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Rehab adventures


ken27

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I am making a list of rehabs that I attended to better understand the best approach to take after a stroke and hopefully help others. On September 25, 2008 I had a right side ischemic stroke which led to left side hypertension, hypercholesterolemia, and thalamic pain I was 43 years old in good shape and very athletic. Two days after the stroke I started PT which was the hardest thing I ever did in my life but I though to myself I will walk again and use my left side. Somehow with the help of a therapist and a four prong walker I got out of bed and slowly moved and made it two rooms down the hall then back into the room. Every movement was very difficult but with the help of my PT I did as much as I could and after I was as tired as I ever was in my life and experiencing pain that I never felt before. Every day I did as much PT as I could and made it a goal to walk to one further hospital door each day. The pain I was feeling was nerve pain, I have a pins and needles pain in my left hand and foot. Early on when I moved my joints on the left side I would experience pain and every little movement was extremely difficult. I had to think about every move and will that part of my body be able to move it is very hard to explain unless you have been through it before.

After I was discharged from the hospital I had PT and speech therapy at home 3X a week. Here we worked on getting in and out of a chair and get up from the floor. I was in good shape before the stroke which helps me tremendously in my rehab because I could use my right side to get in the proper positions to better my rehab. We worked on a walking course inside the house using my four prong walker and doing a little more each time. My PT would have me sit in a chair and have me toss and catch a soft ball he thought of all kinds of exercises and my attitude was always the more I do the better with my weak side. My speech therapist had me say the abc’s then concentrate on the letters that I had trouble with, then I would read sections of the paper too her. After two months I graduated to a walking cane, and then was given the ok to go to outpatient rehab at the same hospital I was discharged from.

I went to physical, occupational and speech therapy as an out patent three days a week. At PT I learned all kind of stretching and physical exercises; at OT I tried to use my left hand as much as possible. At speech therapy I would read out loud and concentrate on proper use of the English language. I knew all my therapists were trying to help me so I did the best that I could and did not complain because there were many patents there in a lot worst shape then I. After two months of therapy my occupational therapist asked me if I would like to take a driver evaluation course. The driver evaluation course was two parts a reaction eye test and a driving test; to get ready I would take practice rides around the hospital with the instructor. The reaction test was a stimulated test, they had a gas and break pedal and steering wheel, I looked into the stimulator and when it was green you would drive and red you would stop. The stimulator would tell the instructor the reaction time between accelerating and breaking and the instructor would keep tract of the results and rate them against the national average, which I did pass. I took the driving test next, I was off the road for nine months and besides the stroke this was the hardest thing I had to do, I thought about it day and night. I cannot tell you what a relief it was to pass the driving test but I can sum it up in one word freedom. After another month of rehab I was discharged at the time I did not know it but it was because of insurance limits.

My left side was still very weak, I could move my hand and arm some and I was walking with a cane but my gait was way off I was stumbling more than walking. Every day I would exercise using my discharge plan and sum light weights and a rubber ball for my hand. I felt like I was discharged to early from rehab so I did some research on the internet and with the help of my secondary insurance from the job I held before my stroke I signed up for PT at the closes place to my house. The first day I was looked at by the PT instructor and put through different workouts on weight machines. I did this for four months then was discharged, I only talked to the PT instructor that first day the other days I worked out by myself and was asked once in awhile how are you doing. There was a gym not too far away that I joined after this where I could ride a bike, do some light weight lifting, stretch and explore some new ways of improving. I worked out at the gym for two years doing different exercises, I stared mostly riding the bike a little more each day till I got up to 30 minutes, then I increased the resistance or try a different routine on the bike. This help my endurance and balance which resulted in me being a lot less tired and I slept a lot better at night. I started to use the different weight machines they have to build up the strength in my left side, and then I would do one hour of weight training and an hour of endurance on the bike, elliptical and treadmill.

I did a lot of research on the internet and found that there was a top rated stroke hospital in my area. I called the hospital and asked about rehab and got a number. I called the rehab and found out they were no opened spots for rehab at this time so I had them keep my number to call me when there was an opening. It was October so I wanted to use my insurance before the end of the year so I called a different rehab facility and sighed up for PT. This place was very nice I met my PT instructor and we went over a routine step by step using pull rubber pull cords and some of the newest equipment available. We worked on balance and using my left arm and hand more. This was good PT but again I would call it general PT which handles people with all types of injuries and disabilities.

At the gym I go to there is a trainer who was a wounded warrior reconditioning instructor in the United States Marine Corps. I took 12 lessons from him that where very helpful, he knows how to work people who are disabled and I still use a lot of the things that he showed me. There are rowing machines at the gym and hanging bands that you can use to stretch your upper body that he showed me how to use and I use them weekly. He showed me a lot of different way to uses light weights to strengthen my weak left side and maintain balance it was well worth the money to train with him. I had one training section left with Pete the Marine when I received a call from the therapy service from the certified stroke center.

The hospital is called Gates Vascular institute and Gates is a certified stroke center and only 1% of hospitals in the US have that distinction. I waited over a year to get into therapy at gates because the hospital was being moved, it is brand new, and patients from the hospital have first dibs at therapy. The wait was well worth it because this by far is the best therapy I ever had. There are four therapist at Gates who only deal with stroke patients and there are all kinds of devices that they use, some handmade that help stroke survivors. On my first day my PT Judy evaluated me, stretch my arm and legs, watch me walk and she knew right away what was wrong with me. Judy told me that I was plenty strong and did not need weight training but that my walk was way off. My left leg was swinging out like a half circle and I was landing only the outer part of my foot. I was not bending my left knee mush which led to a very stiff left leg that swung in a half circle and using only half my foot to walk and not bending my knee. My posture was also off which led to the right side of my lower back and right knee to hurt because of my bad walking and standing form. My torso on the left side was also very stiff as well as my left arm and shoulder and I thought I was in good shape. Judy first asked me about what happened to me, my passed therapy, if I had any pain, spasticity or tightness and if I had a support system at home. I told Judy I had went back to school and have been working part time for two years and had plenty of support from family and friends. She helped me stretch my arms, legs and shook my muscles to help them relax. She hand me stand and showed me proper posture with shoulders square with the inner thigh and inner feet. If you draw an imaginary line your shoulder blade will line up with your inner thigh, knee and inner ankle. Every PT class is one on one and Judy gives me homework to improve and reinforce what was done that week. One is to slide instead of walking do not let your feet leave the ground almost like ice skating. She told me to slide frontward, backward and sideways in my socks and to use the kitchen counter for support if needed. Judy told me to imagine my shoulders and knees are head lights and to keep them straight when stand and doing different exercises. We are working on making my left leg and midsection stronger without weights, one way is to stand with my right foot in front of my left and stand on your toes with your right foot this puts more weight on the left foot. Another way is to elevate your right foot on a step or crate and keep your left foot on the ground the higher you keep your good foot the more weight the bad foot was. These exercises are all designed to make my left leg stronger and use muscles that I have not used before the stroke. Judy is teaching me the science of walking; she shows me very slowly and in great detail the way to step correctly. As of today I am feeling muscles in my left leg that I have not felt since the stroke and I am slowly stepping with my left leg correctly. Judy also told me to sit and swing my left back and forth slowly and steadily so my knee gets use to moving. I have not used a single weight throughout rehab but I am still very sore (in a good way) the next couple days after rehab. I am slowly learning to walk the correct way and it is not easy but it sure does feel good to know I am getting by far the best rehab I ever had.

Throughout this whole rehabbing process I felt that I was discharged from rehab as an outpatient because of insurance limitations. This was at the hospital I went to for my stroke. I was discharged hardly able to walk with no course of action for my future; I did not know what to do next. I think this happens way too much to stroke survivors, luckily for me I could drive, went to the gym and worked out on my own and went to more rehab. At the time of my stroke we went to the closes hospital around the care was good but I was told at rehab one day that this would be my last time and that was it. They did not sit me down and go over any plan or give me any take home material for rehabbing on my own. I was lucky that my OT therapist ran the driver training or I would have never now about that. My therapists were all great but I believe their bosses told them Kens insurance is done he must be discharged and that is it. Today I am going to the best therapy I ever had and with the new decision that expands Medicare coverage for long term disabilities things are looking better. I would encourage all survivors to ask there therapists on a plan of rehab before they are discharged form therapy. I hope my rehab adventures help others, I will keep updating my rehab and I will post the landmark decision that boosts Medicare coverage.

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Ken, you had, for a long time, persevered by yourself , doing the best you could so at least you kept yourself strong. That made it easier when you found Gates and much better PT than you had done before. Reading here I do so wish my dear Ray had found something similar. Here in Australia they often discharge without a follow-up plan and you are discharged simply because they have done six or eight weeks and that is your limit. It is a cruel system.

 

Keep on working out and getting as much improvement as you can. It is hard to unlearn old habits though so you do have to be 100% alert when you walk and do it "their way". Thank you for the detailed information you have provided here. I am sure others will be able to learn from it.

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Ken, Please keep us updated. It does take a lot of work and perserverance to get good therapy. I am very glad for you. I am trying out a new rehab place for my husband. We will see tomorrow. Ruth

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