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Rehabilitation can mean quite different things for stroke survivors since no two strokes are the same. Each survivor faces a different path to recovery based on the location in the brain where a stroke occurs.

鈥淩ecovery from a stroke depends upon the extent of the stroke and what personal听abilities听it has affected for the individual,鈥� says Dr. Diane MacKenzie, an assistant professor at Dal鈥檚 School of Occupational Therapy.听鈥淪trokes that affect the cognitive, perceptual or language areas often are more challenging to recover from than those only affecting an individual鈥檚 motor skills.鈥� 听

Paralysis, trouble with memory, altered walking, difficulty reading and aphasia are commonly acknowledged effects of a stroke. Young stroke survivors, however, are faced with an added challenge: how their stroke and rehabilitation will impact their future. Often, young stroke survivors may have to create a new vision of the future for themselves than they had prior to their stroke.

Intensive Post-Stroke Programs

The School of Human Communication Disorders offers an intensive speech therapy program for people with aphasia post-stroke. Aphasia 鈥� an impairment in the ability to communicate as a result of brain injury 鈥� can have a broad impact on an individual鈥檚 life because it effects all aspects of interaction with others.

In the InteRACT program, participants spend five hours a day on speech and language therapy, five days a week for four and a half weeks. 鈥淚t鈥檚 about communication, and returning to a productive life and looking into something that鈥檚 going to give them something to feel positive about themselves,鈥� says Linda Wozniak, a speech language pathologist and the program director. 听

The trouble when you鈥檙e young and you鈥檝e had a stroke is you have to ask yourself 鈥榃hat鈥檚 the new life path?鈥欌�� Linda explains. 鈥淵ou have a goal, you know where you鈥檙e going and then all of the sudden there is a big detour put in the middle of the road.鈥�

Participants in the program also receive physiotherapy twice weekly, recreation therapy, and participate in discussion groups, lecture series and book clubs, with reading supports based on the level of aid they need.

During this spring鈥檚 InteRACT program, Linda met Rosa Valente, a young stroke survivor. Prior to her stroke, Rosa was a national fitness competitor and certified pro-trainer.

Rosa suffers from aphasia as a result of her stroke and she and her family fundraised for her to attend the InteRACT program. Rosa says the most difficult things she has had to work on are her speech 鈥� she鈥檚 currently working on creating complete sentences in response to questions 鈥� and regaining control over her arm, for which she attends physiotherapy twice a week..

鈥淭he trouble with aphasia is that it鈥檚 severity will determine whether or not people will be able to go back to work,鈥� says Linda. 鈥淢aybe the kind of work they did before, they won鈥檛 be able to do again.鈥�

For young survivors with most of their working years ahead of them, grappling with a new and unexpected future can be a major challenge.

Unique Challenges for Young Survivors

鈥淪troke and brain injury is trouble no matter when you have it. But for someone who is young they haven鈥檛 gotten to do what they wanted to do yet,鈥� says Linda.

Questions about the future and a loss of control are stroke side effects that may have powerful consequences for younger survivors. Unfortunately, for many survivors the social supports in place prior to the stroke aren鈥檛 there in the aftermath.

鈥淩esuming their typical lives and maintaining social connections is often the biggest challenge young stroke survivors鈥� face,鈥� says Gail Creaser, a lecturer with Dal鈥檚 School of Physiotherapy.

鈥淚n my experience, retaining friendships can be a big challenge, especially if the brain injury is severe or the recovery period is protracted. Friends may come around initially but it takes work to relate to someone who鈥檚 behavior has changed, who maybe frustrates easily [and] isn鈥檛 that fun person he/she once was.鈥�

Best Practice and Interprofessional Care

鈥淚t is a big deal, for a young person at the point in life of learning and beginning to exert independence to find him/herself in a situation where most control has abruptly disappeared,鈥� says Gail. 鈥淚t is our challenge, as parents and health professionals, to offer or structure opportunities for this young person to begin to regain some control.鈥�

Linda believes an interdisciplinary approach is needed for successful stroke recovery for all survivors, but especially for young survivors: 鈥淚 can make someone sit in my office all day and help them speak, but if they don鈥檛 get out there then they won鈥檛 ever be able to use those skills.鈥�

Linda notes that stroke recovery involves a lot of different types of interventions from different health professions, which is why the InteRACT program involves speech and language pathology, physiotherapy and recreation therapy. 鈥淒uring the recreation therapy portion of InteRACT, we look into what kind of leisure activities they did before and ask can they still do those or are there other activities they might be interested in.鈥�

鈥淚nterprofessional care for stroke survivors is evidence informed best practice 鈥� no other way to deliver care should be done - period!鈥� says Diane.听鈥淚t is very important for the survivor to receive client-centered coordinated and integrated care.鈥�

鈥淩ecovery is complex and an IP team is better able to set reasonable and achievable goals with the patient than a group of healthcare providers focused only on profession-specific goals. Decisions can be made collaboratively and team members can share some of the tasks that are less profession-specific but are important to that patient's overall rehabilitation and discharge,鈥� adds Gail.

The New Future

The level of recovery possible is dependent upon the severity and location of the stroke, but Linda notes 鈥渋ntensive care early on has proven to be the most effective.鈥�

As for Rosa, she鈥檚 still working with a physiotherapist and speech-language pathologist. For fun, she took some golfing classes while in the InteRACT program last year and says she looks forward to getting back to golfing this summer.

鈥淪he has a good swing,鈥� Linda adds.

**For health professionals looking into best practice care for stroke survivors, the is a great on-line resource.

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