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TIRR MEMORIAL HERMANN STROKE PROGRAM A © Copyrighted by Memorial Hermann Health System ABOUT THE COVER Barry Oakes Makes a Comeback On Sept. 18, 2010, 49-year-old Barry Oakes collapsed in his home while walking to the bathroom in the middle of the night. Awakened by a pounding on the wall, his wife, Nicole, called 9-1-1. An EMS team rushed him to Christus St. Catherine Hospital in Katy, Texas, where doctors diagnosed a massive ischemic stroke and administered tPA. Oakes quickly regained his speech and was transported by air ambulance to St. Luke’s Episcopal Hospital in the Texas Medical Center for observation. “I met him in intensive care with a change of clothes and sneakers, assuming the worst was over,” his wife recalls. “But by the time I arrived, his speech had begun to slur again.” The stroke left him with a large basilar artery thrombosis in the brainstem, which is associated with a very poor prognosis. Oakes was in surgery for three hours. He spent over a week in intensive care battling pneumonia while his care team worked to reduce swelling in his brain. “Barry could move his head and feet a little, blink his eyes and squeeze my hand every so often,” Nicole Oakes says. “He was in and out of consciousness and on a ventilator. The doctors told me we had a long road ahead and advised me not to expect too much. They could tell Barry was a fighter and encouraged me to be patient. Ultimately, they said the first three months would be critical in determining the prospects for and extent of his recovery.” A week after the stroke, Nicole learned she was pregnant. Although Oakes could barely move, his cognitive ability was unimpaired. Once he could hold a marker, he communicated using a white board. In October, he transitioned from St. Luke’s to a local long-term care facility, where he worked with physical, occupational and speech therapists several hours daily. In the evenings, he and Nicole continued the work together. “Our goal was always to get to TIRR Memorial Hermann,” Nicole says. “We were unfamiliar with the name, but family, friends and doctors at St. Luke’s described it as the place where miracles happen.” Oakes was admitted to the rehabilitation hospital on Nov. 2, 2010, under the care of attending physiatrist Luz Tastard, M.D. Oakes remembers his first day at TIRR Memorial Hermann, “They start by asking you what your goals are. I’m a very goal-oriented person, so this approach worked well for me. We had moved into a new home just two weeks before my stroke. One of my goals was to be able to walk upstairs to the media room. So on my first day of physical therapy, my therapist said, ‘Okay, let’s go climb some stairs.’” With assistance, he climbed 10 steps, and never looked back. Oakes left the hospital with a wheelchair and a walker, but he never again used the wheelchair. “We’re forever indebted to the dedication of the staff at TIRR Memorial Hermann. You very quickly get the feeling that you’re part of a big family,” says his wife. In June 2011, Oakes returned to work fulltime at ConocoPhillips, where he manages the Unites States refinery supply. Today, he leads conference calls and travels at least once a month for business. In his free time, he works out at the gym, jogs, plays golf and spends time with his wife, his two sons, Sean and Ryan, and his new twin daughters, Stella and Maddie, who were born May 12, 2011. In March 2012, he finished the Memorial Hermann Sugar Land half marathon. ABOUT TIRR MEMORIAL HERMANN A 134-bed not-for-profit rehabilitation hospital, TIRR Memorial Hermann has been named one of “America’s Best Hospitals” by U.S.News & World Report each year since the survey began in 1990. TIRR Memorial Hermann provides rehabilitation services for adults and adolescents with spinal cord injuries, brain injuries, stroke, amputations, neuromuscular disorders and multiple trauma. In May 2006, TIRR Memorial Hermann joined the Memorial Hermann Health System, a not-for-profit community-owned system dedicated to providing high-quality services to improve the health of Southeast Texans. This manual is dedicated to the patients and caregivers who inspire us every day. WELCOME TO TIRR MEMORIAL HERMANN On behalf of all the staff, I would like to welcome you to TIRR Memorial Hermann. Our dedicated team of affiliated doctors, nurses, therapists, psychologists, social workers and case managers has a combined experience that rivals any rehabilitation hospital in the world. TIRR Memorial Hermann has consistently been ranked as one of the top rehabilitation hospitals in the country for many years, an accomplishment that is only possible because of the clinical expertise of our staff combined with the passion and commitment to provide exceptional care for each of our patients. This manual was prepared to help you and your family become familiar with the Stroke Program at TIRR Memorial Hermann. Patient and family education is one of the most important parts of a successful rehabilitation program. Our goal is to help you understand the medical issues and therapy needs following a stroke, and much of this education involves a “hands-on” approach. Our goal is to help you and your family learn the skills and gain the confidence to discharge home safely. The majority of patients are able to discharge home with their families around three weeks after admission and then continue a treatment program as an outpatient. Because of this short time frame, we will start working with you and your family right away to learn about the community resources and insurance benefits that will help you continue your rehabilitation as an outpatient. As we work with you to overcome obstacles and learn new skills, we remember the words of rehabilitation pioneer Howard Rusk: “Medicine adds years to life, and rehabilitation adds life to years.” We look forward to working with you to achieve your rehabilitation goals and a successful reintegration into the community. Please let us know how we can help you and your family during your stay with us. With warm regards, MONICA VERDUZCO-GUTIERREZ, M.D. Clinical Chief of the Brain Injury and Stroke Program Clinical Co-Director, Outpatient Medical Clinic at TIRR Memorial Hermann Assistant Professor, Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth TABLE OF CONTENTS Chapter Subject Page 1 History and Mission of TIRR Memorial Hermann ......................... 1 2 The Stroke Program Philosophy and Continuum of Care .............. 3 3 Introduction to the Stroke Program ............................................. 5 4 The Brain .................................................................................... 9 5 Types of Stroke and Stroke Recovery ........................................ 14 6 Health and Medical Effects of Stroke ........................................ 18 7 Medications and Stroke Rehabilitation ...................................... 29 8 Urinary System ......................................................................... 40 9 Bowel Management .................................................................. 46 10 Diet and Nutrition ..................................................................... 52 11 Cognition and Communication .................................................. 54 12 Emotional and Behavioral Problems After Brain Injury ............... 56 13 Mobility and Equipment ............................................................ 62 14 Recovery After Stroke ............................................................... 68 15 Secondary Stroke Prevention .................................................... 69 16 Caregiver Support ..................................................................... 71 17 Discharge ................................................................................. 75 18 Resources ................................................................................ 79 19 Glossary ................................................................................... 81 HISTORY AND MISSION OF TIRR MEMORIAL HERMANN Chapter 1 TIRR (The Institute for Rehabilitation and Research) was founded by William A. Spencer, M.D., in 1959. Previously, TIRR was known as the Southwestern Poliomyelitis Respiratory Center in Houston, one of the first polio treatment centers in the United States. Dr. Spencer’s efforts in treating polio survivors led to William A. Spencer, M.D. the donation of funds for a not-for-profit hospital in the Founder Texas Medical Center. Originally named Texas Institute for Rehabilitation and Research, the hospital later “The purpose of rehabilitation is to protect the became The Institute for Rehabilitation and Research. individuality of the person facing disability and to The knowledge and skills that Dr. Spencer gained while provide opportunities to pursue goals, expectations treating polio survivors became the foundation for and dreams that are important to that individual. treatment of patients with a broad range of disabilities That’s what makes you a person. Having some control caused by illness and injury. Dr. Spencer believed in over your existence is a basic human right. My vision helping people become as independent as possible was guided by how much people could do in spite of and achieve the best possible quality of life. His tremendous losses. commitment to treatment, research, education and the community continues to be the guiding force at TIRR In reflecting on what rehabilitation should be Memorial Hermann and can be seen daily in the work today, I don’t think the key areas are any different.
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