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Ann Schwacke admits she was feeling down after a stroke four years ago severely limited her mobility. "I thought, 'Why me?' " the 84-year-old James Island woman said. "Why did this have to happen to me?" But once Schwacke began seeing therapists at Roper Rehabilitation Services , that changed.
"They helped me with my depression," she said as she steadily pedaled on a stationary bike inside the outpatient rehab unit at Roper Hospital. "When I came up here, my depression had to go ." Physical therapy assistant Lonnie Castellano (left) guides Ann Schwanke, 84, through exercises at Roper Rehabilitation Services at Roper Hospital on Sept.
10 in Charleston. Focusing more on the often-neglected emotional and mental health toll a stroke has on survivors is part of a new initiative in South Carolina funded by a grant from The Duke Endowment to Medical University of South Carolina . It aims to incorporate cognitive behavioral therapy alongside the physical and occupational therapy stroke patients are already getting.
And it would use a statewide telerehabilitation network to reach patients around the state, particularly those in rural areas where services can be lacking. Every year there are more than 795,000 strokes in the U.S.
, and the majority — 610,000 — are in patients who have never had one before, according to the Centers for Disease Control and Prevention. It accounts for nearly 1 in 5 cardiovascular deaths, and South Carolina is tied with Arkansas for the sixth-worst death rate from stroke, according to Statista.com .
SC Congressman Joe Wilson remains stable, but details on his medical condition unknown It is the leading cause of severe disability in the U.S. and cuts down mobility in half of those 65 years and older who survive a stroke.
It is also the leading cause of disability in South Carolina, said Michelle Woodbury, a professor at MUSC who is a longtime occupational therapist and researcher, as well as co-principal investigator on the Duke Endowment grant. Those sudden physical impacts also affect the mind and spirit of those patients: half of stroke survivors experience anxiety, dread and hopelessness afterward, a third of them are diagnosed with depression, and a quarter of their caregivers also suffer from depression, she said. Those mental and emotional effects can also have serious consequences: those who experience anxiety, dread and hopelessness are five times more likely to die within the first year as those who don't, and they are twice as likely to commit suicide, Woodbury said.
That's a particularly worrisome issue for the Palmetto State. "This is a problem because in South Carolina we have this high incidence of stroke and so we have these symptoms that need to be treated. But it's extraordinarily difficult for people to find mental health support," Woodbury said.
Ann Schwanke lifts weights during her rehab exercises. Stroke is the leading cause of severe disability in the U.S.
and cuts down mobility in half of those 65 years and older who survive one. Using $900,000 from the Duke Endowment, Woodbury and co-principal investigator Lisa McTeague are designing an emotional support network for stroke survivors in South Carolina that can help deliver that care. They aim to use cognitive behavioral therapy — talk therapy, that can be delivered to patients as they are getting the other services, such as physical and occupational therapy.
Most stroke patients have access to some form of rehab, including speech language pathologists for those who have trouble speaking or finding words as they recover. That is true even in rural areas of South Carolina after Woodbury and others used a previous Duke Endowment grant to add those services to MUSC's statewide telehealth network to create the telerehabilitation network. The next piece, which they hope to launch in October, is to add the emotional support.
A therapist works with a patient on the telerehabilitation network at Medical University of South Carolina. Other therapies focus on helping patients recover physical abilities and skills, fine motor dexterity, the ability to dress themselves, to walk, maintain balance and communicate. But this would "flip the script a bit and center the emotional recovery within the therapies that people already get," Woodbury said.
One way to achieve that is through a principle of talk therapy known as behavioral activation, using positive activities and goal-setting to help patients improve mood and outlook. "The idea is that when people do things that they want to do, so you set a goal for yourself and you achieve it, you feel great that you achieved that goal," Woodbury said. This is already done routinely in rehab now, particularly in occupational therapy, where patients might set a goal of being able to walk around the block or cook dinner and accomplish other tasks, she said.
The program would draw that out and help patients see they are gaining the skills they need and also emphasize those good feelings as a way of combating anxiety, dread and uncertainty. Flannery O'Neil knows all about that. She was only 34 years old when, in the middle of a conversation with her boss one day, she heard a loud ringing in her ears and suddenly lost the ability to speak.
She was rushed to a hospital, where she was given a clot-busting drug, but then had to be flown to a larger hospital for further recovery. She suffered from aphasia, the inability to understand or use language, and also a form of it known as acalculia, an inability to understand or process numbers. Today's Top Headlines Story continues below School districts change plans after tropical storm warning announced, inclement weather expected After 27 years, execution nears for Greenville's notorious killer Freddie Owens Islander 71 employees rescue elderly couple from submerging car at Isle of Palms Marina Editorial: Did SC mean to ban Bible from schools? Of course not, but it apparently did.
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But beyond even those difficulties was the uncertainty and loss of identity she felt as someone whose career was based on her ability to communicate. "In the blink of an eye all of that is taken away, and you don't know how much of that is going to come back and how that's going to come back," O'Neil said. "It's very scary.
It's very isolating." Helping patients deal with that, and the emotional part of it, is part of what rehab does, said Jerry Hurst, an occupational therapist with Roper Rehab Services who has worked with Schwacke. Patients are screened for anxiety and depression at the beginning, but therapists also work with them on seeing where they are now, where they are going and how far they've come, he said.
"If we stay focused on the past, it's hard to move forward," Hurst said. 'I'm a survivor': Community members come together for CSRA Heart Walk Part of what MUSC wants to do with the project is not only implement the emotional support but also provide a cost-benefit analysis that can then be used to show insurers and policymakers it is worth sustaining. Part of the project is also making sure it can be sustained for patients.
Most of them run into caps on how much rehab therapy insurers or the government will pay for. And when they hit those limits, the emotional support would end, along with those services. But MUSC is partnering with Stroke Onward , a national nonprofit, to continue to provide South Carolina patients access through that group.
It is stroke survivor-led and has a focus on emotional recovery and helping stroke patients rebuild their lives and identities. O'Neil, who's now Stroke Onward's chief operating officer, still remembers that feeling of "kind of reeling from going from, like, this healthy, happy-go-lucky, carefree (person) to, in the blink of an eye, your whole identity has changed," she said. Part of what helped her, in addition to rehab, was forming a support group where one didn't exist in her small town before.
Stroke Onward has contacts with 100 now. The MUSC project will also be creating specific approaches for emotional support for patients with particular issues, such as patients with aphasia, and also potentially facilitating approaches such as group therapy. ‘The spirit of improv’: A stroke upended his life.
Improv helped him regain it That kind of standardized, proven content has been lacking for stroke support groups and would be particularly welcome, O'Neil said. "Then that information can be easily distributed to support groups widely, and survivors can have easy access to that within the support group context," she said. Integrating this kind of focus on emotional well-being makes sense for occupational therapy in the clinic, Hurst said.
"We look at the person as a whole," he said. Schwacke, who has been receiving services at Roper for nearly four years, has received a lot of help. Physical therapist assistant Lonnie Castellano (left) watches as Ann Schwanke, 84, holds onto bars performing leg exercises at Roper Rehabilitation Services at Roper Hospital, Tuesday, Sept.
10, 2024, in Charleston. "Her right side was affected," said physical therapy assistant Lonnie Castellano. While her right arm is still a project, Schwacke pedaled away on her stationary bike for 22 minutes before she noticed and decided to stop.
"They don't feel sorry for you here," she joked while catching her breath. "They make you work." But she can also see how far she has come.
And she smiles when she talks about it. "I couldn't walk," Schwacke said of when she got to Roper. "I was in a wheelchair.
It has been unbelievable what they have done for me.".
