Back in the game—rehab after stroke and skull fracture

“If you’re going to fall and hit your head, it’s good to do it in a hospital,” says 50-something nurse Andy of his own experience following a stroke at work last November.

Andy has been working in patient flow roles for decades, responsible for admitting and discharging patients from hospital efficiently and with care. He says his stroke happened at a critical moment where the stresses of life, work, and an abnormal heart rhythm, converged.

“I fell, fracturing the back of my skull from top to bottom. It was a big fracture.”

Andy recalls waking up in the emergency department with no idea what had happened. He spent 24 hours in intensive care and then 10 days as a patient in a stroke unit. After being discharged from hospital, Andy needed to keep his activity level low for six weeks to give the skull fracture time to heal. In his mind throughout this time was the knowledge that if he put the work in with rehabilitation, he’d be better off long term with his abilities and independence.

Despite some hearing loss in his left ear and resultant balance issues, Andy was assessed as being young and well enough to undertake his rehabilitation as an outpatient. He was referred to Royal Rehab for a multidisciplinary clinical therapies program.

“On assessment day, I sat down with the team to discuss where I’d come from and where I could now go. My wife was with me so she could be part of the planning process too,” Andy said.

The clinical therapies team developed a personalised program for Andy based around his goals. A few days later, he met with the occupational therapist who asked questions “that I would have never thought of.”  This assessment quickly identified whether Andy could get around safely at home. It also offered him the opportunity address some bigger life changes. A social worker helped Andy plan his return to work, recommended a counselling service and offered to help with Centrelink and insurance paperwork.

Physically though, Andy’s hearing loss was playing havoc with his balance and he remembers this being a key part of his rehabilitation.

“I was working on the treadmill and exercise bike for mobility but also needed help with a balance issue with my left side. The physiotherapists provided me with balance exercises like standing on one leg for 10 seconds, then 15 seconds and so on. They’d also get me to play round-ball soccer around 10 witches hats so I could improve my fine motor skills,” said Andy. “I was given these balance exercises to do as homework, which have been very helpful.”

Early in his rehabilitation, Andy had some vertigo issues. “At night, I could only lie on one side because if I rolled over, the room would spin. During two of my sessions, my therapists got me to lie in a certain position on my side and then I’d sit up gently after 30 seconds to reset the crystals in my inner ear. Both times my vertigo dissipated,” he said.

Andy describes the Royal Rehab team as “supportive, amiable and friendly”.

“The approach of everyone I met, from Dianne at the front desk on my first day, to the rehab team, was first-class,” said Andy. “Stephanie’s help with goal setting was terrific. One week, I was having a low day and she said, ‘you’ve come today, thanks for pushing on – you could have cancelled’. She was supportive in setting realistic goals and being aware of my limitations,” he said.

Andy says the outpatient service was a hub that helped him move forward with his recovery, with everything coordinated and clustered to make it easy for him to see different members of the rehab team.

“In the middle of all this, one of my sons broke his knee and they were flexible in shifting appointments around. I never once lacked confidence in the team’s support or worried about their professionalism,” said Andy.

Three months on, life is basically normal for Andy. Married with three kids, the music-lover and rugby fan is driving again and he’s catching the faint scent of his aftershave, his sense of smell starting to return. He’s still committed to his profession, working on an abstract for a health conference presentation next month but describes his incident as a ‘wake-up call’. He has made some lifestyle changes.

“Working with the physio and occupational therapist at Royal Rehab gave me a forum to explore my plans for life and career. I’m re-evaluating things – I don’t want to end up in such a stressful situation again,” Andy said.

Andy’s advice for others

Being realistic about the effect of his brain injury has been important. He plans around the fatigue that kicks in during the afternoon and accepts the reality of interrupted sleep.

“Rehabilitation is not a gym session with a personal trainer driving you. Here, you get to identify your own goals and the Royal Rehab team will lead you through with excellent advice and support. Give yourself time. There will be dark days and weeks – keep going.”