Thursday, February 2, 2012

Stroke Recovery: One Myth, Two MDs

Assume no plateau.

Time and time again, the idea of a plateau in post-stroke recovery has been refuted, both in research and anecdotally. It is the responsibility of the therapist to let the patient know that the culmination of therapy this is not the beginning of the end, but the end of the beginning. The patient's rehabilitative efforts after discharge can be confusing, frustrating and not always entirely fruitful. But motivated patients can make gains if they are willing to try new ideas, adapt and research new techniques.

 Know the role of the physiatrist and neurologist.

I've asked physiatrists how often they suggest that their patients should schedule an appointment with them, once they've been discharged from therapies. Their answers tend to be all over the place. "If there is a change in function," or "If the patient is having an issue with meds," or "Once a year." But when a typical patient with stroke, who is perhaps five years post-stroke, is asked, "Who is your physiatrist?" the usual answer is, "I don't have any problems with my feet."

The fact is that patients with stroke often lose touch with their physiatrists because many don't see the need for a doctor who directed their acute rehabilitation. They know they've "plateaued"—so why would they need the "stroke doctor" (as physiatrists and neurologists are often called)? But there are good reasons to reintroduce yourself to your physiatrist. Only physiatrists and neurologists are trained to measure nuanced change, know about the latest applicable medications, and understand the true breadth of rehabilitative care as it relates to patients with stroke.


oc1dean said...

My original doctor who directed my rehabilitation did absolutely nothing other than write ET(Evaluate and Treat) on prescriptions to PT, OT and ST. I don't think he knew anything, as evidenced by his non-response to my showing him an article on the Saebo-flex.
Maybe that's way I'm a fanatic on stroke knowledge.
I will never go back to him and a second one I visited told me about de-myelination was the reason motor functions would not recover.

Peter G Levine said...

My point is that physiatry always has new tools and most survivors never go back. The ones who know about stroke rehab are a bit rare, but they're there.

Mike said...

Everytime I visit my neuro, therapists and physiatrist,I end up knowing my opinions are most of the time correct and up-to-date.

Peter G Levine said...
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Peter G Levine said...
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Peter G Levine said...

Mike: Your opinions are probably right. Well informed survivors know more than therapists (on average. Although there are therapists-pockets here and there- that blow me away with what they know and how they use different recovery options in tandem). I see clinicians as tools: you tell them what you want and they provide the expertise to get 'er done. You could say "I want a dorsal root rizotomy because I can't stand the spasticity and pain." But you can't do it on yourself: you need a neurosurgeon and neurologist or physiatrist.

Mike said...

For a long time I was at the rehab but the clinicians has no idea how to make me walk on the treadmill without inverting my foot.It took a bunch of university PT professor/ reseaechers to figure out how to make the locomotor training work for me.The team of Dr.Behrmann,Dr.Rose and Dr Miller and their students were able to make me walk.Therapists at the rehab could not believe what they saw when I walked at the rehab sans my afo.At the hand of the experts, spasticity is nothing.That was my first evidence that neuroplastic beats spastic.To see & feel it is to believe.Now I'm a big fan of neuroplasticity.

Elizabeth, John and Jack said...

Finding doctors that know anything and actually care is like pulling teeth...worse I think. I've seen probably 12 doctors since my problems started 3 were keepers. I'm still looking for a good neurologist, and probably should be looking for a physiatrist. I too thought I was done with him. I still have a few minor physical problems, I thought I just had to live with them...maybe not?

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