Brain Stem Stroke: Recovery And Rehabilitation Possibilities

A brain stem stroke is a life-threatening condition that can cause severe long-term complications and even death. The brain stem, located at the base of the brain, is responsible for controlling vital bodily functions such as breathing, heart rate, blood pressure, eye movement, facial movement, and swallowing. Due to its crucial role, a stroke in this area can have devastating effects, including difficulty breathing, weakness, altered consciousness, and dysphagia (difficulty swallowing). However, with prompt diagnosis and treatment, recovery is possible, and survivors can regain significant function through intensive rehabilitation. This involves physical therapy, occupational therapy, and speech therapy to address the various impairments caused by the stroke. The recovery journey is unique to each individual, and some may require psychological counselling to adjust to any long-term disabilities.

Brain stem stroke recovery stories

Kevin's Story

Kevin Moss, a 46-year-old retired engineer, was playing a round of disc golf with friends in February 2022 when he experienced a rare type of brain stem stroke. He felt a subtle pain in the back of his neck and dizziness but dismissed it as the cold weather. As the game progressed, he became nauseous and almost passed out. Kevin's friends called 911, and he was hospitalized at West Chester Hospital, where he was diagnosed with a complex case of a brain stem stroke.

Kevin's left side became weak, and he lost all sensation on his right side, rendering him unable to walk, eat, or swallow. He spent nearly four weeks in the hospital, undergoing daily physical and occupational therapy sessions essential for stroke recovery. He was placed on a feeding tube and later a Percutaneous Endoscopic Gastrostomy (PEG) tube to receive nutrition.

Kevin's recovery continued after he was discharged. He underwent speech and swallowing therapy but felt disappointed with the lack of progress and partnership. However, with exceptional physical and occupational therapy, he went from being 100% wheelchair-bound to walking again by June 2022, four months after his stroke.

Kevin still struggled with swallowing and speaking, so he was referred to Dr. Rebecca Howell, who performed a 6-hour intricate surgery to restore his vocal cord function and his ability to eat and swallow. Kevin then began weekly swallowing therapy and twice-weekly speech therapy sessions. By mid-October, he was eating 100% of his meals, and his PEG tube was removed before Thanksgiving 2022, a massive milestone.

Today, Kevin continues to deal with weakness on his left side, minimal feeling on his right, and balance issues. He does weekly personal training, rides an e-bike, plays disc golf, and works as a sales associate and mechanic at a local cycling shop. He embraces his new normal and is determined to keep moving forward.

Barbara's Story

Barbara Collard, a mother of five and grandmother of nine, suffered a massive stroke while at work in July 2008. Her coworkers recognized the signs and rushed her to a local hospital, from where she was airlifted to Massachusetts General Hospital, the largest stroke center in the state. A CT angiogram revealed a life-threatening blood clot at the base of her brain stem, but unfortunately, she had missed the window of opportunity to benefit from clot-dissolving drugs.

Barbara's family was faced with difficult decisions. They chose to proceed with an intra-arterial thrombolysis procedure to restore blood flow to her brain stem. When Barbara woke up in intensive care, she couldn't walk or talk, and she faced a long road to recovery.

Barbara and her family maintained constant communication with her doctors, who closely monitored her progress. Small gains, such as squeezing a hand or lifting a leg, motivated her to keep fighting. She was eventually transferred to a rehabilitation hospital.

Now, six years later, Barbara reports that she is almost fully recovered. She continues to challenge her brain with puzzles and crafts and is forever grateful for the care she received.

Dave's Story

Dave, a single father of two daughters, suffered an embolic stroke in January 2020 that caused severe damage to his brain. He woke up from an 11-month coma to a changed world in the midst of a global pandemic. Dave was told he would likely be in a wheelchair for life and never regain full cognitive functioning. For months, he couldn't walk, move his left side, speak, eat, or breathe on his own.

Then, someone in his stroke support group recommended the Barrow Neurological Institute, and everything changed for the better. With the expertise and dedication of his medical team, Dave went from being wheelchair-bound to walking on his own. His speech and cognition also improved tremendously. He recently bought a house and is learning to drive again, allowing him to spend quality time with his daughters and watch them grow.

Luke's Story

Luke experienced a brain stem stroke in July 2019 and was in a coma for six days. He had to re-learn everything, from walking and talking to basic human functions. He was confined to a wheelchair for two months but persevered with rehabilitation.

Luke participated in physical, occupational, and speech therapy for over a year. He has since graduated from all therapies and now has a job. He continues to work towards his unique goals, staying consistent with his rehab exercises and believing that recovery is possible.

Becky's Story

Becky experienced a brain stem stroke in November 2007 and was initially paralyzed from the neck down. She has since recovered and can now move her body again, proving that recovery from locked-in syndrome is possible.

The impact of a brain stem stroke on the body

The brain stem is located at the base of the brain and connects the main cerebrum to the cerebellum and spinal cord. It controls many of the body's vital functions, including breathing, heart rate, blood pressure, consciousness, speech, swallowing, hearing, and eye movements. As a result, a stroke affecting the brain stem can have severe and life-threatening consequences.

A brain stem stroke can cause a wide range of symptoms, including atypical ones such as vertigo, nausea, and headache, as well as hallmark stroke symptoms like slurred speech or weakness on one side of the body. It can also lead to:

• Coma
• Locked-in syndrome, where the individual is completely paralyzed but can move their eyes and is conscious and able to think and reason
• Difficulty breathing
• Dysphagia (difficulty swallowing)
• Hemiparesis or hemiplegia (weakness or paralysis on one side of the body)
• Vision problems, such as nystagmus (repetitive, uncontrolled eye movements)
• Ataxia, or difficulty with voluntary motor control, resulting in poor balance and uncoordinated movements
• Wallenberg's syndrome, a rare condition with various secondary effects, including numbness or weakness on different sides of the body
• Loss of sensation, including loss of smell and taste
• Vertigo or intense dizziness

The importance of prompt treatment

A brain stem stroke is a life-threatening condition that requires immediate medical attention. The brain stem, located at the base of the brain, is responsible for controlling vital bodily functions, including breathing, heart rate, blood pressure, eye movement, facial movement, swallowing, and balance. Due to its crucial role, a stroke in this area can have severe consequences and a relatively high mortality rate.

For ischemic strokes, caused by blood clots or blockages in the blood vessels, the focus is on restoring blood flow. This can be achieved through clot-busting drugs, anti-platelet medications, or endovascular therapy to remove the clot. On the other hand, hemorrhagic strokes, resulting from a burst or leaking blood vessel, require controlling the bleeding and reducing intracranial pressure. This may involve surgical procedures, such as coil embolization, and administering drugs to control blood pressure and prevent seizures.

The urgency of treatment is emphasised by the fact that the fastest improvements in recovery are often seen in the initial six months after a brain stem stroke. The first 3-6 months are critical for neuroplasticity, the brain's ability to rewire itself and restore functions. Therefore, intensive rehabilitation, including physical therapy, occupational therapy, and speech therapy, should begin as early as possible to maximise the chances of regaining independence.

In addition to immediate medical treatment, addressing lifestyle factors that increase the risk of a brain stem stroke is essential. High blood pressure, high cholesterol, diabetes, obesity, and smoking are significant risk factors that can be mitigated through behavioural changes. Adopting a healthy lifestyle, including a balanced diet, regular exercise, and avoiding harmful substances, can substantially reduce the likelihood of experiencing a brain stem stroke.

In conclusion, prompt treatment is of paramount importance for individuals suffering from a brain stem stroke. Early medical intervention, combined with intensive rehabilitation and addressing underlying risk factors, gives patients the best chance for a full recovery and minimises the potential for long-term disabilities.

The role of rehabilitation

The road to recovery from a brain stem stroke is challenging and often long. The brain stem's role in controlling vital functions such as breathing, heart rate, and blood pressure means that a stroke in this area can have severe secondary effects, including difficulty breathing, weakness, altered consciousness, and dysphagia (difficulty swallowing). However, intensive rehabilitation gives survivors a chance to regain lost functions and increase their independence.

Inpatient Rehabilitation

After the initial hospital stay, many brain stem stroke survivors are transferred to inpatient rehabilitation facilities. During this period, they undergo intensive therapy, typically participating in 3-4 hours of therapy per day. The therapy team usually includes physical, occupational, and speech therapists who work collaboratively to address the survivor's specific needs.

Physical Therapy

Physical therapists help survivors address physical impairments caused by the stroke. They guide survivors through exercises to increase strength, improve balance, and reduce muscle atrophy. This therapy is crucial in helping survivors regain functional abilities, such as walking and performing independent transfers.

Occupational Therapy

Occupational therapists assist survivors in relearning activities of daily living, such as bathing and dressing. They also provide sensory retraining for those dealing with loss of sensation, such as numbness or difficulty with smell and taste. Occupational therapists play a vital role in helping survivors regain their independence and confidence in performing everyday tasks.

Speech and Language Therapy

Speech-language pathologists, or speech therapists, are crucial in addressing impairments related to speech and swallowing. They provide exercises to improve facial muscle strength and help survivors regain their ability to swallow. Additionally, they offer guidance on safe eating practices to reduce the risk of aspiration pneumonia, a common complication after a brain stem stroke.

Neuroplasticity and Consistency

One of the primary goals of rehabilitation is to stimulate neuroplasticity, the brain's remarkable ability to rewire itself. By forming new neural connections, functions affected by the stroke can be rerouted to healthier, unaffected areas of the brain. This process is most active in the first 3-6 months after a stroke, emphasizing the importance of early and consistent intervention.

Interactive Neurorehabilitation Devices

To stay motivated and engaged in their recovery, survivors can explore interactive neurorehabilitation devices for at-home use. These tools provide interactive and gamified exercises that complement traditional therapy, helping survivors stay committed to their rehabilitation journey.

Emotional Support

The emotional impact of a brain stem stroke cannot be overlooked. Many survivors experience fear, anxiety, and a loss of confidence as they navigate the challenges of their new reality. Support groups, talking therapies, and medications can play a crucial role in helping survivors manage these emotional difficulties and adjust to their new life.

Long-Term Commitment

Recovery from a brain stem stroke is a marathon, not a sprint. While the fastest improvements often occur in the initial 6-12 months, progress can continue for months and even years. Survivors must remain dedicated to their rehabilitation routines, even after being discharged from inpatient therapy. Outpatient therapy and at-home exercises are essential to maximizing recovery and helping survivors adapt to their new normal.

The emotional difficulties after a brain stem stroke

A brain stem stroke can cause emotional difficulties, including changes in mood and personality. These emotional difficulties can include:

• Low mood and mood swings
• Laughing or crying easily, sometimes with no apparent reason or in socially inappropriate situations
• Increased feelings of anger
• Feeling a loss of confidence in accomplishing everyday tasks or social activities
• Developing generalized anxiety disorder or post-traumatic stress disorder
• Denial about the consequences of the stroke and the need for help with day-to-day tasks

These emotional difficulties tend to improve over time and with treatment. Support groups, talking therapies, and medications such as antidepressants can help manage and improve these emotional challenges.

In addition to emotional difficulties, a brain stem stroke survivor may experience physical challenges and long-term disabilities. The physical challenges can include weakness, altered consciousness, difficulty breathing, dysphagia (trouble swallowing), and impaired vision. Intensive rehabilitation, including physical therapy, occupational therapy, and speech therapy, can help individuals regain function and independence.

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