Profile in Determination

by Laurie Blue Lunderberg
She’s articulate, vivacious, and speaks with enthusiasm about the subject. The pretty 33 year-old mother of two girls, ages 2 and 4, is slender, has long, shiny dark hair, and a healthy glow to her freckled face. It’s hard to believe–no almost impossible to believe–that just a year ago Kate Adamson suffered a stroke that nearly killed her. And yet it’s true. On June 29, 1995, a severe stroke at the base of her brain left her paralyzed and unable to speak. During the first few days of the six weeks she would spend in the intensive care unit at Torrance Memorial Medical Center, doctors gave her a 1 percent chance of surviving, let alone recovering to the miraculous extent that she has.

What Kate Adamson had was determination. A quality that is considered key by rehabilitation therapists in determining the level of activity and functioning that a stroke patient will eventually attain. In addition, she had the support of family and friends from her church at Hope Chapel, who were there throughout her struggle.

The fact that Kate experienced a stroke at so young an age is not as unusual as people think. While it’s true that the majority of strokes occur in people age 65 and over, more than one-fourth of the people who suffer stroke in a given year are under age 65, according to the American Heart Association. Statistics show that stroke is the nation’s third-ranking cause of death, following heart disease and cancer. It is also the number-one cause of disability in the United States. Almost 5,000,000 people suffer a new or recurrent stoke each year. And like heart attack, knowing the warning signals of stroke can reduce the damage a stroke can cause, including saving your life.

However, strokes in younger people are often caused by different factors than strokes in older people, says Luis Chui, M.D., neurologist at Torrance Memorial Medical Center. These factors could include problems with the immune system, trauma to the carotid arteries in the neck, causing a dissection of the artery, or other conditions. Whatever the cause, most stroke survivors face some level of rehabilitation.

Kate’s story started with a fight for survival, then continued through four grueling months of inpatient rehabilitation. At first she was in a haze, unaware of what had occurred. However, words cannot express the emotional anguish she felt when she realized that she couldn’t move and couldn’t speak. Her inability to speak was caused more by the presence of a tracheotomy tube she needed to help her breathe than it was by the stroke, but it was very frightening, nonetheless. “I cried constantly when I was in the ICU,” says Kate. But the church arranged for someone to be with her pretty much around the clock, which was a great source of comfort initially since she couldn’t even move to push the nurse call button. “Plus, I couldn’t even tell people what I needed,” she says. “I couldn’t scratch an itch, and couldn’t ask someone else to scratch it for me. It was horrible,” she recalls. It was a great relief when she and her family devised a way for communicating by blinking her eyes. “Two blinks meant yes, and three meant no, or something like that.”

Moving from Torrance Memorial to an acute-care rehabilitation center was a huge step for Kate, but initially she didn’t see it that way. “When I saw all that I was going to have to do to relearn every thing, I became really depressed. I didn’t know if I could do it. Every day was a mile stone,” she recounts.

Learning to swallow was one of the biggest milestones of her recovery. “I hadn’t eaten for a month. All I wanted was a big glass of water.”

The ability to swallow is one of the first functions that must be assessed in a stroke patient. According to Carolyn Erratt, speech pathologist at Torrance Memorial, stroke patients are at great risk for swallowing difficulties that could result in aspirating food or liquid into the lungs which can cause pneumonia–a very serious complication for a stroke patient. Because a stroke can also affect a patient’s ability to cough, problems with swallowing could go unnoticed if not evaluated immediately.

Once a patient has been evaluated for swallowing, a nutritional plan can be devised in conjunction with hospital dietitians. “If at all possible, we like to see the patient take food orally,” says Erratt. “A sense of being well accompanies the ability to eat in very significant ways. It is often very discouraging for patients to find out they cannot eat,” she explains. Sometimes therapists can adjust a patient’s sitting position to facilitate food intake. They also work with dietitians to modify the consistency of the food. Liquids actually pose a greater risk for aspiration because they are harder to control. In this case, thickeners can be used. Some patients may be able to handle foods that are pureed or finely chopped. “Even being able to eat a little food, and then supplementing it with tube feeding can improve a patient’s outlook and quality of life greatly,” says speech pathologist Shirley Reisch.

A common theme throughout the rehabilitation disciplines is helping patients regain independence to as great a degree as possible. Physical and occupational therapists work with a patient to regain use of the patient’s legs, arms and hands. The first thing all rehabilitation therapists must do is determine at what level a patient was functioning prior to having a stroke. “Many people make a good recovery,” points out Julie Bathke, physical therapist. In fact, some recover completely, and many of the approximately 5 million living Americans who have had strokes have been rehabilitated and are living productive lives.

“It’s not true that you can’t return to your former interests,” says Carolyn Theriault, occupational therapist. “Many people return to doing things they did prior to the stroke at modified levels,” she continues. She emphasizes that it’s absolutely possible to pursue your former interests following a stroke. The trick is devising adaptive techniques that work for the individual patient.

For Kate Adamson an important adaptive technique was learning how to hold her 1-year-old daughter on her hip. “One of the toughest things I had to face was being separated from my two sweet little girls–it crushed me,” she recalls. Being able to pick up and cuddle her daughter-an ability many mothers take for granted–was something Kate longed to be able to do again. So her therapist showed her how she could balance the little one on her hip, no easy task considering Kate has little use of her left arm and leg, and uses both a walker and a wheelchair.

Another key role of the speech therapist is to help stroke patients relearn to communicate. In Kate’s case, her tracheotomy tube was fitted with a speaking valve which allowed her to control the air in her trachea needed to speak. Other stroke patients need help relearning skills that enable them to physically produce speech, as well as to think and to read.

The prospect of having to relearn things you’ve done all your life might seem unfathomable, even insurmountable, but modern stroke care can prevent long-term disability. According to Chui, the treatment of stroke involves medical and surgical interventions. Modern drugs, called thrombolytics, can be used to dissolve a clot in the brain to reduce cell damage if used within the first three hours of stroke onset. Other drugs can be used to protect adjacent cells from further damage.