Optimizing Poststroke Recovery for Patients Through Use of Comprehensive Care Teams

Stroke is a leading cause of serious, long-term disability for patients which can impact them physically, emotionally, socially, and financially during their recovery. According to a previous research paper published in the Journal of Multidisciplinary Healthcare, the application of the stroke care unit in hospitals has reshaped the landscape of care for poststroke patients.¹ The stoke care team encompasses medical professionals collaborating to bring their knowledge and skills to benefit patients to significantly have an effective recovery. Therefore, research demonstrates that a multidisciplinary team is essential to deliver quality care for patients.

In many of these patients, spasticity is common which can cause muscle tightness and prevent individuals in their life from completing simple tasks. Prior additional research revealed that poststroke patients with spasticity usually require long lasting care and interventions yet reported limited outpatient and community treatment available.² Thus, research displays that poststroke management such as rehabilitation and spasticity care services are important for effective recovery but access to this care is still an unmet need for these patients.

In a recent conversation with NeurologyLive®, Harmony Sierens, MD, a physiatrist and medical director at Ascension Genesys Inpatient Rehab Unit, talked about how a multidisciplinary care team contributes to the comprehensive recovery of poststroke patients. She also spoke about the role that personalized support plays in helping patients to navigate the complexities of poststroke life and reclaim a sense of normalcy. In addition, Sierens shared some of the key strategies for recognizing and managing poststroke spasticity, and how they assist with having improved quality of life.

NeurologyLive: Could you please share some insights into what comprehensive care looks like for patients who have experienced a stroke?

Stroke is a condition that necessitates a large, multidisciplinary team to achieve the best outcomes in recovery. The journey begins with neurologists diagnosing the stroke in an emergency room setting, working alongside internists to modify risk factors and prevent future strokes. The focus then shifts to rehabilitation, led by a physiatrist – a specialist in physical medicine and rehab. This rehabilitation team includes physical therapists, occupational therapists, speech therapists, driving specialists, vocational therapists, psychologists, and neuropsychologists. Orthotists and assistive technology professionals are also involved to provide braces and adaptive equipment, ensuring optimal outcomes for poststroke patients. As a physiatrist, my role involves coordinating this diverse team, ensuring patients receive timely and comprehensive care across all aspects.

Is there anything else you'd like to add about the significance of having a care team for stroke patients?

Access to a comprehensive, multidisciplinary care team is crucial for achieving the best outcomes after a stroke. Following a stroke diagnosis, patients often face uncertainty about how it will impact their lives and goals. Our care team steps in to understand each individual's unique situation, goals, and preferences. Whether it's an 80-year-old aspiring to drive independently or a young stroke survivor pursuing a specific hobby, our team collaborates to address various challenges. This level of personalized care and support is essential for navigating the complexities of poststroke life and helping individuals reclaim a sense of normalcy.

Can you shed some light on how to care for patients who experience post-stroke spasticity?

Poststroke spasticity, characterized by muscle stiffness, is a common challenge. Early awareness and education about its potential occurrence are important. Patients need to recognize signs, such as stiffness in the morning or difficulty with certain movements, and communicate these changes promptly. Close monitoring is key, allowing for early intervention when spasticity is identified. Stretching exercises play a significant role in managing spasticity, emphasizing the importance of consistent, daily routines. Additionally, orthotic interventions, such as splints or braces, may be utilized to address specific issues. While various treatment options exist, including oral medications and botulinum toxin injections, the choice depends on the patient’s circumstances, balancing benefits and potential adverse effects. The goal is to provide effective and personalized care to manage poststroke spasticity and improve overall quality of life.

Is there anything else you feel is crucial to mention for the stroke community?

It's essential to highlight the long-term impact of stroke on patients and their families. While there is significant emphasis on early stroke intervention, the importance of poststroke management often gets overlooked. The ripple effects on family dynamics, relationships, and financial stability can be profound. Education and awareness about available resources for poststroke care are vital. Unfortunately, some patients only encounter specialized care years after their stroke, hindering the optimization of rehabilitation. Acknowledging the concept of a "new normal" pos-stroke is equally important. Many patients express gratitude for positive life changes following a stroke, emphasizing the potential for growth and adaptation. Overall, the stroke community needs ongoing support and understanding, ensuring that patients receive comprehensive care throughout their poststroke journey.

Transcript edited by artificial intelligence.

REFERENCES
1. Clarke DJ, Forster A. Improving post-stroke recovery: the role of the multidisciplinary health care team. J Multidiscip Healthc. 2015;8:433-442. Published 2015 Sep 22. doi:10.2147/JMDH.S68764
2. Bavikatte G, Subramanian G, Ashford S, Allison R, Hicklin D. Early Identification, Intervention and Management of Post-stroke Spasticity: Expert Consensus Recommendations. J Cent Nerv Syst Dis. 2021;13:11795735211036576. Published 2021 Sep 20. doi:10.1177/11795735211036576