Michael Johnston, 37, planned to spend his Christmas vacation at home with his wife and three young children, but those plans came to an abrupt halt when he had a stroke last December 17. Michael had been admitted to UAB Hospital that day for severe dehydration due to a stomach virus. “I thought I was going home the next day, when I had the stroke. I knew something was very wrong when I suddenly couldn’t get up, couldn’t move my arm. I was completely paralyzed on the left side.”
“Michael had a stroke on the right side of his brain, affecting the left side of his body,” says Alison Brown, his occupational therapist at UAB’s Spain Rehabilitation Center. “It’s very uncommon for someone his age to have a stroke—most stroke patients are between 50 and 80.”
Why a stroke so young? Smoking is the strongest preventable risk factor for a stroke. Michael smoked a pack a day for 20 years, but began cutting back in 2004 and is now down to two cigarettes a day. According to his physician, UAB neurologist James Halsey, Jr., M.D., the risk to blood vessels virtually disappears one year after complete smoking cessation.
Michael’s other risk factors for stroke include a history of high blood pressure and high cholesterol. He also has an elevated level of homocysteine, an amino acid in the blood. Each of these factors must be monitored closely by a physician. Dr. Halsey explains that dehydration from the stomach virus was quite possibly the “straw that broke the camel’s back,” resulting in Michael’s stroke.
As an inpatient at UAB Hospital and at Spain Rehabilitation Center, Michael received physical, occupational and speech therapy. After 11 days, he was released for outpatient treatment. Michael, his wife, Jodi, and his occupational therapist, Alison Brown, met with ehealth to explain how therapy is helping him recover.
Jodi: “At first Michael’s speech was slurred, so therapists worked with him on activities such as blowing. They also worked on range of motion and strengthening exercises for his arm. As an inpatient at Spain, he could move his arm but it was very, very weak.”
Michael: “Christmas morning I got up around 4:30 because I was so excited about my children coming to visit me at the hospital. I went in the family room at Spain and did some hand exercises. It was the first time I could make a fist. I was so tired after the effort, I told my wife it was almost like trying to perform telekinesis, it took so much concentration.
“When I got home, Jodi basically had another kid to take care of. I needed help getting dressed. My 12-year-old daughter, Haley, helped me tie my shoes each morning. I had to be careful about cooking—I could cut or burn myself because I still didn’t have much feeling in my left hand.”
Alison: “When Michael came to outpatient therapy his left hand had no fine motor coordination or dexterity. He had ‘learned non-use’ of his left side—he was using his right hand because his left was so weak. The more he compensates with the right hand, the less the left will want to do.
“Our main goals are to re-educate his muscles to perform everyday tasks, and to strengthen his left hand. We’re focusing on activities of daily living, such as typing, because he’s a computer programmer.”
Michael: “When we started working on typing, I would hit several keys at one time with my left hand. Now I’m doing much better.”
Alison: “One way we are re-educating his muscles is with a neuromuscular electrical stimulator (e-stim), attaching electrodes to specific muscles of his hands to make them contract for a certain task such as pinching to grip something. When the muscles contract, they send a message to his brain, enabling him to relearn these movements.
“Michael also had left visual field deficit, which caused him to miss seeing something on his far left, such as the left side of a page when reading.”
Michael: “Haley helped me work on this, telling me to me find the capital P’s on a page, or playing cards where you have to do things left to right. My eyesight is better, so I’m driving now.”
Alison: “Michael has played the guitar and drums for years, and that’s helped a lot with his therapy because years of practice have ingrained many coordinated movement patterns in his brain. We’re using music as part of his therapy because it’s something he does for fun, and in our sessions on the piano his isolated finger movements and coordination are improving.”
Michael: “My brain and hand are starting to communicate more now. A month after my stroke, I was back at work at UAB full time. My typing is slow—I primarily use my right hand at work. At first it took so long to type it was frustrating. In computer programming, if you have a period or space in the wrong place, it completely messes up the code. But I’ve learned to be patient, and my co-workers have been great.
“I was extremely lucky to be at UAB when I had my stroke. Ten minutes after I couldn’t get up or move my arm, I was having a CT done. From the time I came to the ER, the doctors and nurses—everyone—went above and beyond what I expected.”
Alison: “At Spain, we have advanced treatment tools because it’s a university-based hospital—we have access to cutting-edge equipment and many different treatment options.”
Michael: “I’m participating in a UAB study with Dr. Georg Deutsch—they’re monitoring my recovery process for a year, to see how my brain recovers. I want to be able to help other people who have suffered from a stroke.”
Alison: “Research influences the treatments we provide, such as the studies they’ve done at UAB’s Taub Therapy Clinic with constraint-induced therapy, in which the patient’s good arm is constrained to force the patient to relearn how to use the affected arm.
“There is great plasticity in the brain. Neuro re-education can be achieved through neuromuscular electrical stimulation along with therapeutic exercises. In this way, the brain can be retrained to perform more functional, coordinated movements.”
Michael: “My personal goal is to be back to normal in six months. I will recover fully.”
For more information about rehabilitation services at UAB, or to schedule an appointment with a UAB physician or therapist, call UAB HealthFinder at (205) 934-9999 or 1-800-UAB-8816. Or visit www.uabhealth.org.
For more information on the symptoms of stroke, log on to our Web site at www.uabhealth.org/strokesigns.
If you’d like more information about the Comprehensive Stroke Center at UAB, log on to our Web site at www.uabhealth.org/strokecenter.