The Most Common Mistakes I See in Stroke Recovery

[0:00]Here are the worst and most common mistakes I see therapists making when treating stroke survivors. But before we jump in, make sure you support the channel however you can. Give this video a like, subscribe, become a channel member by clicking the join button or give us a super thanks by clicking in the YouTube bar below. All right, let's get into it. Mistake number one, pushing the one-year recovery myth. Unfortunately, there is this myth that stroke recovery stops after one year and it continues to be perpetuated. In fact, I made an entire video dedicated to it that really explores why it happens and why it's still continues to be perpetuated. But this is simply not true. And I know this based on anecdotal evidence as well as evidence that is now coming out in the literature. I have worked with stroke survivors whose stroke recovery continues five years, 10 years, 20 years out of their stroke. Now they're putting in the work to make that progress happen, but one year after your stroke doesn't mean that there is a hard stop to your progress. And anyone who tells you that just simply doesn't have their facts straight. Mistake number two, starting with compensatory strategies. What we understand about the way the brain works is that over the course of our lives, our brain is constantly making neuroplastic changes. It is adapting, creating new pathways or remaking pathways. What we understand specifically about stroke recovery is that after that injury happens to the brain, the brain has this heightened state of neuroplasticity in that first three to six months. So while neuroplasticity never stops and that's why, you know, we can crush down that one-year stroke recovery myth. We do want to capitalize on that heightened state of neuroplasticity. What does this have to do with compensatory strategies? Well, in those early stages of stroke recovery, we absolutely want to focus on remediation strategies, helping to correct those underlying impairments. So remediation means that if you have muscle weakness, we're focusing on strengthening the muscles, right? Rather than doing compensatory things like giving you adaptive strategies like one-handed dressing, um or using some type of adaptive equipment, like maybe a button hook or a shoe horn. The ultimate goal early on is to help get those functions back online and get the brain rewiring and recreating new pathways so that you get those functions back. Mistake number three, only treating physical issues. Often after a stroke, there is a huge focus on improving range of motion, improving strength, you know, getting you back on your feet trying to walk again or improving arm movement. And don't get me wrong, all of those things are incredibly important and need to be focused on. But I think often therapists forget about invisible disabilities that come along with a stroke. And this often comes in the form of not looking at mental health. Having a stroke is an incredibly traumatic event in your life. You know, you've been through this life-threatening event, you maybe didn't know if you were going to live, and now you've got, you know, all of these other things going on that are going to change your life. You know, it's it's a very traumatic thing to go through. So addressing mental health, anxiety, depression, panic, fear, all of those things, uh that may come along with having a stroke is incredibly important. Not forgetting about neurofatigue, which can directly impact someone's ability to engage in their rehabilitation or continue with rehab after they've been discharged home. And forgetting about sensory issues. On my last video I made exploring sensory changes after stroke, I had so many comments saying, you know, I thought I was going crazy because I was having these altered sensations or, you know, I was getting really overstimulated when I went out in large crowds. Um and because nobody had ever talked to them about this, unfortunately, a therapist is often the first and only line of defense when it comes to talking about these changes. And if they don't address them, you may never hear about them again. Mistake number four, lack of future planning. Unfortunately, I think that some therapists are more concerned with meeting insurance goals or the hospital goals of getting somebody good enough to discharge home. They're not necessarily thinking about how they can progress that someone to continue to get better over time. Often what happens in the discharge process is a therapist will say, okay, I'm going to recommend this next level of care. And they say, you're appropriate to go to outpatient therapy or maybe get home health therapy. But I think what therapists fail to realize is often, you don't get that next level of care or you only get a certain amount of visits that's really not going to be helpful for you. What would be ideal is that that therapist would be thinking, okay, maybe I send this person home with more progressed home exercise programs or home activity programs so that as you continue to make progress at home, regardless of whether you're able to get structured therapy in outpatient or home health, you have some sort of guideline for your specific situation, um that's been recommended to you by a therapist. Mistake number five, treating a neurological condition like an orthopedic one. Now, let me say there are definitely orthopedic complications that can result uh after a stroke. Say for example, having a shoulder subluxation, uh maybe having a frozen shoulder or a rotator cuff issue, but we shouldn't be focusing in on those issues alone. They're part of a bigger system-wide problem, right? When there is an injury to the brain, it affects all of our systems. So we can't just focus in on a specific orthopedic problem. We need to be focusing on the brain as a whole, how an injury to the brain impacts the body. And that's going to guide our treatment planning and what interventions that we're picking, uh because again, neurological treatments are just very different from strictly orthopedic ones. Mistake number six, not educating about plateaus and backslides. So before I get into it, let me just say, plateaus and backslides are a normal part of the stroke recovery process. They're not pleasant and they can be really discouraging, but I want you to know that because if you didn't, and you end up hitting one of them, you may just think, oh, that's the limit to my stroke recovery and I guess I don't need to try anymore. This is as good as I'm going to get. When in fact, that is simply not true. This often happens because the brain kind of just gets in a pattern, in a habit, in a routine. Maybe you've been doing the same exercises for a long time. Maybe you've been seeing the same therapist for a long time who's been running you through very similar treatments. You really need to shake your brain up. Try new exercises, try new activities, something that's going to get the brain out of its routine so that it can start creating new neuroplastic changes. Mistake number seven, not listening. So this one really burns me up, and it's when a therapist doesn't listen to what the patient actually wants. So they might be setting the goals that they think that you should work on, versus actually asking you what you want to work on. A good therapist in their initial evaluation is going to be asking you what you want out of therapy. What are your biggest goals? What do you want to work on? Because if a therapist sets the goals that they think that you should work on or what they want to work on, why would you be motivated to work on a therapist's goals? Therapy isn't about the therapist, it's about you, and a good therapist should be designing their treatment plan and goals around what you want. Mistake number eight, they're not evidence-based. So unfortunately, there are therapists and other medical professionals out there who rely on what they learned in school. Maybe they don't keep up with the latest evidence or they go to continuing education, but they don't really implement it because they fall back to what's comfortable and what they've been using for the last 10, 20 years. And unfortunately, this does a huge disservice to the patient. Because when you're using outdated treatment approaches, you're not going to get the best results for the person that you're working with. And this is incredibly frustrating because even just our understanding of stroke recovery has changed drastically within the last 10, 20 years. It has completely changed how we approach neurological recovery, and if somebody is still going based on what they learned in school, say 15 years ago, they likely don't have the most updated information. Mistake number nine, they treat you like a number. There are a lot of problems in the therapy field. Often insurance companies, hospital systems, other healthcare entities, want therapists to do very unethical things. They may want you to treat multiple people at the same time when really, you need individualized treatment for that person. They may want you to only bill certain amounts of time, and so you try to adjust your therapy times according to what they want you to bill for. They want you to focus on getting that person discharged rather than getting them to their optimal level of progress. And this can lead to therapist burnout. I understand it, I've been there. But the thing is, as a therapist, as any medical professional knows, you have an ethical responsibility to serve the patient to the best of your ability. To do no harm, to give them the best of yourself even when you don't feel like it. But what often happens with therapy burnout is that, unfortunately, they do end up treating their patients just like a number. Mistake number 10, providing cookie cutter treatment. This is when a therapist provides the exact same treatment and often similar goals to what they set for everybody else. That's just simply not correct. What should be happening is you should be getting an individualized approach. A therapist should be looking at your specific situation, getting to know what you are like, what's important to you, what your home looks like, what your home life looks like, the support that you have. Looking at every aspect of who you are, what's in your life, what is meaningful to you and then creating a treatment plan and goals around those things and making sure that when they're working with you in a treatment, that they're doing something that is actually meaningful and important to you, versus giving you the same home exercise program or the same exercise program as they're giving to every single other person. Leave me a comment and let me know, did any of your therapists make these mistakes? And of course, a huge thank you to all of the donors who make videos like this possible with a special thanks to Heather G., Ryan D. and Motus Nova in our empower tier on Patreon. Thank you all so much for watching. I'll see you next time.