​​​​​​​Terra exercising with physiotherapist by her side
Terra Gregson is pictured here performing an exercise assessment with Toronto Rehab Physiotherapist Louis Biasin. (Photo: UHN)

For Terra Gregson, the first sign that something was wrong came in the form of a migraine headache.

The headache continued to prolong from a few days to one full week – and soon after a trip to the Emergency Department, Terra experienced bilateral ischemic strokes: a stroke affecting both sides of the brain.

"I'd never experienced anything like that pain," says Terra.

"I remember going to the ER, but can't recall anything else from that evening, like ordering food or putting my son to bed. Later that night, I had the stroke."

"After spending time at Toronto Western Hospital and St. Joseph's Health Centre, Terra became an inpatient at Toronto Rehab's Bickle Centre for Complex Continuing Care. At Bickle, Terra was in a wheelchair and focused on recovering her strength and mobility.

​"My experience at Bickle was great. The physical therapy made me feel a lot better, but then I found myself thinking 'I could do more,'" explains Terra.

New Toronto Rehab clinic accelerates Terra's stroke recovery

Terra's care team at Bickle suggested she be transferred to Toronto Rehab's Stroke Rehab Inpatient Service​ for stroke patients with increased mobility.

She continued to progress, and shortly after transitioning to outpatient stroke rehab about a month later, Terra was referred to a new clinic at Toronto Rehab called the Cardiopulmonary Exercise Assessment (CPA) Clinic.

'Those who have strokes are at risk of heart disease – and likewise those who have heart disease are at high risk of stroke'

The CPA Clinic, offered once per month, is an integration of two Toronto Rehab programs: Cardiac Rehab and Brain & Spinal Cord Rehab.

The purpose of CPA is to provide specialized exercise testing to determine an optimal exercise prescription for the patient within their cardiac and/or neurological limitations. The ultimate goal is to allow early access and participation in fitness and exercise for optimal recovery for patients who have recently experienced strokes or brain injuries.

W​hat is vascular disease?
​Vascular disease is an abnormal condition of the blood vessels. Blood vessels (arteries and veins) are the tubes through which blood is pumped throughout the body. Arteries carry oxygen-rich blood from the heart to nourish every part of the body, including the brain, kidneys, intestines, arms, legs, and heart.  If there is a disturbance to the blood supply to one of these organs, then problems can occur.

"The underlying problem in both heart and stroke disease is vascular disease. So those who have strokes are at risk of heart disease, and likewise those who have heart disease are at high risk of stroke," explains Dr. Mark Bayley, Medical Director of the Brain & Spinal Cord Rehab Program at Toronto Rehab.

"Both Toronto Rehab programs have a common interest in preventing heart disease and recognizing the important role of fitness and exercise in doing so."

Pushing the limits of stroke recovery

The CPA clinic has two goals for Toronto Rehab's stroke patients – prescribing the appropriate amount of exercise for each patient and enhancing recovery.

"We need to overcome this concern we have about pushing stroke patients during exercise. The CPA clinic provides clear answers about any problems the patients may have, so we know how hard we can push them," explains Dr. Bayley.

The second goal is about helping patients meet their limits based on research evidence that early aerobic and fitness training can enhance the speed and extent of stroke recovery.

Did you know?

Research findings indicate that within five years of a stroke, 42 per cent of men and 24 per cent of women will have a repeat stroke. Fitness is a key element in both stroke recovery and secondary prevention.

​Toronto Rehab's Risk Factor Modification & Exercise Program Following Stroke (TRI_REPS) program is designed for patients with mild to moderate stroke deficits to help improve cardiovascular fitness, strength, function, and reduce risk. Dr. Susan Marzolini, the program's supervisor, says research shows that most patients who leave outpatient stroke rehab become sedentary. "The fitter the person is, the lower the risk of developing heart disease and a repeat stroke," she says.

"Getting active early after a cardiovascular event, such as stroke or heart attack, is critically important to encouraging recovery of strength, fitness and function," explains Dr. Paul Oh, Cardiovascular Disease Prevention and Rehabilitation Program at UHN – Toronto Rehab and Peter Munk Cardiac Centre. 

"Receiving advice and direction from a health professional who is experienced in safe and effective exercise prescription is also key, and we are very lucky to have the talented individuals in our Brain and Cardiac programs."

Terra's turning point: An exercise prescription to take home

Terra has noticed tremendous advancements in her mobility.

"When I first started as an outpatient, I had to use a leg brace to keep my knee straight," says Terra.

"I'm no longer using it and I feel stronger… I can walk with just my cane now."

Chris Peppiatt, Terra's primary physiotherapist at Toronto Rehab's Stroke Day Hospital, began seeing Terra shortly after she began outpatient stroke rehab. Chris' role includes creating exercise prescriptions for her patients after thorough assessments.

"When I first meet a patient, we discuss their priorities. Terra's goals were to walk without a walking aid outdoors and continue to exercise in her community so she can take care of her son," explains Chris.

"The CPA clinic provides patients with parameters for how hard they can push themselves. It helps the patient set goals and develop a fitness plan, and offers them something they can enjoy and use to help them connect with their community."

Terra's found the CPA Clinic exceptionally helpful in guiding her exercise plan upon completion of physical therapy.

"This clinic is such a positive thing. It makes you think about what you're doing after this stage of recovery," Terra says.

"It encourages you to come up with a plan so you can still be healthy when you leave."

Toronto Rehab offers various stroke programs to patients based on their levels of mobility and stroke deficits – learn more about the Brain and Spinal Cord Rehab Program and Cardiac Rehab and Prevention.

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