Traveling the Road to Recovery From Stroke

Since her stroke in April, Carla Musselman-Smith, right, has been rebuilding her strength, capabilities and confidence in partnership with the rehabilitation team at Cedars-Sinai.  Also pictured: Occupational Therapist Kendra King, OTR/L.

Creativity, Critical Thinking Play Key Roles in Stroke Rehabilitation

Motivated by music and forward-thinking therapists, Carla Musselman-Smith is on a path to regaining her independence.

Musselman-Smith, right, found inspiration and motivation in Clinical Recreation Therapist Wilson Wong’s holistic approach to her recovery.

Once an avid concertgoer who would stand for hours while waving a lighter above her head, Musselman-Smith recently found herself facing a very different reality – one where she was begging her limbs to reawaken after an ischemic stroke caused severe weakness and nerve damage to the right side of her body.

"Arm, I love you," she remembers saying, tears running down her cheeks, just weeks after the stroke. "Do you remember what you use to do for me? I need you to remember how to be an arm again. And leg, you have been so strong. You have to learn to do it all over again.

"We will all start all over again."

Musselman-Smith knows her journey toward recovery will be long, but thanks to the rehabilitation experts at Cedars-Sinai, she also knows she is not alone. The therapy and support the 61 year old received in the Inpatient Rehabilitation Unit's Stroke and Neurologic Rehabilitation Program helped her to walk and empowered her to communicate.

"They really taught me how to take care of myself, and sometimes that can be a whole new ball of wax after a stroke," she said.  "But I'm going to be a reliable, thinking, speaking and walking person. I am going to recover."

The Stroke

After spending the afternoon of April 4 at the pool of a Los Angeles country club, Musselman-Smith noticed she could not walk in a straight line. Assuming her blood sugar levels had dropped, she ordered a chicken sandwich and took a short rest in the sun.

When she got home, though, she was still groggy. Hours later, around midnight, Musselman-Smith went to the restroom and collapsed. A clot had developed in one of the vessels that delivers blood to her brain, resulting in numbness to the right side of her body and loss of balance.

Based on the severity of her symptoms paramedics rushed her to Cedars-Sinai, a Comprehensive Stroke Center equipped to treat the most challenging stroke cases.

For many ischemic stroke patients, neurologists are able to stop the stroke and reverse its symptoms by injecting the clot-busting drug tissue plasminogen activator (tPA). In order for the drug to work, though, it must be given within four and a half hours of the stroke's start.

Musselman-Smith was well outside of that treatment window.

"When I woke up the next morning I couldn't talk, roll over or lift my right hand," Musselman-Smith said. "My shoulder, hip, leg and ankle were just dead weight. I couldn't even move my toe when I tried."

The Therapy

Although dead brain tissue cannot be restored, the intensive rehabilitation at Cedars-Sinai helped Musselman-Smith overcome some of her disabilities by training other parts of the brain to do what the damaged part originally did.

Lauren Shrigley, a physical therapy student, left, and Physical Therapist Sarah Zaluski, right, work with Musselman-Smith during a recent visit.

The hospital's Physical Medicine and Rehabilitation Department provides patients with an interdisciplinary team of physical, occupational and recreational therapists, speech language pathologists and neuropsychologists who work with patients to achieve their individual goals.

Through myriad specialized activities focused on building strength, skills and confidence, the team of rehabilitative specialists helped Musselman-Smith relearn and adapt what were once everyday activities – the stuff of life.

This adaptation is a core part of building future independence and the best possible quality of life for patients after a stroke.

"It's really about getting them back to whatever they were doing," said Pamela Roberts, PhD, OTR/L, CPHQ, FAOTA, director of the Physical Medicine and Rehabilitation Program. "We even have a car that is used to help patients learn how to drive again."

Recognizing Musselman-Smith required extra care and attention, Clinical Recreation Therapist Wilson Wong took a holistic approach to her therapy. To help patients relax, Wong typically inquires about their leisure and recreational interests.

"When I asked Carla what kind of music she likes, she lit up and said the Grateful Dead," he said. "I knew instantly that music was my way into her rehabilitation. She's gone to almost every single one of their concerts."

Wong found a live recording of the 1980 New Year's Eve Grateful Dead concert at the Oakland Auditorium and played it during one of their sessions. Unbeknownst to Wong, Musselman-Smith had been in the audience that very night.

Listening to the American rock band had Musselman-Smith working on her physical and motor skills without realizing it. Wong said she was on point while tapping her feet to the beat of the music, sharing stories about concerts and singing along with bandleader Jerry Garcia.

"This is such a forward-thinking hospital that goes above and beyond protocol to make sure a patient is on their way to a healthy recovery," Musselman-Smith said. "Wilson designed a program especially for me and that perked me up and made me want to do better."

The Recovery

Zuluski, left, and Shrigley, center back, assist Musselman-Smith in physical therapy exercises to rebuild her strength and balance.

Neuropsychologist Martin Stern, PhD, said one of the messages he tries to convey to patients is to learn to be satisfied with small gains and have hope that tomorrow will be better – that it's OK to have a "new normal."

"We are really focused early on in helping patients cope with any limitations they may have and instill in them this is not the end point, but rather it's the beginning of a gradual recovery process," he said.

That process starts right after the patient has had a stroke. The patient's neurologist works closely with the rehabilitation team to order treatments and therapies based on their unique needs, Roberts said.

"Depending on where patients are, Cedars-Sinai is invested in providing them with the therapy they need to get them back to a productive life," she continued. "Our whole philosophy is to get patients up, moving, feeling good and taking care of themselves."

In Musselman-Smith's case, she was admitted to the Inpatient Rehabilitation Unit for intensive rehabilitation right after her stroke. A month later, it was clear that she would need continuing care, and was transferred to a skilled nursing facility. She later went to another rehabilitation facility specializing in stroke recovery.

Cedar-Sinai's social workers helped Musselman-Smith along the way, by accessing specialized care in the transitional rehabilitation home. There she received daily physical and occupational therapy and participated in group activities, such as going on shopping trips and out to restaurants for a meal.

By August, Musselman-Smith was able to move back into the comfort of her own home. She meets regularly with Jana Baumgarten, MD, her physiatrist, and is continuing her therapy at Cedars-Sinai Outpatient Therapy Services.

New Normal

In honor of his personalized efforts on her behalf, Musselman-Smith brought Wong a copy of the May edition of Rolling Stone magazine, featuring the Grateful Dead.

Musselman-Smith is working through the lingering nerve weakness, regaining coordination in her right arm and wears an ankle and foot brace to support her leg. She can walk short distances with a cane and uses a wheelchair for longer excursions. Her speech continues to improve – especially when she gets to talking about the Grateful Dead or the shenanigans she got up to in her 20s and 30s.

"Quite often I would spend hours before the concert waiting in line so I could be on the rail that was in front of the stage," she reminisced. "It was worth six hours in line before the concert to get that spot, and then another four at the concert. I didn't want anyone in front of me – then again, all the hard-core kids would do that."

The stroke may have stopped her from seeing her favorite band perform for the last time in Chicago at their July 50th anniversary concert, but it didn't prevent her from visiting the "Bill Graham and the Rock & Roll Revolution" exhibit at the Skirball Cultural Center in Los Angeles. Graham was a concert promoter and manager for some of the most prominent bands in the music industry, including the Rolling Stones, Santana, Led Zeppelin, and of course, the Grateful Dead.

"It was one of the best things I've done culturally since I had my stroke," Musselman-Smith said. "I was my first excursion in my wheelchair, but that's ok, it was an amazing exhibit."

Before an acupuncture visit at Cedars-Sinai in August, Musselman-Smith surprised Wong with the May edition of the Rolling Stone magazine with the Grateful Dead on the cover.

Occupational therapist Dawn Hironaka, OTR/L, who was instrumental in helping Musselman-Smith recover motor function of her right hand, was impressed when the former patient used that hand to flash the "shaka" sign – a common cultural greeting in Hawaii, Hironaka's home state and where Musselman-Smith once studied healing arts.

The three spent about an hour catching up in the rehabilitation gym, a room Musselman-Smith spent hours in while she was recovering from her stroke in April.

"I could not have come this far in my recovery if I didn't have your smiling faces and positive attitude," she told them. "Having you say, ‘You can do it Carla' helped me believe I really can."

Since her stroke in April, Carla Musselman-Smith, right, has been rebuilding her strength, capabilities and confidence in partnership with Cedars-Sinai rehabilitation experts.