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Dr. Alyson Jones, Methodist Rehabilitation Center

When it comes to stroke survivors facing debilitating effects, recovering the ability to hope can be as critical as relearning how to walk, talk and care for oneself.

“Depression is a big deal as they consider their own mortality,” said Dr. Alyson Jones, who recently joined the Methodist Rehabilitation Center stroke-care program in Jackson as a physical medicine and rehabilitation specialist. “After stroke, it’s often hard for a patient to see what else their future could hold for them. We have a team approach and work closely with our neuropsychology department, to let the patient know there can be life after stroke.”

The complex way a stroke can affect a patient’s mind and spirit is something Jones first observed as a child, long before she would learn a name or reason for it. From visits to her wheelchair-bound paternal grandmother, Jones recalls a feeling of helplessness in watching her grandmother struggle to express herself, the futile effort producing tears instead of speech.

“There were things she wanted to tell me, but she just couldn’t get it out,” Jones said. “I realize now she probably got depressed — and there are plenty of reasons to be. You can’t move the way you want to, you can’t express what you want to. In her case, you couldn’t do anything but sit inside the shell of your own body.”

Memories of her grandmother and those of other close friends and relatives who’ve suffered from stroke help fuel Jones’s commitment to serving the stroke survivors who make up the majority of her patients each day.

Among them, most of her patients are elderly and suffer from multiple medical issues, including diabetes, high blood pressure and high cholesterol. Just as challenging are the younger patients, including one recent patient stricken with the rare Moyamoya disease, which causes a succession of strokes.

Other younger patients of Jones’s have been chiefly blacks whose strokes were connected to other diseases or disorders, such as atrial fibrillation, bacterial infection and dysfunctional uterine bleeding.

According to the U.S. Department of Health and Human Services, blacks have twice the risk of stroke as do white adults and are 60 percent more likely to die from stroke. They’re also more likely to become disabled and have difficulty with the activities of daily living, Jones said.

Much work remains to be done to educate people about how to avoid the risk of stroke, Jones said — both among the black community and across Mississippi as a whole.

“I think the challenges are in bringing awareness and understanding to things like diet and going to see your primary-care provider,” she said. “A lot of people still believe if they don’t feel bad, nothing must be wrong. Or they say, ‘I don’t want to know what’s wrong with me. I’m just going to live my life, and whatever happens, happens.’”

When stroke does happen, the process of recovery begins in working with the patient and their family to determine what kind of lifestyle the patient hopes to reconstruct.

“We determine whether you were working or were a stay-at-home person, and what you want to do when you get out of here,” Jones said.

The next critical goal for Jones and her team is keeping a patient’s other medical issues in check as they undergo the rehabilitation regimen.

Acute-stroke patients who encounter no other complications on the road to recovery may be able to return home within a week of their stroke, Jones said. Patients with more severe problems may spend as many as four weeks at Methodist, and then step down to a sub-acute treatment facility.

For both kinds of patients, the recovery and rehabilitation process continues at home.

In contrast to the days when her grandmother was stricken with stroke’s aftereffects, patients today have the benefit of rehabilitation therapy having come to the forefront, Jones said. Therapists and nurses work to keep a patient’s joints from becoming contracted, so that joints and muscles will have a chance at recovery if and when the brain’s ability to control them returns.

“Improvements in spasticity treatment are a major development in the care of stroke patients,” Jones said. “We’ve also developed therapies to teach parts of the brain to take over functions that the injured side of the brain once provided.”

Jones has also seen benefits of the “clot-busting” drug tPa, although its use remains controversial in emergency room practice.

“There’s been a lot of litigation associated with that, but I’ve seen it work and seen people who otherwise would have a large deficit come through fairly nicely,” she said. “That’s a hopeful thing, although so many people don’t get to the ER within the 3-hour window after the first symptoms occur. That’s where we come in to treat the aftereffects, and determine how they can achieve the best possible recovery.”

Methodist Rehabilitation Center treats more than 260 stroke patients annually and provides a stroke-specific rehabilitation program.

In addition to the lead PM&R physician and neuropsychologists, the stroke team also includes certified rehabilitation nurses, physical therapists, occupational therapists, speech therapists, therapeutic recreation specialists, vocational rehabilitation counselors and dieticians. A patient’s referring physician is also encouraged to remain involved in his or her care.

The rehabilitation process may include use of Methodist’s Motion Analysis Laboratory, as well as recreational activities like art therapy, pet therapy and game night. Patients learn to modify leisure activities to continue enjoying them at home, and also take part in organized outings to restaurants and malls in preparation for returning to their own communities.



April 2008

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