make sure that any body part that can be moved, is moved,” Hargett explains. For example, he notes that many stroke patients present with a weaker arm or leg on one side. That puts them at high risk for fractures, loss of muscle, bed sores, and other problems. Hargett and the therapists will try to get the patient’s affected extremities moving to minimize the risk for those complications.
The same focus on mobilization during therapy largely applies to persons who have suffered a major traumatic insult to the body due to an accident or other violent act and those who have suffered brain or spinal cord injuries. Accident victims require acute treatment for their broken bones and internal injuries, but then a comprehensive rehabilitation program must be organized ASAP. “The rehab physician needs to be involved as early as possible so we can work at minimizing the prolonged adverse effects of these injuries,” Hargett says.
Re-learning the Essential Functions of Everyday Life
There are three main treatment modalities for rehabilitation medicine, Hargett says. Physical therapy, discussed above, starts soon after a patient is initially treated for their underlying condition and involves mobilization. Occupational therapy focuses on teaching daily activity and living skills that a patient may need to re-learn. Lastly, if a person has mental impairment after their stroke or injury, they will need speech therapy.
Persons who have suffered a stroke often need some speech therapy, Hargett says. He will assess their cognitive function and motor skills, including their ability to swallow. Some patients may have severely impaired swallowing function and will require a feeding tube. Once speech therapy begins, Hargett and his staff will focus both on improving how well the patient talks but also how well he or she understands speech in order to have a conversation.
“When you hear the word ‘stroke,’ there are many different kinds of strokes depending on the part of the brain (that is affected),” Hargett says. “And so we see as a result, different deficits the patient has. The patient may be able to look at you and talk and make sense but may be paralyzed on one side and can’t move it. Another patient might not be able to speak, but he might be able to get up and walk.”
Occupational therapy requires the patient to engage in daily tasks such as washing their face, brushing their teeth, bathing, and dressing – over and over again. This will give the physiatrist a good sense of just how far they will be able to recover the skills affected by stroke or injury.
“Each person is individualized in what we are seeing and what we can accomplish with them, and so the key is repetition, doing the same thing over, re-training the brain, to get back what’s lost,” Hargett says. “And what you’re seeing is, the part of the brain where you’ve had the stroke and the damage completely done, you also have surrounding those cells, damaged cells that are going to recover.”
The physical/occupational therapist supplies special utensils for the patients to use during rehab, which will assist them as they regain their ability to clothe themselves, eat, and perform other routine tasks. And some patients may need anti-spasm medications that will help relieve tight muscles and facilitate full movement, Hargett adds.
Patients who have suffered major injuries may require having one or more extremities amputated. This, of course, makes rehabilitation more difficult and lengthy, but according to Hargett, innovations in technology have improved long-term prognoses for amputees, and many of them who have legs amputated below the knee can regain near-full function and mobility.
Once a person does have an extremity amputated, Hargett will consult with a prosthetist (maker of prosthetic limbs) to determine just what sort of prosthesis will be required. The person will measure the patient at the point of attachment, and then make a prosthesis designed specifically for the patient’s anatomy. After that, Hargett will create an individualized rehabilitation program that gradually teaches the patient to learn how to accomplish daily tasks with a new artificial limb. Different prostheses will be ordered for patients at different age levels and with different needs – senior citizens vs. athletes, for example.
“It’s a very traumatic event, if you can imagine your extremity being gone, and you have to live with that for the rest of your life,” Hargett says. “Initially what we’re involved to do is to teach a person how to take care of themselves now that that body part is gone. And the bigger the body part, the more it takes.”
