Adesh's story
Adesh Shahare had been in the U.S. for only eight months when he had a stroke. Adesh, a 39-year-old graduate student from Saint Louis University, originally a dentist in India, was in the midst of finals when he began feeling dizzy and lightheaded. He shrugged it off at first, but things took a turn for the worse.
“One day I couldn’t stand at all and I fell four or five times,” Adesh recalled. “Then I got a really bad headache from my neck to my head, crawled to the kitchen and my roommates called 911,” he said.
Adesh was taken to Saint Louis University Hospital where a CT scan and MRI revealed he had a carotid dissection — a tear in one of the carotid arteries, which supply blood to the brain — causing blood clots on the right side of his brain and, ultimately, a stroke. He was left unable to move the entire left side of his body, walk or stand on his own and required assistance to complete all daily activities. He also had slurred speech and difficulty swallowing and communicating. Cognitive impairments, including difficulty concentrating and remembering, made it difficult for Adesh to focus.
“My left hand and left foot were flaccid and I couldn’t eat properly as my mouth was drooping. I also had a hard time recognizing faces and I was confused,” he said.
Once stabilized, Adesh transferred to SSM Health Rehabilitation Hospital – Richmond Heights to begin restoring his strength, mobility and independence. His brother, Jeet, a New Jersey resident, was present daily during his therapy sessions to provide support and learn transfer techniques. From day one, Adesh and Jeet had a clear goal: for Adesh to be able to fly to New Jersey to continue his rehabilitation close to his family.
At SSM Health Rehabilitation Hospital – Richmond Heights, his physical therapists focused on improving his balance and mobility through gait training exercises using parallel bars and climbing stairs. Adesh progressed from requiring assistance for all transfers and walking five inches using the parallel bars to walking 400 feet with a cane, performing transfers and climbing four stairs with minimal assistance. Jeet also received hands-on instructions on how to safely transfer Adesh from an airplane seat or toilet to prepare for the upcoming travel.
In occupational therapy, he focused on increasing his left arm strength and learning adaptive techniques to perform daily activities on his own. His therapists used proprioceptive neuromuscular facilitation (PNF) stretching — advanced flexibility training that involves contraction and stretching of the muscles with the help of a partner or object — to increase his range of motion and stability. With hard work and grit, his balance improved and he progressed to completing transfers and daily tasks such as bathing and dressing with minimal assistance.
His swallowing difficulties were resolved by his work with speech therapists who used swallowing exercises and techniques to slow down his eating. Soon, he was able to eat and drink safely. Focusing on cognitive function, they also helped Adesh improve his ability to think and communicate clearly, including building memory and concentration skills through a range of exercises. His speech therapists were pleased to see that Adesh was making progress; he was speaking louder and more slowly so others could understand, and he was able to identify and remove distractions to improve his focus and memory.
In the meantime, his case managers worked diligently to transfer Adesh to New Jersey, where his mother (who traveled from India) was waiting to provide additional support. After 18 days, he got the green light and flew to New Jersey to continue his rehabilitation journey at Kessler Institute for Rehabilitation – West Orange.
His objectives upon admission at Kessler were “to get back to normal life in college and get mentally and physically fit.” Adesh’s new physician-led team of rehabilitation nurses, therapists and other stroke specialists tailored a treatment plan to help him reach his goals.
Adesh jumped right back in. In physical therapy, he participated in high-intensity gait training using the LiteGait and Andago body-weight support systems while walking over the ground and a treadmill. Step-by-step, he progressed from standing to walking with a cane and a left foot orthotic — specially designed shoe inserts that help support the feet and improve foot posture. A turning point came when Adesh stood for the first time. “When I stood on my feet I felt that “ah-ha” moment and my confidence came back.”
Similarly, his occupational therapists incorporated neuromuscular electrical stimulation (NMES) — sending electrical impulses to the nerves — by using the functional electrical stimulation (FES) cycle for his left arm. His arm strength steadily improved until he was able to move his entire left arm, wrists and fingers to perform daily activities such as dressing, eating and grooming on his own.
“Here I started walking and that gave me confidence … then my hand started moving,” Adesh said. “Before, it wasn’t even moving a millimeter. Now it’s moving. All the staff has been very caring at both hospitals.”
Along with the Kessler speech therapists, Adesh participated in various exercises to work on his reasoning, organization and attention skills. This included naming the pros and cons of situations, making schedules and solving puzzles. He enjoyed the critical thinking activities, noting, “They are mind-boggling, those questions. You don’t know what you lost in terms of cognition and this helped me see that.”
Throughout his rehabilitation journey, Adesh learned the importance of mental strength. “I learned that stroke is a big emotional challenge rather than a physical challenge. You need to be very mentally strong during the rehabilitation process. I feel more impulsive after my stroke and I realize it is a long process to recover. ”
After two weeks, he left the facility and went to his brother's home to be with family. Continuing his recovery as an outpatient at Kessler, his aim was to return to Saint Louis University and finish his master's program. Alongside his own goals, Adesh joined the Kessler Foundation as a volunteer, helping others facing similar challenges.