Stella Cogno, 44, is a wife, mother and full-time real-estate agent living in Miami. One afternoon as she was watching television, she suddenly experienced an intense headache. She lost consciousness and was rushed to the emergency department at her local hospital where tests revealed that several brain bleeds had caused a stroke. She immediately received treatments to lessen the bleeding and relieve pressure on her brain including surgery to temporarily remove part of her skull. During that procedure, a tracheotomy tube was also placed to assist her breathing and a feeding tube was placed to deliver hydration, nutrition and medication.
After stabilizing, Stella transferred to West Gables Rehabilitation Hospital to continue her recovery. Upon admission, Stella was evaluated by the physical, occupational, speech and respiratory therapy teams to create a plan and set goals for her treatment. She had severe cognitive and communication deficits as a result of the stroke, and could only communicate with occasional thumbs up and or thumbs down reactions and follow one-step commands. Physically, she required total assistance from a mechanical lift to be transferred.
During her first month of therapy, Stella started sitting at the edge of her bed with help from her physical therapists. Through the speech valve in her tracheotomy, she verbalized the words “bye” and “yes” and was also able to say her name and count up to 30. As her strength and awareness increased, she had her first nourishment by mouth in three months, trialing ice chips, pureed solid foods and some liquids under the close supervision of speech therapists. Through her therapy, Stella relearned to feed herself and her diet expanded to soft, bite-sized solids. In occupational therapy, Stella worked on fine motor activities with hand-over-hand assistance. Her tracheotomy was then removed which was an important development in her recovery journey as she was now able to maintain healthy oxygen levels breathing on her own.
To focus on her mobility, Stella practiced sit to stands and began working with therapists in the parallel bars. She was introduced to a sit-to-stand transfer aid and progressed to standing for longer periods of time. Therapists also worked with her on cognitive tasks such as reciting the days of the week, identifying common objects and implementing a communication board to help her express more complex thoughts.
Stella continued to make advancements into her second month at West Gables Rehabilitation Hospital. At times, she was limited by anxiety and fears, but her therapy team taught her breathing techniques and played music to calm her nerves. Stella’s family was also by her side the entire time, providing support and encouragement during every step of her recovery journey.
As Stella continued to progress in her strength and mobility, she gained the ability to walk up to 45 feet on both even and uneven surfaces using a rolling walker. Therapists used creativity to ensure she was having fun while being challenged during therapy by introducing dancing, volleyball, gardening and scavenger-hunt style activities to improve movement, hand-eye coordination and visual tracking. Additionally, Stella was introduced to group occupational therapy treatment where she participated in Tai-Chi.
Stella briefly left West Gables to have surgery to replace the bones of her skull that were removed to relieve the pressure on her brain. When she returned, Stella was challenged by increased anxiety and emotional reactions. Her family and therapy team rallied around her to create a positive and safe environment for her to thrive. Stella soon began increasing her independence with toileting and personal care needs. She also practiced writing, coloring, doing puzzles, spelling and counting to improve her attention span. Physical therapy sessions focused on safety awareness as she continued to progress with sitting, standing and walking.
To celebrate and practice her new skills, the team and Stella went for dinner in a community restaurant. Stella practiced her communication skills, navigated the restaurant with her rolling walker and enjoyed a delicious meal.
After four months at West Gables Rehabilitation Hospital, Stella was ready and excited to go home with her family. Therapists provided stroke education to her family and taught them to use the communication tool, AAC (augmentative and alternative communication), to ensure Stella’s continued success in her home setting.
As Stella departed, she and her family expressed their gratitude for the care and support they received during her recovery journey at West Gables Rehabilitation Hospital.