Jennifer's Story
Jennifer Dweik, 49, has faced her share of health challenges.
Over a decade ago, the Lakewood, Ohio native lost vision in her left eye. More recently, she had her right leg amputated above the knee due to complications from diabetes. So when Jen awoke one morning unable to move, she thought it might be a stroke.
Jen, a mother of four, called out to her children. When no one heard her cries for help, she managed to call her mother, alerting her that she needed assistance by saying “Mom, mom, mom, stroke.” Jen’s mother quickly called 911. A specialized stroke unit ambulance rushed her to Cleveland Clinic Fairview Hospital. On the way, paramedics gave Jen an infusion of tenecteplase, a “clot-busting” medication used to dissolve blood clots that cause strokes.
Upon arrival, Jen underwent an MRI, which confirmed she had suffered a middle cerebral artery (MCA) stroke on the left side of her brain. This type of stroke occurs when blood flow to the MCA, a major artery in the brain, is interrupted.
Jen spent the next week in the hospital recovering, during which time she underwent a cardiac catheterization, a procedure that checks for heart or blood vessel problems such as clogged arteries or irregular heartbeats. It uses a thin, hollow tube called a catheter that is guided through a blood vessel to the heart. To monitor Jen’s heart, doctors placed a Zio patch, which is a small, adhesive, waterproof patch worn on the chest to monitors an individual’s heart rhythm for up to two weeks.
The stroke left Jen struggling with weakness on the right side of her body, making it difficult for her to complete personal care tasks. Jen was also experiencing severe aphasia, or impairment in the ability to use or comprehend words, as well as apraxia, which is when a person has difficulty making the lip, jaw and tongue movements needed to produce speech. Her doctors recommended inpatient rehabilitation as the next step in recovery.
Upon admitting to Cleveland Clinic Rehabilitation Hospital, Avon, Jen’s goals were to speak normally and use her right arm and hand again. As an avid cook and crocheter, use of her hand was particularly important. Jen’s physician-led care team of nurses and physical, occupational and speech therapists worked with her to devise a plan to get her back home and doing the things she loves.
Physical therapists focused on improving Jen’s balance and ability to walk independently with her prosthesis. Initially, Jen scored only 11/56 on the Berg Balance Scale, a standardized way to assess balance; a higher score means better balance. Jen also required total assistance to walk 55 feet. Therapists helped her improve both balance and walking with use of the Andago, a specialized piece of rehabilitation equipment that uses mobile robotic technology to sense the patient's movements and actively follow them while providing body weight support via a wearable harness. Using this technology allowed Jen to see significant advancement in her balance and ability to walk without using an assistive device such as a walker or cane.
Physical therapists also had Jen practice stepping up and down off a curb to simulate walking into her home. They also worked with a prosthetist, a healthcare provider who makes and fits artificial limbs for people with disabilities, to help Jen achieve a better fit of her prosthetic leg, which was too large and made it difficult for her to walk.
Occupational therapists concentrated Jen’s therapy sessions on helping her regain movement in her right shoulder, arm and hand. With only about 50% of normal shoulder movement and no hand movement or strength, Jen was unable to dress herself or put on the liner that goes over her residual limb before her prosthesis without assistance. Therapists utilized functional electrical stimulation (FES) where mild electrical currents are applied to the skin to stimulate nerves and muscles to “wake up” after a physical or neurological injury. They also had Jen perform isometric weight training exercises, which involved holding her body in a position without moving her muscles or joints to help build strength and endurance. Additionally, worked on improving movement in her hand by squeezing sponges and play dough.
In speech therapy, Jen’s team helped her regain the ability to express herself verbally. Fortunately, Jen’s stroke had not affected her comprehension, so she was able to follow her therapist’s instructions as they worked on helping her formulate a sentence and say it as clearly as possible. Jen recalled one of the speech activities that she did that was most helpful, saying, “My therapist would give me a verb and I would pick the sentence to put the words together and then repeat it.”
After 14 days at Cleveland Clinic Rehabilitation Hospital, Avon, Jen had made tremendous progress. She was able to walk 300 feet with a cane, go up a step and complete transfers with assistance. She had also improved her score on the balance assessment to 34/56 – a significant improvement from where she started. Jen was independent with her personal care tasks and was able to put on her prosthetic leg without help and could open, close and hold items in her right hand. Her speech has also significantly improved, allowing her to communicate with friends and family.
It was the support of her friends and family that kept Jen motivated and working hard. “My mom was there every day and my kids and best friends all came to visit,” she said.
At discharge, Jen looked forward to returning home and enjoying some French fries. She also planned to continue building upon her progress with outpatient therapy.
Calling her rehabilitation experience “fantastic,” Jen said that she learned a lot about herself throughout her recovery. “I learned how strong I am. Anyone can do it if you have a lot of people around you to keep your mind straight. You can do anything!”