Wednesday, May 26, 2010

Pizza And Therapy: So Much In Common

Some stroke survivors end up frustrated when therapies end. Generally stroke survivors want more therapy. And there's a reason for this.

Let me explain it this way: I have a friend, a food scientist. His job is to make food so desirable, so delicious and so irresistible that you never want to stop buying it. He was a very funny guy, my friend. So please don't misunderstand; this was a joke. One day he said, "I've been thinking about developing a food, maybe pizza, and having in the sauce, pot. Then when people finish eating the pizza they'd get the munchies and buy more pizza."

Therapy is very pot-like. At the point at which stroke survivors "plateau" therapies have to end. So the stroke survivor attempts to scratch and claw their way back into therapy.
The calculus made by stroke survivors is simple:

therapist = recovery.

Understand, therapist have to discharge patients after the first plateau. This is the rule. It is a rule concocted by insurance companies and the Prospective Payment System, part of the balanced budget act. "Balanced budget act."
How quaint!

The rule says, paraphrased, "As soon as a stroke survivor plateaus they must be discharged." The thinking is "Why is this person still in therapy if they're making little if any progress?" But recovery is really about multiple plateaus, that happen for many years to come.

The first plateau is formed by two forces. One force is the fact that therapists have a limited set of tools, and they're under pressure to get people safe, able to live their lives, and out the door. The other force is neurological. The neurons that were "stunned" after the stroke have all come back online. This usually happens during subacute
-->phase – the first 3 to 6 months after stroke. As these neurons come back online recovery is relatively "easy".

The end of the "easy" part hearkens the "chronic" era of post-stroke life. At this point the stroke survivor is essentially on their own.
During this period you can still make progress, and much of that progress has to be made without a therapist. The stroke survivor should have a good strong plan when they are discharged from therapies. Once that plan has run its course and a second plateau kicks in, the stroke survivor should go back to therapist looking for the next plan, to take them to the next plateau.

Recovery is a series of plateaus. And every once in a while you need someone to throw you a rope.


Monday, May 10, 2010


I get so many questions about stroke recovery from survivors and caregivers and therapists. Many of the questions are sad. Survivors and their loved-ones often contact me when they don't have any resources providing direction towards further recovery.

I could probably write a book of questions and answers I get.

Instead, I wrote an article.


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