A Stroke Angel
HEALTHCARE PRO
Featured Interview At
June 2022
Michael J. Abughazaleh, PT, DPT
Senior Physical Therapist
Of all those on my Recovery Team, I have spent the most time with
my out-patient Physical Therapist, Michael Abughazaleh.
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For this reason, and because Michael did so very much to speed my
Recovery and then help me overcome the plateau in my recovery,
I am proud to have him be the FIRST featured guest joining me at
The Stroke Angel Center Court
SKIP
Visitors to Stroke Angel would like to know a little bit about your background Michael, and
how you came to be a Physical Therapist working with Stroke Survivors?
MICHAEL
My interest in the profession, and specifically working with stroke patients, began with my own experiences with my Grandfather. He experienced a stroke at age 66. I was young when he had his stroke. But, I did grow up living with our having to deal with my Grandfather's HEMIPELGAIA
(weakness on one side of his body); and APHASIA (his difficulty in communicating) which altered his speech and mobility - ultimately limiting his independence. As a family, we all appreciated the help his rehab team offered him in getting as much of his function back. It inspired me to pursue my career as a Physical Therapist.
SKIP
What types of Stroke Patients have you worked with Michael ?
MICHAEL
I've worked with patients who've been older, and younger ! My patients have survived mild,
as well as very severe strokes.
SKIP
From a Physical Therapy perspective Michael, what do these patients have In common /
MICHAEL
Every one of my patients experiencing his/her first stroke is taken completely by surprise when their stroke occurs. I have never had a patient say to me . . . "I was expecting this". Or, " I thought I was going to have a stroke ! "
SKIP
What do you find to be the biggest motivator(s) for Stroke Survivors in achieving their rehabilitioan goals ?
MICHAEL
The biggest motivator for Stroke Survivors in achieving their rehab goals is often the opportunity to regain meaningful and important functions like walking without assistance, dressing themselves, or driving an automobile again. For most, they would express their goal as
" getting back to the way they were before their Stroke ". Or, " to do the physical things they were able to do before they suffered their stroke. Patients have said to me, " I want to be able to pick up my Grandchildren again ". I hope that someday soon I can get back out on the golf course".
Or, sometimes their first priority is to "return to my job and be able to provide for my family".
Because strokes take away important things like walking normally or getting dressed by themselves, getting those things back can be a daunting challenge for most patients in rehab.
My patients are motivated most when together with their caregivers, we can finally see measurable progress in their rehabilitation. Success we can measure in days, weeks, and even months. Setting realistic goals with my patients and their caregivers, and meeting or exceeding those goals is more motivating than anything that can be said to them. Positive, measurable results, in my experience, usually lead to positive outlooks for my patients and their caregivers. Progress is the greatest motivator during their entire time in rehabilitation.
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SKIP
What is the biggest challenge for you Michael, as their therapist, in helping Stroke Survivors in their rehabilitation ?
MICHAEL
The biggest challenge for me in my work with Stroke Survivors is helping patients stay motivated
once they have completed the rehab process. But, even a patient that is progressing can still have their motivation challenged if they encounter a halt to, or slowing of their rehabilitation. A development we refer to as a PLATEAU; a shift that can really take the wind out of the sails of a successful recovery. In other words, Stroke Survivors usually make amazing progress for the first 3-6 months. However, in my experience, most will not recover 100%. Something in their speech, strength, walking, endurance or the use of a hand, arm, leg, or foot will be forever different. A plateau, or the leveling off of a patient's physical recovery, usually means the end of that patient's scheduled Physical Rehabilitation. I sometimes see Stroke Survivors months, even years, after their PT Discharge. Unfortunately for too many of them, their motivation to continue the positive life changes they instituted following their Stroke, like a heart-healthy diet and regular exercise, has dwindled. And for a few of these, they have returned to the kind of lifestyle that got them into trouble in the first place !
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SKIP
From your experience Michael, what are the biggest challenges Stroke Survivors, and their Caregivers, face in the Physical Rehabilitation ?
MICHAEL
I see the dynamics of the relationship between spouses and family members/friends change nearly immediately. The person who experienced the stroke may have gone from independent to needing help with daily tasks. The spouse or family member may now have a responsibility to help with medications, dressing, showering, cooking, driving the person with a stroke to doctor appointments, etc. This can be a challenge for both the survivor and the caregiver. Many family members are suddenly pulled into a caregiver role. I often hear the spouse/family is now the home PT and home nurse for their loved one. It can be difficult to be stern about insisting on doing exercises when the stroke survivor is not feeling motivated- or to watch them struggle to get a shirt on instead of helping because they’re trying to help the stroke survivor learn how to regain these abilities. The natural instinct to help is often suppressed to allow the stroke survivor the opportunity to gain their own independence. On the other end, I see the stroke survivor often feeling guilty. They often perceive themselves as a burden on the family. Many feel pressure to be able to return to work or contribute to the family in the way they were able to prior to the stroke. So the stroke presents challenges to changes in identity, dynamics, and responsibilities for both the stroke survivor and the caregiver.
SKIP
What developments in Physical Rehabilitation do you see as deserving more attention by your profession, and the patients they service ?
MICHAEL
What I would love to see one day in the medical field as a whole, is more preventative measures being taken. I think we can very obviously recognize the risk factors for stroke many years in advance: high blood pressure, high cholesterol, diabetes / high blood sugars, sedentary lifestyle, family history, etc. It is wonderful to see more risk factors are flagged and being offered a “healthy lifestyle coaching” program. Offering resources for diet, stress management, etc are categories that most insurance providers do very well with. For example, it is usually encouraged to do regular blood work. If this blood work comes back indicating high blood sugars in the diabetic range the patient is often counseled on ways to manage/ improve blood sugar levels, provided with educational handouts, sent to educational classes, provided medication, and/or a follow-up appointment to offer further guidance and management solutions. This is a great preventative model. I would like to see it as part of this model one day. Currently, physical therapy is often seen as an afterthought once someone has hurt their knee or back, after surgery, or after a stroke. I would like to see more attention to preventative exercise programs in my profession. Preventative programs could provide an exercise program that would reduce future risk for many medical issues like heart disease, stroke, and other orthopedic issues that sometimes result in surgery if not attended to early enough. It is common knowledge that people should “exercise to stay healthy.” I think we’ve all heard this over and over, but the lay person does not often know what is safe for them to do or what they should focus on. Physical therapy could help provide a safe starting point and exercise prescription that is catered to the individual’s needs and interests. For example, a physical therapist may help prescribe a water aerobics exercise program (including specific exercises, duration, intensity, etc) for someone who has knee pain and cannot tolerate or does not, enjoy “traditional” exercise at a gym such as a treadmill or a bicycle. This example shows how physical therapy can help provide a safe and enjoyable exercise routine that promotes cardiovascular health and reduces the risk for future heart attacks and stroke.
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EPILOGUE
I want to thank Michael for his honest and encouraging responses throughout our interview. I also want to sincerely thank Michael for being my inspiration in regaining the ability to WALK following the stabilization in my Acute Rehabilitation. I will never forget our first out-patient PT session when he asked me " What do you want to do ? " My response was . . . " WALK ! " And then he said in his calm clinical voice " then you need to walk ! ". He immediately gave me what seemed to be a daunting challenge. "It is 500 steps from the parking garage to my office. I want you to walk, with your walker, from there to here, for our next session two weeks from today." Just days out of Acute Rehab, that challenge felt more like 500 miles ! So Roberta and I went to our local park and marked off 500 STEPS together. A roundtrip into the park, as far as the pavilion, and back to the curb. We were to walk that length, at least once a day ( sometimes twice ) until my next PT session . . . where I proudly walked the 500 steps to Michael's office. We will be forever grateful to Michael for his vision of my recovery, his faith that we would accept this and his other challenges, and his professional guidance, all through my Journey To Recovery.
Skip and Roberta
