At the “Y” with Mary- One Daughter’s Story of Taking Care of Her Mom

Story by: Polly Esther MacKay

stroke recovery patient story brooks rehabilitationIn 1998, my Mom, Mary Lea McGoogan, retired from teaching with a lot of reservation after my father had suffered a massive stroke in 1992. For six years she continued to be an excellent administrator and mentor to some of the most needy children in the Washington D.C. area with a smile everyday. Then came home to continue being a caregiver to my Dad, who at age 58, had become completely dependent on her.

pollys post about her mom mary brooks stroke recovery

For 13 awesome years my parents enjoyed retirement in North Myrtle Beach, South Carolina as best they could. Mom was and still is an awesome caregiver. She was the first to say let’s focus on your Dad’s abilities not disabilities. So that meant trips to Florida, Alaska, Mexico, the Caribbean, and the list goes on. The focus of my Mom’s world was retraining and caring for my Dad.

stroke recovery patient story brooks rehabilitationIn 2010, after a lifetime of giving to others, my Mom began to have heart problems which sadly led to a pacemaker and complications from a stroke. After three very big scares in North Myrtle Beach, it became apparent it was time for us to take care of Mom instead of her taking care of everyone else.

We transferred her stroke rehabilitation to Brooks Rehabilitation in St. Augustine. She had intense rehabilitation: occupational, physical, and speech therapy. What a blessing to have the outpatient center in St. Augustine. She was having so much fun and making progress that she didn’t want to “graduate”. Slowly but surely Mom graduated from speech, then physical and occupational therapies. Her therapist Becky Ellis mentioned they had a stroke wellness program at the St. Augustine YMCA. We were a little on the fence because of Mom’s unsteady gate but boy am I glad we went.

The Brooks Stroke Wellness Program at the YMCA has helped Mom both physically and emotionally. She has new friends in her fellow stroke survivors as well as a bond with the staff and the interns. I must say, for myself as a caregiver for both of my parents, it is great that the caregivers, spouses and families have a place to gather and be themselves. The bond I have developed with this group is truly amazing since we all come from such diverse backgrounds.

stroke recovery patient story brooks rehabilitationI guess I am a true representative of the sandwich generation. I am a wife, a mother of two boys and a daughter of two wonderful parents with amazing abilities not disabilities. I am also a small business owner. The Brooks Stroke Wellness Program at the YMCA has made a difference in my life and the life of my parents. Brooks Rehabilitation has truly been and continues to be a blessing in our lives.

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Important Things to Consider When Your Loved One Wants to Drive Again

Author: Peggy Gannon

As a mother of 2 teenagers (15 year old boy, 17 year old girl) and a 21 year old young man, I think I have all the anxiety of teaching someone how to drive wrapped up.  I have experienced the male mentality and the oh so different female mentality on their approach to driving.  I have found that regardless of which child is behind the wheel, when it comes to my kids, my patience in the passenger seat is 0%.  Every accident that could possibly happen plays out in my head.  My eyes are constantly darting around and I am asking them, “Did you see that car?” or “Slow down, you’re pulling up too fast.”  By the end of the drive, we are both tired and irritated with each other.  Not a very good experience any way you look at it.

brooks rehab drivers rehabilitation stroke rehabOn the other hand, when I am with a patient/client, I find my patience level is about 99% (we all have our moments) and I can explain, cue, prod and try to get the very best out of them.  You may ask, well, what is the difference?  Why aren’t you the same every time?  In a nutshell—they aren’t mine.  Because they are not my own children, I can separate my feelings and put on the therapist hat…the one that lets me be calm, cool and collected when needed.

How does this apply to you, your family and driving after a stroke?  To me, it is the key factor!  They are yours and no matter what, there is a level of anxiety, emotion and caring that comes into it.  You have seen them from the moment they had the stroke and can recall every struggle and uncertainty that they have experienced.  Sometimes it is hard to get past that.  For example, when I speak at the inpatient Stroke Education group, I usually ask the patients who was driving prior to the stroke and who wants to return to it.  I’d say 95% of the hands go up, regardless of how serious the stroke may have been.  As their hands go up, so does the look of astonishment on the faces of the family members present.  In their minds many are thinking: you can barely walk, how can you drive?  What I try to present to them is that driving is not something they will be doing tomorrow—but it can be a future goal.

The following are a few tips and hints to help you navigate when your loved one wants to return to driving.  Hopefully it gives you some help.

drivers rehabilitation stroke brooks rehabilitation

  • Make sure your loved one completes all of their therapy.  Many people either stop or may have difficulties getting to their therapy.  As hard as it may be sometimes, it is important that the person who has had the stroke gets what has been recommended.
  • Ask their therapist for input.  Most people will get physical, occupational and or speech/cognitive therapy.  Their therapist can help identify areas that need to improve that may affect driving skills.  More than likely they have been given a home exercise program to assist in recovery.  Encourage them to be diligent in completing this.  Help them tie in how their therapy is helping them to return to driving.drivers rehab brooks rehabilitation stroke
  • Be supportive, but realistic.  If they aren’t able to walk or manage independently, they probably shouldn’t be driving.  If they aren’t able to stay home alone, they shouldn’t be driving.  Gently point out areas of concern.  If they see you as the “bad guy”, enlist the help of a therapist.
  • Get their vision checked if needed.  Sometimes there are vision changes or people become light sensitive following a stroke.  They may benefit from new glasses or sunglasses.  I can’t tell you how many times I hear from the patient that they were going to have their eyes checked and then they had the stroke.  Have any eye surgeries done prior to thinking about driving.  Their vision needs to be at their best.  If they did have changes in their peripheral vision following the stroke, it is very important to have this assessed and for them to be cleared from a legal standpoint.  Florida has specific laws in regards to the degrees of peripheral vision that a person must have in order to be able to drive.
  • Allow them to be a front seat driver!  Pretend they are the driver and have them tell you what is going on.  This can let them see if they are catching everything and get out of being in the “passenger” mode.
  • Know the laws regarding seizures and driving.  Not everyone has a seizure, but it is not completely uncommon.  In Florida, the law states that a person is not allowed to drive until they are 6 months seizure free.  Your physician can also advise on this.
  • When you feel it is time to drive, TALK TO THEIR PHYSICIAN.  In order to return to driving, the patient needs to consult his or her physician and get “permission”.  I highly advise that the physician be one that has been involved in the client’s care and who has a good understanding of how strokes affect people.  If they have a physiatrist (rehab physician), a neurologist, or PCP who is well versed, that would be a good starting point.  Many patients feel that they can just resume driving, but truly, in most medical records it is stated that they should not return to driving unless cleared by their physician.
  • If the physician is uncomfortable releasing them, or if you have questions yourself, a Driving Evaluation can be completed at Brooks.  This is a comprehensive 3 hour evaluation that looks at cognitive and physical capabilities as well as their driving skills.  It may be that the person needs the vehicle modified or specialized training.  This can be identified at the evaluation.  The driving evaluation is a self pay item and not covered by insurance, however, is it truly identifies if someone should return to driving and if any problem areas exist.
  • Driving is one of those things we learn and never want to give up.  If you believe, however, that your loved one is not capable and there is no reasoning with them, you can anonymously report them to the State (Florida).  There are online forms that can be completed and submitted.  You must sign your name, but that person will not know it was you and they will not give them that information even if they ask.

More resources:

I hope these tips are helpful to you.  I do believe it can be too soon to return to driving, but I don’t think it is ever too late to try.  Everyone has to have a dream, a goal, a carrot that keeps them going.  I can tell you it is the sweetest feeling to be sitting next to someone who has not driven in months (or even years) and it is their first time back behind the wheel.  Their joy makes your day.

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Exercise After Stroke

Author: Julie Schafer

Hello! After completing formal physical therapy, have you wondered if it is important to keep exercising for months or even years after a stroke? The answer is YES!!! (I am sure you have heard this once or twice from your inpatient or outpatient therapist!)

I am here to share the benefits of maintaining, and possibly even starting, an exercise program during stroke recovery.  I’ve also included resources to exercise at home or with a group at a local fitness facility.

With a background in Exercise Science, I am an absolute advocate of regular exercise, not only because it helps release endorphins (the neurotransmitters that make you feel great!) and makes you feel healthier but it has the power to transform your health by strengthening muscles, reducing blood pressure and cholesterol, and combating depression. We know from recent research that your body will heal and continue to make changes over the next several months and even years after a stroke. That recovery can be affected by many factors. One way to increase recovery is regular exercise. Adults should get a minimum of 30 to 60 minutes of exercise 3 times per week to maximize health.

I get very excited when a new stroke survivor begins a regular exercise program because I see firsthand how much the physical activity strengthens weak muscles, makes activities of daily living easier, and encourages the heart (physically and emotionally)! But consistency is key!!

exercise after stroke treadmill brooks rehabilitation

exercise after stroke workout with clubhouse brooks rehabilitation

After a stroke, many experience weakness, fatigue, and muscle spasticity.

Bodily changes after a stroke:
• Muscles get smaller and weaker
• Endurance decreases
• Metabolism slows
• Blood flow decreases on your affected side

Many of the changes after a stroke can be improved with regular physical activity. I often like to use analogies of how our bodies are similar to automobiles. We need to keep using our body and make sure it doesn’t sit too long. Think about it,  how does your car sound and feel when you try to start it up after it has been sitting for a long time? The same thing happens to our body when we are not active!

There are three types of exercise you should try to incorporate into your routine:
• Cardiovascular exercise (walking, biking, swimming, upper arm bike)
• Muscular strengthening exercise
• Flexibility/stretching exercise

Your physical therapist does such a great job getting you home, but it is up to you to adopt exercise (including cardiovascular, strengthening, and flexibility/stretching) as a regular part of your life! Remember the motto: “Use it or Lose it?” There are many options for exercise, including a group walk or aquatic exercise!

exercise after stroke aquatic therapy brooks rehabilitation
exercise after stroke challenge mile and brooks rehabilitation

So you may be wondering….how do I get started or keep active after a stroke?
Here are a few resources, including Brooks’ very own Stroke Wellness Program, offered in partnership with the YMCA’s of Florida to help guide you to becoming more physically active. Be sure to always consult with your physician to be cleared for general exercise, and save the at-home exercises your therapist gives you!

Exercise at home with a visual guide

• Participate in the Stroke Wellness Program, or visit your local YMCA or fitness facility for a similar program.

• Association/American Heart Association- Exercising After a Stroke

What is your favorite exercise?

tips exercise following a stroke brooks rehabilitation

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Brain Games For Stroke Rehabilitation Part II

Author- Kathy Martin, Brooks Clubhouse Manager

Hello again.  I want to follow up on a previous post I made about fun cognitive activities .  Who knew there would be so many fun ways to challenge our brain and have fun with our friends and/or family? Here are more games that help with brain (cognitive) function.

  • Scrabble – helps with visual scanning; word retrieval; math calculation (scoring), sequencing; and cognitive flexibility. Possible modifications include using a dictionary as an external aid, eliminating double and triple scoring, or adding a time limit to increase difficulty.  Not only is this something that helps your brain, it can also be a source of team building and friendship. See some of our Brooks Clubhouse members enjoying a game in the photo below.Scrabble brooks rehabilitation cognitive games
  • Scrabble Sentence Cubes – can help with sequencing, reading, planning, cognitive flexibility, turn taking, and interaction. Possible modifications include eliminating the bonus points or have the participant play against themself.
  • Scruples -aids in decision making, perspective taking, abstract thinking, and awareness of others. To make this game a little easier, participants can omit challenges to responses, work as team, and use questions without predictions in more of a social interaction format.
  • Simon – helps increase attention; sequencing; and memory. Possible modifications to make the game a litle easier include rehearsing before responding or working as a team.
  • Slapjack – this action packed card game can help with attention/vigilance, impulse control, speed of information processing and visual discrimination. Possible modifications to reduce complexity is to rehearse before responding or work as a team.
  • Trivial Pursuit – this fun trivia game can help remote memory and reading. Possible modifications to help make this complex trivia game a little easier include forming teams, providing clues, and awarding a “pie” for any correct answer.
  • UNO – this game, usually played as a child, is great for adults too.  UNO helps with attention and vigilance, divided attention, visual discrimination, and low-level decision making. Possible modifications to help make this a bit easier include omitting the “UNO” rule, omitting wild cards, and focusing on colors alone before adding number and verbal prompts.  This competitive yet friendly game is enjoyed by some of our Brooks Clubhouse members below.uno cognitive games brooks rehabilitation stroke
  • Whatzit – helps with abstract thinking and cognitive flexibility. Possible modifications to help make the game easier include selecting simpler cards for play and providing a list of possible relationships between words.
  • Who Dun It? – is a game that helps with reasoning, cognitive flexibility, memory, attention, and use of external aids. Possible modifications include providing additional forms for recording information or working in teams.
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Stroke Awareness Month an Inspiration

Stroke Awareness Month has come and gone.  But the need for awareness and recovery continues.

If you haven’t had a chance to see our “Faces of Stroke” Campaign, please take the time to do so.  The campaign features 8 stroke survivors of different backgrounds, ages, and races to illustrate that a stroke does not discriminate.  Our month long campaign ended with a great event to honor our survivors.  It was an evening of fun, friendship, inspiration and song.

Stroke experts held a series of lunch and learn presentations throughout the month.  Presentations included: “My Life: Stroke Prevention” presented by Shirley Koehler, Ph.D.,ABPP, “Tell Me About Stroke” presented by Nathan Matthews, PTA  and “Power Foods for the Brain” presented by Kerrin Going, MS, RD LDN.

stroke expert brooks rehabilitation prevention shirley koehler

On Wednesday May 29th, members of the Stroke Wellness and Brain Injury Wellness Programs gathered to celebrate the anniversary of both programs, along with Brooks’ partner organization, the First Coast YMCA.   Dr. Richard Bultman, Stroke Wellness Program participant and a family physician in Orange Park, spoke to the crowd.  

On the last day of Stroke Awareness Month, the Brooks Rehabilitation Hospital Stroke Team held a Strike Against Stroke.  Walking through the halls chanting: “Strike Out Stroke,” “Do your part!  Take Care of your Heart!”

strike out stroke 031

Thank you to everyone who participated in Stroke Awareness Month!

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What Happens to Someone Who Has Had a Left Brain Stroke?

Author: Kathy Martin, Manager of the Brooks Clubhouse

Greetings from the Brooks Clubhouse.  With a lot of help and support from Brooks Rehabilitation we were able to open the Clubhouse in 2008 to help meet the long term recovery needs of individuals who had experienced (or suffered) from strokes and other types of brain injuries.

Clubhouse brochure pics 076When I was growing up, one of my friends had a father who had a stroke and I thought everyone who had a stroke was just like him. After having worked with hundreds of people who have had strokes or brain injuries (I have worked as a Cognitive Rehabilitation Therapist since 1984), I have learned that this is absolutely not the case. I know now that no two injuries, just like no two people, are exactly the same.  While many survivors have similar types of problems that result from having a stroke, each situation is a unique combination of the severity of the stroke, the type of stroke (blockage of a vessel vs. rupture of a vessel), the location in the brain of the stroke, and the pre-injury personality and intellect of a person.  I would like to share some things that I have come to learn about the general effects of a left hemisphere stroke and some suggestions on the best ways to help a survivor and encourage recovery.

It is important to know that the left side of the brain controls the right side of the body and the left hemisphere of the brain is the “language” center of the brain.  The left side of the brain:

  • Is responsible for many functions and behaviors including expressive and receptive language, right-sided body movement, the ability to solve problems, do math, read, write and spell. 
  • A stroke on the left side of the brain may:
    • cause changes in some or all areas of functioning including: communication, vision and touch, behavior, movement, memory, and general thinking skills.
    • effect receptive language; that is they may have trouble understanding speech, written words and/or gestures. For example, a person can hear what is said, but is unable to understand the message or a person cannot identify letters or understand written words.   
    • effect expressive language. A person with an expressive language problem may have trouble expressing themselves through speech, writing and/or gestures. For example, a person may know what he/she wants to say, but cannot get the words out verbally and cannot express thoughts into the written form. A person may say left when they mean right or yes when they mean no.  A person’s speech may be difficult to understand and they may have slurred speech, trouble pronouncing words correctly and/or a tendency to use words that do not make sense and appear to be made up (jargon).

Clubhouse brochure pics 162I would like to share an example of a person who has experienced a left brain stroke. Currently the Brooks Clubhouse has a member that had a left brain stroke.  For the sake on anonymity I will refer to him as J.W.  Twenty five years ago, J.W., now 57 years of age, was the victim of a random shooting.  He was on a pay phone in Jacksonville Beach and was shot in the throat.  He then had a subsequent stroke which disrupted blood flow to his left hemisphere.  His stroke was considered extremely severe and resulted in many problems with functioning.  For several years, J.W. was unable to communicate any of his thoughts and ideas.  J.W. reports that the only words he could say for over a year were “what cover”, which he thinks meant “What Happened?”  He underwent extensive inpatient and outpatient rehabilitation and even went to Michigan to attend a residential Aphasia treatment program.  He had no use of his right arm and leg, he was unable to walk, talk, read, write, calculate math problems, or take care of himself.  But J.W. was not a quitting kind of guy…he continued to do everything he could to recover from the stroke and he never gave up hope or effort.   He participated in as much therapy as his insurance would allow, followed all home exercise program recommendations for speech and physical therapy (and then some), he participated in research projects, and he slowly improved with the passing of each year. Since J.W. has been attending the Brooks Clubhouse (3 years now), he has seen more improvement in his recovery than ever before.  He attributes this (and research demonstrates it) to being immersed in a stimulating and social environment where he is constantly challenged to think, speak, listen and work.

If you met J.W. today, you would not believe how severe his deficits once were.  He is happy and healthy, lives independently in a very nice and well kept home, he drives, he has many friends, loves to go out dancing and ride his bike at the beach.  He is one of the most productive and active members of the Brooks Clubhouse.  Every day you can find him here, bright and early, cutting up with other members and working extremely hard in the kitchen to help plan, shop for, prepare, serve and clean-up our daily lunch at the Brooks Clubhouse.

Clubhouse brochure pics 048Although he still has notable difficulties with his expressive language; he frequently starts a conversation by saying “can’t talk”, but everyone reminds him that he never shuts up and he can almost always convey what he wants in some way.  J.W. is one of the most admired and well loved members at the Clubhouse.

Clubhouse brochure pics 225Some things to remember and keep in mind if someone you know has difficulty with expressive and/or receptive communication:

  • Just because someone can not speak their thoughts, they can still think.  Never treat them as if they are “stupid” or don’t know what is going on.
  • Just because someone can’t speak well does not mean they can not hear; it is not necessary to speak more loudly or yell.
  • Try to keep questions and comments fairly short and do not overload a person with rapid and detailed instruction/information.
  • Avoid rushing a person and  give them time to try and express themselves.
  • If a person has severe difficulty with expressive language, try to format questions as “yes or no” answers.
  • Remember to encourage a person about recovery and always treat them as an adult who has choices.
  • Remember recovery can last a life time and there is always the capacity for continued improvement.
  • The more active, productive and engaged a person is, the greater the potential for recovery.
  • Repetition can be good, good, good!

Do you know someone who experienced a stroke on the left side of their brain?  What types of difficulties did they have?

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The Lighthouse- Overcoming Post-Stroke Depression

Author- Melynda Rackley, stroke survivor and participant in Faces of Stroke campaign.

Never did I imagine that at the age of 23 I would learn my biggest life lesson.

Becoming a stroke survivor is now on my list of accomplishments. Learning how to walk again is my biggest victory. I can remember being at Brooks Rehabilitation Hospital and meeting my physical therapist, Megan Petrosky, for the first time. stroke recovery at Brooks Rehabilitation Melynda RackleyAs a kid, I was always amazed when I saw a lighthouse on TV. I never really understood their purpose until Megan became my lighthouse at Brooks. As a new mother, being away from my daughter was the hardest part of my recovery. The post-stroke depression was almost as disabling as the physical limitations I faced.

Being hungry for knowledge about strokes, I think I read every piece of literature I was given, but one of them mentioned post-stroke depression. Each day I struggled to get past the negative feelings, trying to deal with them alone. Somehow in the middle of my world of feelings I found the strength to focus on my recovery with the help of a very determined physical therapist. I remember my first attempt at walking again. I was afraid that I would fall because of my left side weakness. Paralyzed by my fear and weighed down with depression, I looked at Megan and all I could say was, “I don’t want to fall.” It was in that moment that she became my beacon of light. She looked at me and smiled and in a reassuring voice said “Don’t worry. I’m not going to let that happen. Just look up at me and let’s walk.” In that moment I found the strength within me to believe that I could walk. On the days that I seemed a little down, she would play music during our sessions. She played “Eye of the Tiger” for me and although I didn’t love the song, I found energy in her determination to help me reach my goal of walking.

stroke recovery at Brooks Rehabilitation Melynda Rackley faces of stroke

As time passed, I was able to cope with my situation better by focusing on the good even in the dark times. I focused on my accomplishments during the times when my depression would creep in, often being proud of my walking because I knew that my therapist believed in me. There is something inspiring about being able to look at someone who knew nothing about me but saw the fighter within me and believed in me. 

I walk and run now because of Megan’s guidance and watchful eye mixed with my stubborn determination. On April 6, 2013, I ran in a 5k and Megan was there each step of the way from start to finish.

stroke recovery at Brooks Rehabilitation Melynda Rackley faces of stroke

A lighthouse contains a beacon of light that helps to guide and/or warn ships at sea. Just like a lighthouse, Megan, along with the other staff at Brooks, helped me find my way through the fog of depression and overcome physical limitations. Some days are still a struggle, but I have learned to look for the light in each day and remember that I don’t have to fight depression alone. I smile often because now I can look into my daughter’s eyes and be the one to say “Don’t worry. I’m not going to let you fall. Just look up at me and let’s walk”.

-Melynda

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