Lakeridge Health helps stroke survivors achieve their potential

Four months after a debilitating stroke left Hans Helmut Nirschl unable to move from a bed to a wheelchair without the assistance of a mechanical lift. Today, the 61-year-old proudly navigates the corridors of Lakeridge Health Oshawa (LHO) with only the assistance of a walker and his physiotherapist – taking him one step closer to regaining the independence he’s so determined to once again enjoy.

While the sit-to-stand and towel-folding exercises he completes at LHO’s Stroke Rehabilitation Unit are a far cry from the active life the Seagrave resident enjoyed in the weeks leading up to Christmas, they are working. At first, just sitting at the edge of a bed proved a challenge, but through determination and perseverance Nirschl regained his balance and soon mastered climbing stairs. His therapist’s goal is to have him walking independently, but the use of assisted devices such as a cane or walker may be needed.

A dentist in his native Germany, Nirschl describes himself as “hopelessly optimistic” and has worked hard for each success he has achieved. “I enjoy all my rehab activities and can hardly wait ‘till the next sessions because it brings me a step forward,” he says near the end of his four-month stay. The affable grandfather recently bid farewell to the hospital’s Oshawa campus and returned home with dreams of skiing and playing tennis again.

Despite the adjustments he has been required to make, Nirschl is one of the lucky ones: stroke is the country’s third leading cause of death, claiming the lives of 13,000 Canadians annually. In Ontario, about 100,000 people live with the effects of stroke, which is the number one cause of severe disability in Canada and has the longest length of hospital stay of any disease.

Rehabilitation can help stroke survivors regain abilities or learn how to adjust to their challenges. It can significantly improve quality of life following a stroke and helps each stroke survivor achieve the optimal quality of life possible. “Research indicates increased activity and a complex stimulating environment are key elements to stroke rehabilitation,” says Dr. Jim Park, Medical Director of LH’s Post Acute Specialty Services (Complex Continuing Care, Geriatrics and Rehabilitation) Program. “There is strong clinical evidence that early admission to rehab results in better patient outcomes.”

Depending on the severity of their stroke, patients often remain in rehab four to five weeks. “We have an inter-professional, multidisciplinary team that includes doctors, nurses, physiotherapists, occupational, speech and recreational therapists, neuropsychologists, physiatrists, social workers and pharmacists. The whole team is there to help our patients regain as much of their independence as possible,” says Mary McAvoy, Patient Care Manager of LHO’s Stroke Rehabilitation Unit.

“Our focus is assisting patients to adapt to their challenges and achieve their potential while working toward productive, independent lives,” says McAvoy. “We develop strong bonds and friendships with our patients – making their success even more personal. While some arrive with significant impairments, you can’t image the pride when some are able to walk out of Lakeridge Health.”

As part of their rehabilitation, patients participate in both individual and group physiotherapy organized much like circuit training. “Patients spend four minutes at one station before moving on to the next and alternate between activities designed to improve upper extremity strength and balance,” explains physiotherapist Amy Maebrae-Waller.

Physiotherapy activities are designed to help patients perform everyday tasks. “Function is the operative word in rehab,” says Dr. Park. “The group aspect is also important. Patients get to know and support one another,” he says. “Many maintain relationships long after they leave.”

A recreational therapy room allows patients to enjoy a variety of activities, including gardening, woodworking, painting, games, computer and balloon badminton. Occupational therapy facilities include a working kitchen, laundry and bathroom, and allow staff to assess a patient’s ability to perform tasks safely at home and make suggestions regarding adaptive tools and equipment.

LHO was designated a District Stroke Centre (DSC) in 2008 where Emergency Room staff are specially trained in stroke response and can offer access to a clot-busting drug to minimize or reverse the effects of a stroke. Previously, area stroke patients had to travel to Toronto, York Region or Peterborough to access the drug.

“In Durham Region, we have 600 to 700 stroke patients annually,” says DSC Coordinator Jillian Ghesquiere. In 2008/2009, 355 stroke patients were admitted to Lakeridge Health campuses, which include Oshawa, Bowmanville and Port Perry. Of those, 98 underwent specialized stroke rehabilitation, which is offered at the Oshawa campus only.

As Lakeridge Health moves forward and expands the services within the DSC, its Oshawa campus will open a 28-bed Integrated Stroke Unit this spring. All stroke patients admitted to Lakeridge Health will be treated on this unit by dedicated staff – all with expertise and best practices in stroke care .The unit will feature five acute, five continuing care and 18 rehabilitation beds, and will reduce wait times for rehabilitation services, while also allowing patients to remain in one location for both acute care and rehabilitation.