A stroke is a life-changing event. It often strikes without warning. And for those who survive, recovery is typically long and difficult.
Shawn Harrington of Sandwich, Massachusetts, was 46 when he had a stroke. He was outside that January day preparing his home for an impending snowstorm. When he came inside, his fiancée, Kelli Davis, noticed he was slurring his words and the right side of his face was drooping.
Kelli, an occupational therapist by training, knew these symptoms were telltale signs of a stroke. She called 911 right away. Paramedics arrived minutes later. But Shawn, who had previously had a traumatic experience at a hospital, refused to go with them.
Over the next two days, Kelli along with Shawn's father and adult son tried to convince Shawn to go to the hospital. When he started to lose function in his right arm and leg, he finally relented.
Shawn initially sought medical care at local non-Mass General Brigham hospitals before eventually receiving inpatient and outpatient therapy through Spaulding Rehabilitation, a member of Mass General Brigham. While he isn't all the way back to his pre-stroke self, he has made incredible progress over the past two years.
"The minute I walked through the doors of Spaulding Rehabilitation Hospital Boston, I knew he was where he needed to be," Kelli said. "These people spoke my language. I knew he was in good hands."
Tackling physical, occupational, and speech therapy
When Shawn first agreed to seek hospital care, Kelli drove him to a local community hospital. There, he was diagnosed with an ischemic stroke. The most common type of stroke, this happens when a blood vessel in the brain is blocked.
Later that day, Shawn was transferred to another local hospital for treatment. He then underwent a thrombectomy to break up the blood clot blocking the blood vessel. While the procedure was a success, his symptoms didn't improve. He couldn't speak clearly, his right arm was limp, and his right leg was weak.
Now Kelli had to decide where Shawn should go for inpatient rehabilitation. Having previously worked within the Spaulding network and living in a town where Spaulding has an active presence, she chose Spaulding. During his stay at Spaulding Boston, Shawn spent about five hours each day doing a mix of physical therapy, occupational therapy, and speech therapy.
Shawn, a former semi-professional soccer player, embraced the rigors of physical therapy. The sessions aimed to boost his strength and ability to get around. "I think the physical therapists enjoyed working with him because they knew he'd try just about anything," Kelli noted.
"They worked me hard, but it was good for me," Shawn added.
His occupational therapy focused on activities of daily living. Through these sessions, Shawn relearned how to do basic tasks like shaving, showering, getting dressed, and preparing meals. Regaining his fine motor skills was also a point of emphasis.
"He managed to move his thumb for the first time while he was in occupational therapy," Kelli recalled. "We all cried."
Speech therapy proved to be particularly tough. When he arrived at Spaulding, Shawn couldn't say anything. With a lot of hard work, he slowly made strides in his ability to speak, name objects, and read.
After almost two weeks at Spaulding, he had made good progress with his balance and ability to walk. The time had finally come to go home, one month to the day since his stroke.
"At that point, he didn't have much arm function, and he had about 25% intelligibility in his speech," Kelli said. "He still had a lot of work to do, but safety-wise, he was ready to be discharged."
Meeting the 'quarterback' of his care team
Now that he was back home, Shawn began outpatient therapy at Spaulding Outpatient Center Sandwich. He started with physical therapy and occupational therapy, each taking place back-to-back, twice a week. In addition, he went for speech therapy at Spaulding Outpatient Center Plymouth.
Shawn's physical therapist, Kinley McCracken, PT, DPT, worked with him on his gross motor skills, gait, and balance through activities like kicking a soccer ball and walking on a treadmill. Meanwhile, his occupational therapist, Jillian Crehan, OTD, OTR/L, focused on tasks that would allow him to return to one of his loves: driving his Mustang. That meant enhancing his right-sided vision and ability to use his right arm to shift gears in the car.
"Jillian worked intensely with him on those things, and I did a lot of work with him on his arm at home," Kelli said. "Slowly, things started to come back."
About three months after his stroke, Shawn had his first visit with Spaulding physiatrist Susan Ehrenthal, MD. Physiatrists specialize in nonsurgical care for conditions that cause pain and impair normal, everyday functions. Through their breadth of training, they aim to rehabilitate the whole person, addressing the patient's physical, emotional, medical, and vocational needs.
When Dr. Ehrenthal first met Shawn, he was showing signs of regaining movement in his right arm. But he was also experiencing shoulder pain and weakness, which she has treated with steroid injections.
Dr. Ehrenthal's initial goal was to have Shawn practice the types of tasks he would do on a daily basis. These included folding laundry and holding a glass. Later, he incorporated guitar lessons to enhance fine motor movement in his right hand.
Then there was the matter of his struggle with a condition common among people who have had a stroke: apraxia.
"That's where you know how to do something naturally, but if someone tells you to do it, you can't do it," Dr. Ehrenthal explained. "For example, if you're apraxic, you might brush your teeth twice daily as part of your routine. But if I asked you in my office to brush your teeth, you wouldn't know how to put the toothpaste on your toothbrush."
To treat his apraxia and continue sharpening his speaking skills, Dr. Ehrenthal referred Shawn for more speech therapy. Along with speech therapist Aubrey Sherman, SLP, at Spaulding Sandwich, he worked on functional communication—that is, doing everyday tasks such as talking on the phone or ordering food in a restaurant.
Dr. Ehrenthal said her role as a physiatrist is like that of a quarterback on the football field. She oversees and coordinates all aspects of the patient's recovery, from physical, occupational, and speech therapy to visual rehabilitation, psychiatric care, and various other types of specialty care.
"I make sure my patients are getting appropriate treatment and taking steps to reduce the chance of another stroke," she said.
