Daril Stewart's story
Daril “Duke” Stewart, 39, woke up one morning with a headache that brought tears to his eyes but he headed to work anyway as a bar back at a historic New Orleans bar in the French Quarter. As the day went on, Duke began to feel worse and called his fiancée, Monya, to tell her he felt nauseated and had a stiff neck. Monya’s daughter was available to accompany him to the hospital, but on their way, Duke pulled over and began vomiting. Monya’s daughter called 911, and an ambulance arrived to take him the rest of the way. A CT scan revealed Duke had a hemorrhagic stroke - a blood vessel burst, causing bleeding in the right side of his brain. An MRI also showed that in addition to the initial brain bleed, Duke had four other strokes on the right side of his brain.
Due to the significant brain damage he sustained, Duke was placed on a ventilator and a feeding tube. After a week, Duke was medically stable but was unable to communicate, feed himself or get out of bed. He also struggled with visual deficits and left neglect, meaning that his brain did not recognize objects in his left visual field or the left side of his body. He spent two weeks in the acute care hospital before being transferred to Ochsner Rehabilitation Hospital for additional recovery.
Upon admission, Duke was unable to tolerate much activity out of bed. He required the assistance of two people for rolling, sitting up in bed and getting into his wheelchair. Duke’s sitting balance and head control were impaired, and he required maximal assistance to maintain his balance and stay awake during therapy.
During the first week, his physical therapist focused on sitting balance and head control by having Duke reach for objects and attempt sitting at the edge of the bed without losing his balance or nodding off. His therapist also worked on turning Duke’s head to his left to improve the left-sided neglect.
By the end of his first week at Ochsner Rehabilitation Hospital, Duke was more awake and able to practice standing and walking in the parallel bars. When walking, Duke required significant assistance to move both legs as well as increased time to process the sequencing of walking. In order to improve Duke’s ability to walk longer distances and move his legs without help, he began practicing walking in a bodyweight support system called the LiteGait. Electrical stimulation was also used on Duke’s left leg to re-educate his muscles.
During his third week, Duke walked nearly 200 feet in the bodyweight support system without assistance. Continuing to show great improvement, Duke soon transitioned to walking with a rolling walker with a platform to support his left arm, then to walking without a device and minimal support from his physical therapist for balance and stability. Duke’s greatest barrier remained his left-sided neglect and visual deficits. Due to this, he needed constant verbal cues to avoid obstacles and pay attention to his left side.
When first assessed by occupational therapy, Duke was having a difficult time performing bathing, dressing and toileting so his team focused on the basics: eating and oral care. As Duke became more alert, he began to be able to feed himself and brush his teeth with his right hand, though he required verbal cues to locate the utensils or toothbrush and assistance to cognitively set up the task. Duke quickly mastered this routine, so his occupational therapist began addressing his left side by working on bathing, dressing and toileting. Towards the end of his stay, Duke continued to be limited on his left side but had greatly improved his abilities to participate in all his self-care needs from bathing, to getting dressed, performing oral care and toileting with supervision and some assistance.
When Duke was initially evaluated by speech therapy, he was not eating or drinking due to difficulty swallowing and was instead receiving food, liquids and medication through a tube inserted directly into his stomach. Duke's speech therapist prioritized working on his swallowing function so that he could eat and drink by mouth again. During therapy, he was given trials of food and beverages to assess whether he could tolerate them. After a week of treatment, he underwent an assessment called FEES (fiberoptic endoscopic evaluation of swallowing). During FEES, a tube with a camera on the end is inserted into the patient's nose, giving the speech therapist a complete view of Duke's swallowing while he consumed different consistencies of food and drink. The assessment showed Duke's swallowing had improved, and with additional therapy and testing, he graduated to a regular diet a week later.
Over the next several weeks, Duke worked on his visual spatial skills in speech therapy. Exercises involved reading words, sorting items, playing card games, completing hygiene tasks and identifying objects in Duke’s left visual field. To further target visual spatial deficits, Duke's speech therapist and physical therapist collaborated and engaged Duke in virtual reality treatment activities including visually following a moving object on a track and scanning for targets on his left side. In addition to visual scanning activities, Duke participated in body awareness activities to increase recognition and use of the left side of his body.
When he first began treatment, Duke also demonstrated poor short-term memory skills and significantly delayed processing skills with poor initiation of tasks and communication. Duke's speech therapist consistently engaged him in conversation regarding his family and interests to improve his functional communication skills. He was given constant encouragement to ask for clarification when he misunderstood something as well as to initiate requests for needs. At discharge, Duke demonstrated considerably faster processing speed and increased initiation of tasks and communication of needs to others.
Throughout Duke's stay, his therapy team used an interdisciplinary approach to maximize his recovery. His physical, occupational and speech therapists often treated him at the same time so that each therapist could work with him on the different skills that were necessary to complete a task. For example, during a walking task, Duke’s physical therapist had him walk to locate specific objects placed on his left side while his speech therapist emphasized visual scanning, recall and comprehension.
At the end of his time at Ochsner Rehabilitation Hospital, Duke only required minimal assistance for mobility as he walked over 800 feet, avoiding obstacles as he went. Additionally, he was able to transfer in and out of the car and could safely navigate stairs. He was also able to successfully operate his wheelchair with some verbal cues.
One of the biggest influences on Duke’s success was his fiancée, Monya. She was at the hospital every day during Duke’s stay to encourage and motivate him. She supported him and advocated for him throughout the entire process and worked closely with his therapy team to complete family training to prepare for his transition home.
At discharge, Duke planned to continue his rehabilitation with outpatient therapy and looked forward to his upcoming wedding to Monya. He shared that his rehabilitation journey with Ochsner was “beautiful” and “life-changing.” For others facing a road to recovery, Duke shared: “Never give up the fight!” As a caregiver of a loved one, Monya’s advice to future patients’ family members is to “trust the people you’re working with” and “take it one day at a time.”
Today, Duke continues to work with occupational therapy to improve the strength and function of his left arm. He is walking independently and doing his best to get in shape and ready for his wedding. Duke has made great strides since his stroke and continues to work hard during his recovery.