Most stroke patients don’t see much progress in their recovery after six months. By the one-year mark, they usually start to accept their health status as their “new normal.”
Susan Klein, a 73-year-old grandmother and resident of Denver, North Carolina, has defied the odds by continuing to achieve goals in physical therapy over two years after her stroke.
Susan had a stroke in July 2020. After completing some initial rehabilitation in spring 2021, she hit a plateau and wasn’t making progress. She continued to work on her mobility at home without much success.
Sixteen months after her stroke, she was spending most of her days in her wheelchair, and she was unable to walk. Her husband, Russ Klein, and her full-time caregiver, Sharlene Burke, were concerned about her safety and that she was gradually losing more of her independence. They encouraged her to give physical therapy another try.
In November 2021, Susan started working with Heather Harrison, a physical therapist with Atrium Health Lincoln Rehabilitation Denver. This was the turning point when extraordinary changes began to happen.
Within five to six weeks of the program, Susan was already making progress. As she started to achieve small milestones, her goals began to change. “Our initial goal was to get her up and out of her wheelchair without falling,” said Harrison. “But then we got her to walk longer distances and go up and down stairs – things I never thought would be possible.”
Now, more than two years after her stroke, Susan is still benefiting from therapy at Atrium Health Carolinas Rehabilitation. With a long history of treating neurological diagnoses, these physical therapy experts offer a stroke rehabilitation program that’s more specialized than what many other centers offer. In fact, Atrium Health Carolinas Medical Center, Atrium Health Pineville, Atrium Health Cabarrus and Atrium Health Union have been recognized as the top 10% for nationwide stroke care by U.S. News & World Report.
Strategies that worked
To help Susan improve her mobility, Harrison and her physical therapy team used the following methods:
Find the right motivation. From the beginning, it was vital for Harrison to identify the type of feedback Susan responded to and what made her feel comfortable to try new activities. “We spent time getting to know Susan in order to figure out her goals and motivations,” said Harrison. “We tried giving lots of positive reinforcement and started noticing small achievements. We then tried to relate how those small accomplishments were going to allow Susan to achieve her larger goals.”
For example, Susan was having trouble standing in the shower. When Heather realized that Susan responds well to music, they worked on practicing standing for long periods of time in the clinic while listening to music in order to improve her standing balance and endurance. At home, Sharlene plays music while she’s in the shower, which has made it much easier for Susan to stand.
Manage anxiety and fear. Susan was coping with severe depression and anxiety after her stroke. She had given up the hope of achieving what she perceived as a normal life. She had some spasticity (muscle stiffness) in one of her legs. She also didn’t have good motor control in her legs for walking. This made her very anxious to try new activities, since she was afraid of falling.
“It was important for us to remain positive but also acknowledge that trying new things is scary,” said Harrison. “We assured her that we would do our best to keep her safe, and this gradually built up her trust and confidence to push a little farther when trying stairs and walking longer distances.”
Sharlene appreciated how the therapists listened to Susan’s concerns if she was timid about trying something new. She explained, “They allowed her to gather her thoughts before doing any activities. And, of course, they helped her to the finish line.”
Set small, achievable goals. As Harrison and Susan set small goals, they built on the success of any small achievements during physical therapy. For example, if Susan walked 30 feet during her session, Harrison would encourage her to take a couple more steps at the following session. She was able to walk into the clinic from the parking lot on her very last day of therapy with her cane for the first time (approximately 200 feet).
“My nurses showed the utmost respect to the pace I needed to help manage my aches and pains,” said Susan. “The therapists explained everything to me prior to each exercise. Sometimes it took visual presentation, but they made sure I understood the task prior to execution.”
Relate functional skills to personal goals. As Susan began building her functional skills, Heather helped relate those skills to her personal goals. Once Susan could see how small activities were helping to achieve her goals at home, she became more motivated to keep trying new activities.
Try photo and video feedback. Sharlene took videos and pictures during Susan’s physical therapy sessions and replayed them at home. This allowed Susan to share her progress with her husband and continue to improve. “After a stroke, it’s important to learn how your new body moves with the neurological issue on one side,” said Harrison. “Susan is a very visual person, so it helped her to see herself as she moved and internalize that feedback.”
Make therapy fun. Heather used music and dancing to encourage Susan’s movements. This helped her have fun while she practiced balancing and shifting during physical therapy.
Goals achieved
An important goal for Susan was to dance on her 73rd birthday, which she achieved this past April. Heather played her favorite music during therapy to help her practice her dance moves. On her birthday, she was able to walk from the car to the restaurant and sit in a regular chair – something she hadn’t been able to do since her stroke.
Susan also achieved the goal of returning to sleeping in her own bed. She had been sleeping in a hospital bed since her stroke and was eager to return to a normal routine. Using a table at the clinic that could simulate the height of her bed, Susan practiced getting in and out of bed safely.
Susan made a recent trip to a retail store and tried on clothes for the first time since her stroke. While trying them on, she was able to put into practice a side-stepping technique that Harrison taught her during therapy. “She was elated because she could see the functional application of her physical therapy, and it helped her reach another goal,” Harrison noted.
Over the summer, Susan successfully walked down her back steps at home and got into her pool to swim. She achieved these goals with little assistance from her support team.
Susan chose Atrium Health’s physical therapy team because of their outstanding care and closeness to home. “The level of care throughout the entire process has been exceptional,” she explained. “I had caring, compassionate therapists who were sensitive to my needs. This brought about a fast healing process in a friendly environment.”
Continued progress
Susan is happy to continue gaining new skills. “I welcome the fact that I’m that much closer to walking again,” she said. “Just recently, I was able to get up out of the recliner without assistance.” Her future goals include taking a boat ride with her family.
Aside from physical therapy, Harrison attributes Susan’s continued progress to her dedication to achieving her goals and her ongoing support from Russ and Sharlene.
“Watching Susan’s progress reminds me of why I chose this profession: to help people,” explained Harrison. “To see someone go from spending most of their time in a wheelchair to moving and enjoying life with their grandkids is so rewarding. Those are the small things we take for granted.”
What has made the biggest difference for Susan? “Confidence is key,” she said. “That and the experience of the therapists will make walking again possible. I recommend Atrium Health to anyone needing help like I did.”
Outpatient physical therapy works in partnership with Atrium Health Musculoskeletal Institute, providing expert rehabilitation care.
