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Waves of recovery

Time, intensity are factors that affect stroke patients' ability to improve

Time, intensity are factors that affect stroke patients' ability to improve

March 21, 2005|by JULIE E. GREENE

julieg@herald-mail.com

Butch Griffith's right hand has been clenched in a fist for more than a year.

It's not that Griffith is mad at the world. He cannot uncurl his fingers without assistance and pain.

Griffith, 58, had a hemorrhagic stroke Jan. 27, 2004, that left him unable to move his right side and temporarily impaired his speech. In a hemorrhagic stroke, a blood vessel ruptures, whereas in the more common ischemic stroke, a clot blocks an artery, experts said.

He regained his speech within four days of the stroke and began walking with the assistance of a hemi-walker, which he can use with one hand, a month after the stroke.

Stroke is the nation's third leading cause of death, behind heart disease and cancer, according to preliminary 2003 data from the Centers for Disease Control and Prevention.

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Washington County Hospital admitted 430 stroke patients last year, compared with 356 in 2003 and 377 in 2002, according to spokeswoman Marina Shannon.

While it is possible to have a mild stroke and walk out of a hospital two days later like New England Patriots linebacker Tedy Bruschi did last month, the length and difficulty of the recovery process varies depending on factors such as the cause of the stroke and the individual's age and medical condition, said Dr. Mark Yacyk, a physiatrist - doctor of physical medicine and rehabilitation - with Washington County Hospital.

"Anytime the brain is involved, really all bets are off in predicting what will happen in the future," Yacyk said.

Yacyk said he likes to see motor improvement or muscle come back to life within the first six weeks. The longer the arm or leg is weak, the less positive the long-term prognosis.

For stroke patients who can tolerate the intensity, the hospital offers a therapy program that is rather unique in its intensity, according to occupational therapist Tim Burkhart and Matt Lilly, clinical coordinator for the Maryland NeuroRehab Foundation (MNRF) at Total Rehab Care. The program, which was developed four years ago, is not for severe stroke patients, Lilly said.

Before the program, a stroke patient might be seen two to three times a week for one to three hours of therapy. Now, a patient in MNRF's Brain Injury Day Program attends therapy from 9 a.m. to 3 p.m. five days a week, according to Lilly and Khrys Thompson, program manager for neurologic rehab for the hospital's Total Rehab Care.

"The brain recovers better with repetition, repetition, repetition. So I think the intensity allows for more repetition so the brain can recover faster," Thompson said.

What might have taken three months to achieve before, now might be done in six weeks, she said.

Griffith said he spent 30 hours a week in rehab for six months for physical, occupational and, initially, speech therapy.

The Keedysville area resident visits Total Rehab Care at Robinwood Medical Center two days a week, an hour each day, and works on other exercises at home with the assistance of his wife, son or sister, he said.

At home, he tries to accomplish at least three 90-minute therapy sessions a day that might include resistance exercises with large rubber bands, deep-knee bends, and leg and arm curls.

"Sometimes I get lazy, but the more you do it the more you're benefiting yourself," he said.

"You've got to really have the willpower. You've got to have family that's willing to help you," Griffith said.

Occupational Therapy Assistant Michelle Ost uses a mild electric current to reduce the tightness in Griffith's arm so they can stretch his arm to increase range of motion.

The brain is not telling the hand what to do because that part of the brain was injured by the stroke from lack of blood flow, Burkhart said. The theory is that the brain forms new pathways to relearn such motor movements, he said.

The simple movement of having his arm raised and pushed back a little brings a grimace to Griffith's face.

Griffith said his diabetes, heredity and stress probably contributed to his stroke. He was trying to make up for lost income by working multiple jobs after having to take disability and retire early in 1996 after falling down a flight of stairs. Griffith worked as warehouse supervisor for State Use Industries with the Maryland Division of Corrections.

He has cut back on sodas and bread, losing 60 pounds since his stroke, to prevent having another stroke, Griffith said.

"I'm like every stroke patient. I've said so many times, 'Why me? Why me? Why me, Lord?'" Griffith said. "The Lord didn't do this to me. I done it. By not eating right, always a worrier."

In the know about strokes


There are several traits or habits that increase the risk of having a stroke, according to the American Stroke Association's Web site at www.strokeassociation.org.

The following traits or habits can be controlled or treated:

· High blood pressure.

· Tobacco use: Nicotine and carbon monoxide reduce the amount of oxygen in the blood and damage blood vessels, increasing the odds of clots forming.

· Diabetes mellitus.

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