Stroke

Reducing mortality, disability and other complications 

Although medical developments have not reached the stage where stroke is prevented, however, what we are witnessing today is the development of prevention and treatment programs that have led to a reduction in mortality, disability and complications resulting from stroke. We are also witnessing the promotion of health awareness, understanding the potential risks if stroke occurs and how to prevent it.

These developments helped in the implementation of the best programs and treatment protocols as well as the development of clinical practices, in addition to rehabilitation, physical therapy and occupational therapy programs that have played a positive role in improving the patient’s movement, speed of recovery, and movement restoration.

The problem is that stroke occurs suddenly without any prior warning, as it is possible that the patient is completely healthy and does not feel any sign or symptom and yet he suffers from stroke; this increases the difficulty of rapid intervention, and damage is irreversible. Adequate awareness of the patient or those around him makes early medical intervention more effective. 

A stroke is a medical emergency that happen when blood flow to the brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke.

Symptoms

If you or someone you’re with may be having a stroke, pay particular attention to the time the symptoms began. Some treatment options are most effective when given soon after a stroke begins. Signs and symptoms of stroke include:

Trouble speaking and understanding what others are saying: You may experience confusion, slur your words or have difficulty understanding speech.

Paralysis or numbness of the face, arm or leg: You may develop sudden numbness, weakness or paralysis in your face, arm or leg. This often affects just one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile.

Problems seeing in one or both eyes: You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.

Headache: A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate that you’re having a stroke.

Trouble walking: You may stumble or lose your balance. You may also have sudden dizziness or a loss of coordination. Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to come and go or they disappear completely. 

Think “FAST” and do the following:

• Face: Ask the person to smile. Does one side of the face droop?
• Arms: Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise?
• Speech: Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
• Time: If you observe any of these signs, seek emergency medical help immediately.

Atrial Fibrillation and Stroke

Atrial fibrillation, a common heart rhythm disorder, can increase your risk of stroke. In atrial fibrillation, blood can pool in the heart’s upper chambers and form blood clots. If a blood clot forms in the left-sided upper chamber (left atrium), it could break free from your heart and travel to your brain. A blood clot can block blood flow to your brain and cause a stroke. Blood clots can also block blood flow to other organs.

The risk of stroke from atrial fibrillation rises as you grow older. High blood pressure, diabetes, heart failure and some valvular heart disease also increase your risk. To reduce your risk of stroke or damage to other organs caused by blood clots, your doctor may prescribe a blood-thinning medication (anticoagulant).

Managing your atrial fibrillation and any other conditions you have that increase your risk of stroke also can help you reduce your risk of stroke.

Types of stroke and how to treat them

There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn’t cause lasting symptoms.

Ischemic stroke is the most common type of stroke. It happens when the brain’s blood vessels become narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through your bloodstream and lodge in the blood vessels in your brain.

To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. This may be done with emergency IV medication. Therapy with drugs that can break up a clot has to be given within 4.5 hours from when symptoms first started if given intravenously. The sooner these drugs are given, the better. Quick treatment not only improves your chances of survival but also may reduce complications.

Doctors sometimes treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. Doctors insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly where the stroke is happening. The time window for this treatment is somewhat longer than for injected tPA, but is still limited.

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in your brain caused by the excess fluid. If you take blood-thinning medications to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners’ effects. You may also be given drugs to lower the pressure in your brain (intracranial pressure), lower your blood pressure, prevent spasms of your blood vessels and prevent seizures.

If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain. Surgery may also be used to repair blood vessel problems associated with hemorrhagic strokes. 

Rehabilitation and Physical Therapy

The goal of stroke rehabilitation is to help you relearn skills you lost when a stroke affected part of your brain. Stroke rehabilitation can help you regain independence and improve your quality of life. The severity of stroke complications and each person’s ability to recover vary widely. Researchers have found that people who participate in a focused stroke rehabilitation program perform better than most people who don’t have stroke rehabilitation.

There are many approaches to stroke rehabilitation. Your rehabilitation plan will depend on the part of the body or type of ability affected by your stroke.

Physical activities might include:

• Motor-skill exercises: These exercises can help improve your muscle strength and coordination. You might have therapy to strengthen your swallowing.
• Mobility training: You might learn to use mobility aids, such as a walker, canes, wheelchair or ankle brace. The ankle brace can stabilize and strengthen your ankle to help support your body’s weight while you relearn to walk.
• Constraint-induced therapy: An unaffected limb is restrained while you practice moving the affected limb to help improve its function. This therapy is sometimes called forced-use therapy.
• Range-of-motion therapy: Certain exercises and treatments can ease muscle tension (spasticity) and help you regain range of motion.

Speech Therapy

A stroke is one of the most catastrophic experiences an individual can undergo. Strokes often cause temporary or permanent paralysis on one side of the body. Balance, memory, speech, cognition, and vision may also be affected. In addition, muscle spasms and pain are common complications of a stroke. Because of these issues, stroke survivors may have difficulty managing basic tasks such as bathing and dressing. Consequently, it may be challenging for them to continue to manage their roles as spouses, parents, or employees.

One of the most serious complications of stroke is difficulty communicating, with many stroke patients experiencing a decrease in speaking ability. While it does not affect intelligence, aphasia can make it challenging for the patient to speak and understand others, while also impeding their abilities to read and write.

Speech and language pathologists help improve your language skills and ability to swallow. Speech and language pathologists can also work with you to develop tools to address memory, thinking and communication problems.

Treatment of swallowing

Your stroke may cause a swallowing disorder called dysphagia. Aspiration is a common problem for people with dysphagia. It occurs when something you’ve swallowed enters the airway and lungs. Normally, aspiration causes a violent cough, but a stroke can reduce sensation. In this case, you may not know you’re aspirating (silent aspiration). While in the hospital after a stroke, you are screened to determine your ability to swallow safely. If you have a problem with swallowing safely, you may not be allowed to eat until a speech-language pathologist evaluates how well muscles in your mouth move, you can swallow and your voice box works.

The speech-language pathologist may recommend you change what you eat and drink. That’s because some foods are hard to chew and thin liquids are often hard to swallow. The speech-language pathologist will determine when it’s safe to eat more normal foods.

Adequate nutrition is essential. So if it’s not safe for you to swallow, a feeding tube may be suggested to help meet your nutritional needs.

Improving patient skills

The focus of occupational therapy is to help individuals achieve health, well-being, and participation in life through engagement in occupations (i.e., activities). Occupational therapy practitioners collaborate with clients and their families or caregivers to determine what activities are necessary, meaningful, and/or relevant to them. 

Occupational therapy practitioners understand the importance of emotional well-being, social connections, and healthy life habits for individuals post-stroke. In addition to ongoing physical rehabilitation as needed, they engage stroke survivors and family members to take charge of their lives, create human connections, and lead healthy lifestyles. This may include developing coping strategies to deal with loss, individualized ways to promote psychosocial health, education to minimize potential for a second stroke, promotion of increased exercise and healthy eating, and strategies to overcome barriers to sexual intimacy.  

Stroke can cause serious long-term disability, and many stroke survivors face barriers to engaging in productive activity. Occupational therapy practitioners use their expertise in activity analysis and adaptive methods to facilitate the client’s performance of needed or meaningful occupations within realistic contexts to promote independence.