Category Archives: Treatment

Rehabilitative Services

The following is a list of organizations providing rehabilitative services. Key: PT = Physical Therapy, OT = Occupational Therapy, ST = Speech Therapy

Christiana Medical Arts Pavillion 2
4735 Ogletown-Stanton Road, Suite 1205
Newark, DE 19713
302-623-4050
Speech Therapy

Christiana Care Rehabilitative Services
christianacare.org/rehabilitation
With locations in Brandywine, Chadds Ford, Glasgow, Middletown, Newark, Pike Creek, Smyrna, and Wilmington
PT, OT, ST, Audiology Services

Concord Health Center
161 Wilmington-West Chester Pike, Suite 200
Chadds Ford, PA 19317
PA: 610-361-1195 | DE: 302-320-7610
Vestibular PT, Neurological PT/OT/ST

Delaware Rehabilitation Institute
University of Delaware, STAR Campus
540 South College Avenue
Newark, DE 19713
302-831-4615
www.udel.edu/dri

Middletown Care Center
124 Sleepy Hollow Drive, Suite 101
Middletown, DE 19709
302-449-3050
Aquatic Therapy, Hand Therapy (OT), Neurological OT/PT/ST, BIG & LOUT (Parkinson’s Disease)

Post-Acute Medical Rehabilitation Hospital of Dover
Coming 2019!</em
1240 Mckee Road
Dover, DE 19904
PAM Rehabilitation Hospital of Dover

Pivot Physical Therapy
Various locations throughout Delaware, Pennsylvania, and Maryland
www.pivotphysicaltherapy.com

Springside
300 Biddle Avenue, Connor Building, Suite 101
Newark, DE 19702
302-838-4700
Aquatic Therapy, Neuropsychology, Neurological OT/PT/ST, Audiology

Wilmington Hospital
501 West 14th Street, 6th Floor
Wilmington, DE 19801
302-320-6920
Center for Rehabilitation, Neuropsychology, Fluoroscopy, MBS Studies, Neurological OT/PT/ST

Hospital Care for the Stroke Patient

LEE P. DRESSER, M.D. NEUROLOGIST.

WILMINGTON NEUROLOGY CONSULTANTS

 

Stroke patients are often admitted to specialized sections of the hospital where they can be monitored closely. If the patient has received T.P.A., the clot dissolving medicine, they will spend the first day in the intensive care unit (I.C.U.). Often they wear leads on their chests to monitor the electrical activity of their hearts. To make sure the injured part of the brain receives a rich supply of oxygen, it is frequently supplied to stroke patients by nasal tubes or a mask. Most patients are given fluids through tubes in their veins to help prevent dehydration. Nurses will check their neurological status frequently to make sure the symptoms of stroke are not worsening. The stroke patient may not be given anything to eat or drink until they are seen by a speech therapist. This is to make sure they can safely swallow and do not choke or have food or drink go into their lungs and cause an infection. Patients may be instructed not to get out of bed and to lie flat for the first 24 hours after they suffer a stroke. After that they may be told to only get out of bed with help since balance problems are common with stroke and can lead to falls. One of the problems that can occur after a stroke is the development of blood clots in the legs. This happens because of lying in bed and being unable to move one side of the body. To prevent this, some patients will be given injections of low doses of a blood thinner or fitted with air powered compression stockings. A catheter tube may be temporarily used to help drain the bladder of stroke patients immediately after admission to the hospital.

 

The first day in the hospital for stroke patients in often filled with testing. They may have a computerized tomography (C.T.) picture of their brain made if it was not done in the emergency room. A magnetic resonance imaging (M.R.I.) scan of their brain may be performed. At the same a M.R angiogram (M.RA.) picture of the blood vessels supplying the brain may be made. The blood vessels in the neck can be investigated with a carotid ultrasound. Because a blood clot coming from the heart is a common cause of stroke, sound wave pictures of the heart may be ordered. Sound waves can be bounced off the heart from the chest (transthoracic echocardiogram) or from a probe placed in the swallowing tube (transesophageal echocardiogram or T.E.E.). Blood tests are often taken during the first few days in the hospital. If a blood thinner is used to prevent stroke, it may be necessary to do blood tests more than once a day. Most tests are done to find out what caused the stroke and help doctors prevent any more strokes.

 

Usually within 48 hours of entering the hospital the stroke patient is evaluated by a number of therapists. These include speech therapists who help evaluate and treat problems with talking and swallowing. Physical therapists help patients recover the strength in their arms and legs and improve their ability to balance and walk. Occupational therapy helps patients with skills needed to take care of themselves, such as feeding, cleaning, dressing and bathing. Patients may be evaluated by a physiatrist, which is a doctor who specializes in rehabilitation. The physiatrist will help determine where the stroke patient should go to continue rehabilitation after leaving the hospital. If the patient has minor problems, they may go home. If they have more severe problems, they may go to a rehabilitation hospital or a nursing home (also called an extended care facility). Most extended care facilities offer speech, physical and occupational therapy. Stroke patients are usually evaluated by social workers and discharge planning nurses, who work with the doctors to help decide what is the best place for the patient to go when they leave the hospital. Most stroke patients leave the hospital 3-7 days after they had their stroke.

Atrial Fibrillation

HELEN SENSENY, M.S.N., R.N., DTCC NURSING FACULT Y

 

Atrial fibrillation is an irregular heart rhythm where the top chambers of the heart (atria) quiver. Normally these chambers beat in sequence with the lower parts of the heart (ventricles). This quivering or fibrillating does not allow for complete emptying of the upper chambers. Without complete emptying the blood can pool and this increases the risk of blood clot formation. The blood clots can then break loose and travel into the brain, lungs and other parts of the body. The blood clot that travels to the brain can cause a stroke because it will block circulation to that part of the brain.

 

The biggest danger of atrial fibrillation is stroke. Atrial fibrillation is found in 2.2 million Americans. Atrial fibrillation is responsible for 140,000 strokes annually, which is about 25% of all strokes. If you have atrial fibrillation, you can greatly decrease your risk for stroke with appropriate treatment.

 

Some people may have atrial fibrillation and not know it. Others may start to feel tired and a little unwell, while others my feel acutely ill. Atrial fibrillation may cause the heart to beat very fast which can be life threatening and slowing down the heart is a important to prevent heart failure.

 

The goals of treating atrial fibrillation are to convert to a normal rhythm and to prevent clot formation. Converting to a normal rhythm is not always possible, so preventing the blood from clotting while remaining in atrial fibrillation, is an important part of therapy.

 

Medications can be used to slow down the heart rate, stop atrial fibrillation and to keep the blood from clotting. When medications are not successful, there are several different treatments to try to convert the rhythm. These include electrical cardioversion, radiofrequency ablation and/or surgery.

 

In electrical cardioversion, sedation is given, and then an electric shock is delivered to the heart to restore normal heart rhythm.

 

In radiofrequency ablation, a thin flexible catheter is inserted through a blood vessel and guided to the heart muscle. Sophisticated equipment is then used to determine the exact area of the heart that is causing the abnormal electrical responses that are causing the atrial fibrillation. Once identified, this tissue is then altered using radiofrequency energy to stop the abnormal stimulus which causes the atrial fibrillation.

 

Surgery can also be used to destroy the abnormal electrical pathways that cause atrial fibrillation. “Maze” is a surgical procedure where a heart surgeon makes multiple cuts into the atria in a Maze type pattern. The scars created from these cuts do not conduct electrical energy so the abnormal electrical impulses which caused atrial fibrillation do not spread through the atria. This helps prevent atrial fibrillation and restores a normal rhythm.

 

The most common place for clot formation in the atria is an area called the left atrial appendage. Anticoagulation medications can be given to prevent clot formation in this area. New procedures and devices such as the Watchman Device and the Lariat II are being used to close off this appendage and are showing success in preventing clot formation.

 

To prevent blood clot formation, anticoagulant and antiplatelet medications make the blood less prone to clotting. Warfarin (Coumadin) and Pradaxa (dabigatran) are the anticoagulants most often used. Aspirin and Plavix (clopidogrel) are the antiplatelet drug most often used. Antiplatelets medications are not as effective as anticoagulants in preventing stroke, but have a lower risk of bleeding complications. Long-term use of warfarin in patients with atrial fibrillation and other stroke risk factors can reduce stroke by 68 percent. A stroke caused by atrial fibrillation is often worse than other causes of stroke. It is therefore very important that patients with atrial fibrillation get treatment.

 

References and Further information on Atrial Fibrillation:

http://www.a-fib.com/Overview.htm

http://www.mayoclinic.org/maze-heart-surgery/

http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/HealthyLivingAfterStroke/ UnderstandingRiskyConditions/When-the-Beat-is-Off—Atrial-Fibrillation_UCM_310782_Article.jsp