Everyone has heard of FAST for identifying stroke. Now, I introduce SMILE, which is my version of 5 easy actionable tips to help kickstart your road to recovery.
Over the years in treating stroke, I have noticed some themes in my patients, and I would like to share them with you. SMILE is my simple way of giving my patients an easy to use structure to recover from stroke and stay healthy. It stands for:
- Single out the area
- Mention differences
- Identify priorities
- Lefts and rights matter
- Engage the heart
So what does all that mean?
Single out the area
It astounds me how patients do not know which part of their brain has been affected by their stroke, because this is really important information in therapy and rehabilitation, and I think we as health professionals tend to underestimate our patients ability to consider this information. Knowing this helps guide both parties decide HOW therapy should be delivered. For example, I find that strokes that happen in the front part of the brain (frontal lobes) require more repetition, anticipation and attentive focus for effective carryover, and the window for this to occur tends to be smaller than other strokes. On the other hand, strokes that involve the parietal areas tend to require a lot of visual input in combination with tactile input to help the brain make more sense of the task and integrating that information so the task is better achieved.
Mention differences
The patients who are able to speak up about their deficits and problems are often the ones that do better, simply because they make their case better known. Less visible symptoms such as pain, hypersensitivity and sensation loss are more difficult to quantify and assess, yet are at times even more debilitating than obvious weakness. Some patients lose the ability to identify and acknowledge their deficits (anosognosia), which is why family members and carers are often valuable in helping them realise this. The more that is known and the more insight there is, the better the attentive exploration of ways to overcome and improve the situation. This is a key driver of neuroplasticity and recovery.
Identify priorities
Everybody has goals following their stroke, and I think it’s great that people aim high towards full recovery because hope is hugely motivating. I would suggest patients writing the top 3 things they want to get back to doing as soon as possible to get the best sense of what is most meaningful and therefore most motivating, because this will form the basis of focussed therapy. Without focus, the steps in between are much harder to define and therefore successful rehabilitation, in my opinion, becomes more difficult.
Lefts and rights matter
Despite what most people know about strokes affecting both sides, clinically there is evidence to show that a right sided stroke also causes right sided symptoms, but just much less obvious. This is because there is a lot of cross communication across hemispheres, so I consider it important to assess and treat the “non-affected” side as well.
Engage the heart
Every comprehensive stroke rehabilitation program should consider the primary causes of the stroke, which often relate to cardiovascular system. High blood pressure and cholesterol should be taken into consideration, and can be partially effectively treated with aerobic forms of exercise. This usually involves engaging large muscle groups and getting at least 30 minutes of physical activity a day. Once someone has a stroke, they are much more likely to suffer another one and that is why this is an important part of staying healthy.
