By Thomas Goldsmith
The Durham Stroke Camp has a routine as forthright as its name: It’s an intensive week dedicated to recovery by a small group of stroke survivors, working each day with the same therapists.
In a testament to the value of the camp, students in their second year of training for doctoral degrees in physical therapy skip their one week of break between spring and summer semesters.
In other settings, survivors within nine months of their strokes may get as few as three sessions per week for eight weeks, the maximum number for which the state-federal Medicaid program will reimburse providers. That’s for a combination of speech, physical and occupational therapy, all of which are needed by many survivors of devastating strokes.
In a Durham office building near Ninth Street last week, a different approach bore fruit for seven patients who were treated free, along with 15 clinicians and 15 students in training for doctoral degrees. Sponsored by the Duke University School of Medicine’s Doctor of Physical Therapy program, the camp fills a large main room and several nearby locations in the building.
“It’s an incredible experience for every individual,” said Jody Feld, a Duke assistant professor, physical therapist and a leader of the event. “The patients get a chance to have a six-day experience of intensive therapy.”
“A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells.
“If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms, or legs (paralysis is an inability to move); trouble speaking or understanding speech; and trouble seeing.
“A stroke is a serious medical condition that requires emergency care. A stroke can cause lasting brain damage, long-term disability, or even death.”
This year’s event was the second edition of Stroke Camp at Duke, where students screen potential participants, help devise complicated schedules for each patient, and even raise money. Event leaders and faculty members Feld and Jeffrey Hoder, both already doctors of physical therapy, joined several community therapists in consultation and up-close supervision.
“A marathon, not a sprint”
On April 27, the fifth of six days, stroke survivors sweated and pushed as therapists cajoled and corrected. Everyone worked with intense concentration among these two groups of people with so much at stake.
“Recovering from a stroke is a marathon, not a sprint,” said participant Brian Donaghy, 50, of Wake Forest. “But this week I feel like I was on a sprint.
“The progress is the result of the length of the therapy. It’s eight hours, where normally it’s 45 minutes.”
The program doesn’t recruit participants, instead making its presence known through the medical community and picking participants who are experiencing acute or chronic after-effects of strokes. The camp aims to help each survivor regain as much prior ability as possible and achieve a full return to his or her community.
Donaghy, who’s returned to work as an IBM consultant following a stroke Aug. 10, said he’s made progress because of the week of focus on him and his situation.
Antoine McCoy, 38, who works in IT in retail sales, experienced a bleed in his brain (known formally as a hemorrhagic stroke) in August 2015. He goes to a gym every day as part of his recovery but found the camp more daunting.
“Definitely, it’s been harder,” he said between arduous stints shifting his balance back and forth on a knee rocker. “This is probably the hardest I’ve worked on consecutive days.”
He was getting a workout; he was on the floor doing stretches and other hard exercises that saw him break a sweat.
But is the work rewarding?
“Definitely,” said McCoy, who unlike some campers, has not experienced aphasia, or speech impairment.
Students Kayla Chee and Tess McCloud worked with McCoy as he walked back and forth repeatedly, sometimes asking him to spread his gait farther across foam barriers placed on the floor.
“At the end we were really excited, because he was returning to his normal gait,” McCloud said.
Derry Washington, of Raleigh, who formerly drove both limousines and hearses, has difficulty talking because of his stroke, almost five years ago. Second-year students Lindsay DiMarco and Ben Ramger worked with Washington on his speech as well as his walking.
Close-up experience counts
“I think what’s unique is that we get work with the patient all day long and all week long,” DiMarco said.
Each participant starts the week by setting goals for the week’s work. Therapy is designed accordingly.
“We like to look at what worked and what didn’t work,” Ramger said.
Washington worked on his speech during the physical therapy.
“Arms,” he said, pointing to parts of his body with his unaffected right arm. “Legs. Mouth.”
Music played throughout the session and Washington heard something familiar.
“Classic rock,” he said, pointing to a sound device that played “Back in Black” by AC/DC and “Dream On” by Aerosmith.
Hoder, one of the professors, said the crammed curriculum gives doctoral students plenty of technical and medical lore to absorb. But there’s no substitute for working with a patient who’s learning how to walk in a straight line again.
“Every class we teach should be this kind of experience,” he said. “But logistically that’s hard.”
Patients at Stroke Camp typically receive more therapy in a week than Medicaid patients usually receive in total.
“A beneficiary 21 years of age and older may have up to three therapy evaluations, and a total of 24 therapy treatment visits when the beneficiary is within nine calendar months of discharge from inpatient services for a cerebrovascular accident (stroke), traumatic brain injury (TBI) or spinal cord injury diagnosis…”
— Medicaid and Health Choice outpatient specialized therapies clinical coverage policy No. 10A Amended: December 15, 2017