STROKE
Incorrect answers in red.
1) The “stroke belt” lies within what region of the United States?
- Northwestern Region
- Southeastern Region
- North Central Region
- Northeastern Region
2) ____________ strokes account for 87% of all strokes.
- Transient Ischemic
- Ischemic
- Hemorrhagic
- Brain Stem
3) Which of the following is not a modifiable risk factor for strokes?
- Diet
- Obesity
- Gender
- Smoking
4) The mnemonic phrase FAST is utilized to determine if someone is experiencing a stroke. T stands for __________.
- Telephone
- Take to the hospital
- Time
- Talk
5) Many stroke victims suffer from disabilities. Which one of these disabilities do not apply?
- Dysphasia
- Confusion
- Insomnia
- Severe Headaches
6) If a health care professional suspects someone is having a stroke they should give them aspirin.
- Yes
- No
7) What is the most important aspect of stroke treatment?
- CT Scan
- MRI Imaging
- Time
- Surgery
8) Which is not a typical acute serious post-stroke medical complication?
- Brain swelling
- Alzheimer’s Disease
- HTN
- Urinary tract infections
9) Occupational Therapy is utilized for post-stroke patients to:
- assist with the prevention of contractures.
- assist with incontinence.
- assist with activities of daily living.
- assist with speech difficulties.
10) Health care professionals will work with stroke patients by assisting them with:
- what they want to eat.
- their ADL.
- financial matters.
- making them understand what they need to do.
Abstract:
A stroke, also referred to as a cerebrovascular event, is a neurological event that causes damage to the brain.
Strokes are caused by a sudden interruption of blood flow to the brain and can result in severe, irreversible neurological damage.
A stroke victim may permanently lose the ability to speak, walk, or live independently. Blood clots that interrupt the flow of blood to the brain and bleeding or hemorrhage in the brain are the basic causes of strokes and involve specific risk factors.
Strokes can be prevented by identifying risk factors and adjustments to current lifestyle choices by making healthier choices.
Learning Objectives:
1. Identify the types of strokes.
2. Explain the common signs and symptoms of a stroke.
3. Describe a stroke patient’s daily care needs.
Introduction-Stroke is the medical term for a specific type of neurological event that causes damage to the brain due to interruption of blood flow. A commonly used term for stroke is a cerebrovascular accident (CVA). Strokes are caused by a sudden interruption of blood flow to the brain. Some people recover from a stroke but for many others, a stroke is a devastating event that causes severe, irreversible neurological damage. In some cases, a stroke victim will permanently lose the ability to speak, walk, or live independently. A patient may minimize the effects of a stroke if the patient receives immediate medical attention. Strokes can be prevented by identifying risk factors and adjustments to current lifestyle choices by making healthier choices.
Prevalence of Stroke
Stroke is the most common neurological emergency. Every year, more than 795,000 people in the United States will suffer from a stroke. About 610,000 of these are first or new stroke victims. About 185,000 strokes, nearly 1 of 4 are in people who have had a previous stroke. About 87% of all strokes are ischemic strokes, in which blood flow to the brain is interrupted due to blockage.
According to the Center for Disease Control and Prevention (CDC), mortality from stroke was the fourth leading cause of death in the United States, and stroke was a leading cause of long-term severe disability. Nearly half of older stroke survivors experience moderate to severe disability. The CDC reports in 2017 in their “Sociodemographic and Geographic Variation in Awareness of Stroke Signs and Symptoms Among Adults” article that previous studies have shown that stroke morbidity and mortality vary across populations and communities and disproportionately affect racial and ethnic minorities, persons with less education, and persons living in the Southeast (i.e., the “stroke belt”).
Also, in some subgroups, stroke mortality might
be increasing, and overall, declines in stroke death rates have stalled in most states. The extent to which an increase in stroke knowledge could affect existing disparities and trends in stroke mortality is unknown. CDC previously reported that in 2005, 2.6% of U.S. adults had a history of stroke. The prevalence of stroke was higher among older persons, American Indians/Alaska Natives, African Americans, and persons with lower levels of education compared with younger persons, whites, and persons with higher levels of education. Also in 2005, a nearly two-fold difference was observed between states with the lowest and highest estimated stroke prevalence.
Causes and Types of Stroke
A stroke is a sudden and serious loss of blood flow to the brain. There are two basic types of stroke but some experts divide strokes into smaller, more specialized categories. The American Heart Association has 5 different
classifications of strokes:
1. Ischemic Stroke (Clots) Occurs when a blood vessel supplying blood to the brain is obstructed. It accounts for 87 % of all strokes.
2. Hemorrhagic Stroke (Bleeds) Occurs when a weakened blood vessel ruptures. The most common cause of hemorrhagic stroke is uncontrolled
high blood pressure
3. TIA (Transient Ischemic Attack) Called a mini-stroke, it’s caused by a serious temporary clot. This is a warning sign of a stroke and should be taken seriously.
4. Cryptogenic Stroke
In some instances, despite testing, the cause of a stroke can not be
determined. This is called a cryptogenic stroke.
5. Brain Stem Stroke
When stroke occurs in the brain stem, it can affect both sides of the body
and may leave someone in a ‘locked-in’ state. When a locked-in state occurs, the patient is generally unable to speak or move below the neck. The brain is a vital organ. The brain controls movement, circulation, breathing, digestion, speech, amongst other things,and it is the source of consciousness and higher intellectual functions. The brain is the most metabolically active organ in the body. The brain requires almost 25% of the total blood flow the heart pumps in a minute for it to function, even though the average brain only represents about 2% of a person’s body weight.Any significant disruption of blood flow to the brain can have seriousconsequences due to the brain's immense metabolic need.
The disruption in blood flow during a stroke happens for two reasons. First,a stroke can be caused by a blood clot and is called an ischemic stroke or an embolic stroke. Thrombosis and embolism share many similarities, but they are unique conditions. Thrombosis occurs when a thrombus, or blood clot, develops in a blood vessel and reduces or blocks the flow of blood through the vessel. An embolism occurs when a piece of a blood clot, foreign object, or other bodily substance becomes stuck in a blood vessel and largely obstructs the flow of blood (thromboembolus). Ischemia is a condition in which the blood flow (oxygen) is restricted or reduced in a part of the body. An ischemic stroke occurs when there is decreased or no blood flow and oxygen to the brain. Clots are a common condition. If a clot is small and stable, it will not cause harm. However, if a section of a blood clot breaks off, it can move
through the arteries and veins. Eventually, the clot will become stuck in an artery or a vein (the embolism is too big to fit through the blood vessel)and if this occurs in the brain, blood flow and oxygen supply are completely shut off. Approximately 87% of strokes are ischemic strokes caused by blood
clots. Secondly, the other type of stroke is caused by bleeding, which is a sudden rupture of a blood vessel in the vein. This type of stroke is called a
hemorrhagic stroke. There is a type of ischemic stroke that is not caused by blood clots. If a patient has a rapid and severe drop in blood pressure, caused by a severe heart attack, or massive bleeding outside the brain, there will not be enough blood flow to the brain and a stroke is possible. In either type of stroke, the blood supply to the brain is suddenly and drastically stopped or cut off. The brain depends on a constant supply of oxygen and nutrients such as blood sugar (glucose) to survive and function, and oxygen and glucose are transported by the blood. Of course, this is true of all bodily organs and tissues. However, because the brain is so metabolically active and because it has such a high need for oxygen and nutrients, even a short period of disruption in the circulation of the brain can cause enormous and irreversible damage. It has been estimated that ifthe brain is deprived of oxygen for greater than six minutes, irreversible damage will occur.
There is another neurological emergency that closely resembles a stroke. A transient ischemic attack (TIA) occurs when a clot, or in extremely rare circumstances a hemorrhage occurs causing a temporary interruption of blood supply to the brain. However, with a TIA the signs and symptoms are short-term, the patient will recover, and there is no permanent damage.
Many people refer to a TIA as a “mini-stroke” but this does not mean that a TIA is benign.
A TIA is a serious medical event because someone who has had a TIA is much more likely to experience a stroke than someone who has not had a TIA.
Also, it can be difficult to distinguish between a stroke and a TIA when an event is happening.
Approximately 10% of all people who have a TIA will have a stroke within the next seven days, and approximately 25% of all people who have had a TIA will have a stroke within the next few years.
Stroke Risk Factors
Blood clots and bleeding are the basic causes of strokes but the blood clots and the bleeding themselves are caused by specific risk factors. These risk factors increase the chances of developing either the bleeding or the blood clots that cause a stroke. Risk factors for stroke are outlined next.
Age: Strokes are much more likely to happen in people over the age of 65. Advancing age increases the incidence and severity of other risk factors like atherosclerosis or obesity.
Atherosclerosis:
Atherosclerosis is a very common and widespread medical condition. It is characterized by blood vessels throughout the body that have been partially or completely obstructed by deposits of fat, cholesterol, and other substances causing the formation of plaques. The vessels become stiff or hardened and this is referred to as "hardening of the arteries". Pieces of these plaques can break off, form an embolism and cause a stroke. Below demonstrates the process of plaque rupture and clot formation.
Coronary Artery Disease: Coronary artery disease is atherosclerosis that occurs in the blood vessels of the heart. The presence of coronary artery disease increases the risk of having a stroke. The same process can occur in the cerebral vessels of the brain where pieces of plaques can break off, form an embolism, and could lead to a stroke.
Diabetes:
People who have either type of diabetes, type I or type II, often have many of the risk factors like advanced age, atherosclerosis, high blood pressure,and obesity that increase the chances of having a stroke. If you have diabetes, your chances of having a stroke are 1.5 times higher than in people who don't have diabetes.Diabetes can cause pathologic changes in blood vessels at various locations and can lead to stroke if cerebral vessels are directly affected.
Additionally, mortality is higher and post-stroke outcomes are poorer in patients with stroke with uncontrolled glucose levels.
Gender
The CDC reports that strokes are the leading cause of death in men, killing almost the same number of men each year as prostate cancer and Alzheimer’s disease combined. Stroke is also a leading cause of long-term disability, and men under age 44 are hospitalized for
ischemic stroke at a higher rate than women in the same age group.
Heart Arrhythmias: A heart arrhythmia called atrial fibrillation increases the risk for stroke by increasing the risk of blood clots forming in the circulation. Atrial fibrillation is described as the rapid, irregular beating of the atria (upper chambers) of the heart. These rapid contractions of the heart are weaker than normal contractions, resulting in the slow flow of blood in the atrium. The blood pools and becomes sluggish and can result in the formation of blood clots. If a clot leaves the heart and travels to the brain, it can cause a stroke by blocking the flow of blood through cerebral arteries. Atrial fibrillation is quite common with about 0.5% of the world's population. According to the Centers for Disease Control and Prevention (CDC), approximately 2% of people younger than 65 years old have atrial fibrillation, while about 9% of people ages 65 and older have it.The exact incidence of familial atrial fibrillation is unknown, recent studies suggest that up to 30% of people with atrial fibrillation may have a relative with the condition.
HeredityThere is an increasing amount of evidence that suggests that the tendency to be at risk for developing a stroke may be, in part, genetic. Although, teasing apart risk because of genetic mutations and because of shared familial exposures remains challenging. The Journal of the American Heart Association states specific rare single-gene disorders may contribute to individual familial syndromes for which stroke is the primary or unique manifestation, such as sickle cell anemia. Regarded as modest, but some common variants of genetic polymorphisms (the presence of genetic variation within a population, upon which natural selection can operate) have been associated with stroke risk. Genetic causes of conventional stroke risk factors, such as atrial fibrillation, diabetes mellitus, and hypertension, are also, not surprisingly, associated with the risk of stroke. Emerging evidence suggests that genetic studies could help to distinguish stroke subtypes and even contribute to the management of stroke for patients.
Hypertension: Hypertension is the most important modifiable risk factor for stroke, with a
strong, direct, linear, and continuous relationship between blood pressure
and stroke risk. The effect of blood pressure was also greater for
hemorrhagic than ischemic stroke.
Illicit Drug Use:
Drug abusers have an increased risk of both hemorrhagic and ischemic stroke.
The illicit drugs more commonly associated with stroke are amphetamines and
cocaine. Less commonly implicated are opioids and cannabis.
Obesity:
People who are obese often have atherosclerosis, coronary artery disease,
diabetes, and hypertension, which are modifiable risk factors. Lifestyle
changes of these modifiable risk factors may reduce the chances of having a
stroke. With few exceptions, each study reported by the American Heart
Association (AHA) at least one measure of adiposity (fat tissue) to be
significantly associated with increased risk for stroke. For every 1 unit
increase in BMI (7 pounds for a human of average height), the risk for
ischemic stroke increases 5% and the risk seems to be nearly linear starting
with a still-normal BMI of 20%.
Oral Contraceptives:
Ischemic stroke is increased in current oral contraceptive users, even with
newer low-estrogen preparations. However, the absolute increase in stroke
risk is expected to be small since incidence is very low in this age
population.
Smoking:
Cigarette smoking increases blood pressure and increases the risk of
developing atherosclerosis, both of which increase the risk of developing a
stroke.
Nicotine causes blood vessels to constrict or narrow, which limits blood
flow. Over time, the constant constriction results in blood vessels that are
stiff and less elastic. Narrowed, inflexible blood vessels hinder the
movement of blood and could increase the risk of developing a stroke.
Other Risk Factors:
1. Previous history of stroke
2. A prior transient ischemic attack (TIA)
3. People who have had heart bypass surgery
High bloodpressure, age > 65, and atherosclerosis are probably
the most significant risk factors for a stroke. Some of these risk factors
such as age, family history, and gender cannot be changed but others are
related to personal health habits and lifestyle.
Preventing a stroke is better than treating one. People should be educated
by their provider about the risk factors for stroke and the signs and
symptoms of a stroke. Friends and family should be educated as well. Every
effort should be made to encourage someone who has lifestyle-related risk
factors for stroke to stop smoking, eat a healthy diet, lose weight,
exercise, and have their blood pressure checked regularly.
Signs and Symptoms of Stroke
Different parts of the brain are responsible for controlling different vital
functions. These include conscious functions such as speech, memory, and
awareness, and unconscious functions such as circulation, breathing,
digestion, etc. The signs and symptoms of a stroke can vary
depending on what area of the brain is affected. If one part is damaged, the
patient may not be able to speak. If another part is damaged, the patient
may not be able to walk.
The signs and symptoms of a stroke may vary from person to person, but the
American Stroke Association has listed the most common indications that
someone may be having a stroke:
1. Sudden numbness or weakness, especially to one side of the
body.
2. Sudden difficulty in speaking or inability to speak.
3. Sudden inability to walk.
4. Sudden severe headache.
5. Sudden onset of blurred vision.
6. Sudden onset of confusion.
It is important to know all the stroke signs and symptoms; however, these
are the most common signs:
1. Sudden weakness or numbness to one side of the body.
2. Sudden difficulty in speaking or an inability to speak.
3. Sudden onset of confusion.
A simple and useful way to determine whether someone is having a stroke is
to remember the mnemonic phrase F.A.S.T. If you suspect
that someone may be having a stroke, remember:
F - Facial drooping
A - Arm weakness
S - Speech difficulties
T - Time
Very often a stroke will affect one side of the body but not the other.
While the stroke is happening, it is common for the muscles of the face on
one side to be affected and that side of a stroke victim’s face will droop.
The muscles of the arms on one side of the body will be affected, so the
stroke victim will be unable to raise an arm and hold it in position.
Finally, speech difficulties are very common during a stroke. The speech
will be garbled, nonsensical, and/or incomprehensible.
Apply stroke signs to the F.A.S.T mnemonic. Look for facial drooping and/or
ask the person to smile and see if one side of the person’s face droops.
Ask the person if he or she can raise an arm and keep it raised and assess
the quality of the person’s speech.
The T stands for time, and even though it is not part of
determining whether someone is having a stroke, it is the most important
part of the mnemonic. A person who is having a stroke needs
immediate
medical attention. A stroke is caused by an interruption of blood flow to
the brain, and the longer the brain is deprived of blood and oxygen the
greater the damage will be. Also, there are effective treatments for stroke
but these treatments are most effective if given as soon as possible
following the onset of the stroke.
The more time that passes after the onset of the signs and symptoms of a
stroke, the less effective stroke treatment will be and the greater the
risks that neurological damage will be severe and permanent.
The signs and symptoms of a stroke and a TIA are virtually identical. People
recover from a TIA but a stroke is a medical emergency. Both are very
serious medical conditions and the patient needs immediate care.
Without a provider’s exam and especially without specific tests, it is
impossible to know if someone is having a TIA or a stroke. For this reason,
no health care professional should try to distinguish between a stroke and
TIA “in the field.” If there is a suspicion that someone is having either a
stroke or a TIA, 911 should be called immediately.
A stroke can cause elevated blood pressure, abnormally low heart rate, coma,
decreased and inefficient respirations, and death. Approximately 20% of all
people who have a stroke will die within the year. The death rate for people
who have had a hemorrhagic stroke is much higher, and hemorrhagic strokes
tend to cause more damage. The disabilities of a stroke such as the
inability to speak, walk, or move parts of the body may resolve or they can
be permanent.
If someone experiencing a stroke gets skilled medical attention within the
first three to four hours, the damage can be limited. Unfortunately, strokes
can happen when someone is sleeping. A stroke can also happen when someone
is alone, making it impossible to call for help.
A stroke may be mistaken for something else. A stroke can go unrecognized by
the victim or the people who are with the victim. In many cases people who
are having the signs and symptoms of a stroke may be in denial; they do not
want to believe that a serious medical emergency is happening.
Stroke Outcomes and Physical Functioning
The outlook for a stroke victim depends on several things. First, how soon
the victim arrives at a hospital and treatment is established. Second, how
serious the stroke is and the severity of signs and symptoms. Lastly, what
is the patient’s age, and what types of pre-existing medical problems the
patient has had. The following figures are estimates of a stroke victim’s
outlook:
1. 10% of all stroke victims recover completely.
2. 25% recover with a minor impairment.
3. 40% have a moderate to severe impairment and require special
care.
4. 10% require nursing home care.
5. 15% have another stroke within a year.
From this group, about 15% will die shortly after a stroke. One-quarter of
stroke victims will die within 30 days.
Many stroke victims suffer from disabilities. Some of these disabilities
include:
1. Aphasia: Inability to communicate (verbal/written/or
understand either)
2. Hemiparesis: Weakness affecting one side of the body
3. Quadriparesis: Weakness affecting all four limbs
4. Hemiplegia: Paralysis affecting one side of the body
5. Quadriplegia: Paralysis all four limbs
6. Urinary incontinence
7. Bowel incontinence
8. Dysphagia: Difficulty in swallowing
9. Dysarthria: Difficulty speaking or altered speech
10. Confusion
11. Depression
12. Sleep disorders
Many stroke victims will recover some or most of their ability to function
independently. Rapid progress after a stroke is a good sign. If a patient
regains a large portion of his or her ability to ambulate, speak, and
perform activities of daily living within a few weeks of the stroke, the
patient’s prognosis is good. Most patients will recover functions within the
first three months following a stroke but some patients continue to make
progress after that time.
Predicting recovery after a stroke is difficult. The sooner someone gets to
a hospital and receives treatment the better the outlook. Unfortunately, it
is well-documented that for various reasons, many stroke victims do not get
to a healthcare facility quickly enough. An older person is likely to have a
more severe stroke. A person with other medical conditions such as diabetes,
hypertension, obesity, etc., is likely to have a poorer outcome
following a stroke.
Assisting A Person Having a Stroke
If a health care professional is at work and suspects a patient is having a
stroke, the health care professional should take the following steps:
1. Note the time of the event, from onset of first symptoms
(extremely important).
2. Call 911 for help or immediately notify a supervisor.
3. Take the patient’s vital signs (blood pressure, pulse, and
respiratory rate).
4. Perform the F.A.S.T assessment.
If a person is not at work and suspects someone is having a stroke, the
following steps should be taken. The first step is to call 911; immediate
transport to a hospital might save the person’s life. The next step is to
note the time of the event; this is very important because some of the
available therapies for a stroke that might save someone’s life or limit the
damage caused by a stroke cannot be used after a certain number of hours
have passed.
After calling 911 and establishing the time of the event, the person
assisting should either write down or make a mental note of what was
observed. Remember the F.A.S.T. mnemonic. Pay particular
attention to the victim’s ability to speak and whether or not the victim can
understand and respond appropriately to verbal communication. If it is
possible, the person assisting should ask the victim to squeeze a hand to
help determine if the victim has weakness on one side or the other, or both.
Finally, if possible, the victim’s pulse should be checked, and an effort
made to keep the stroke victim comfortable while waiting for an ambulance to
arrive.
Stroke victims are sometimes given aspirin. This can be helpful in some
cases but it may also cause serious harm if the victim is experiencing a
hemorrhagic stroke. Because of the potential for serious harm, a patient
should not be given aspirin to treat a stroke unless a provider or emergency
medical service (EMS) personnel has advised its use.
Some people who are having a stroke will have dramatic signs and symptoms
while others may not. In either case, it is common for people to deny that
anything is wrong and some may refuse transport to a hospital. If this
happens, the health care professional should call 911 regardless. The EMS
personnel may be able to convince the person to get the help that is needed.
If someone may be having a stroke, that person can refuse medical care but
should be informed of the risks and told that if a stroke is happening, it
is vital to get to a hospital as soon as possible.
Emergency Stroke Treatment
If a stroke occurs, it is essential to seek help immediately. It has been
proven that early intervention will save lives and can limit neurological
damage. Some of the medications that can be lifesaving and prevent permanent
neurological damage must be used within 4 ½ hours of the stroke
onset, and studies have shown that for every 15 minutes of reduction time
from the onset of stroke to treatment, the chances of survival and recovery
are greatly increased. It cannot be emphasized strongly enough that
time is the most important aspect of stroke treatment
.
When a patient has a stroke, the patient will usually receive medical
attention up to 24 hours after the stroke. As mentioned above, the delay may
be due to a stroke occurring while a person is sleeping, or while being
alone. When a person is aware of stroke symptoms, he or she may deny that a
serious event is occurring.
Once a patient reaches an emergency room, a physician will determine if the
patient is having an ischemic stroke or a hemorrhagic stroke. This is done
using computed tomography (CT) scan, magnetic resonance imaging (MRI), and
other diagnostic tools. If the patient is having an ischemic stroke, he or
she will probably receive intravenous medication that will break up the
blood clot that is causing an obstruction. If the patient is having a
hemorrhagic stroke, these medications will not be used. The care for these
patients will be supportive and focus on treating the common complications
of a stroke. Surgery is rarely an option for treating hemorrhagic stroke.
Post-Stroke Treatment
After a stroke, treatment focuses on three specific goals.
1. Preventing and treating acute, serious medical complications.
2. Preventing and treating subacute medical complications.
3. Maximizing the patient’s ability to function independently.
Preventing and Treating Acute Stroke Complications
Typical serious post-stroke medical complications include brain edema
(swelling), fever, hyperglycemia (high blood sugar), hypoglycemia (low blood
sugar), hypertension, hypotension, pulmonary embolism, respiratory
infections, seizures, thrombophlebitis (inflammation of a vein that can
cause blood clot formation and blockage in the vein), and urinary tract
infections. Patients are also at risk for suffering a myocardial infarction
(heart attack) or another stroke. These complications occur in the first few
hours and days while the patient is still in the Intensive Care Unit (ICU)
or an acute care facility.
Preventing or Treating Subacute Medical Complications
Preventing and treating subacute medical complications is often initiated
during the acute phase of stroke care. These problems are called subacute to
distinguish them from serious complications such as hypotension and seizures
that can be life-threatening. The subacute complications can cause
significant harm but they are not immediately dangerous. The more common
ones are listed here.
Contractures:
A contracture is a permanent tightening of the muscles, tendons, skin, and
nearby tissues that causes the joints to shorten and become very stiff.
Contractures can be prevented with proper positioning, range of motion
exercise, splinting, and other preventive techniques.
Dysphagia:
Dysphagia literally means “difficulty swallowing.” Stroke is the most common
cause of dysphagia. Approximately 65% of people who suffer a stroke will
have dysphagia and for many of them, the condition will be permanent.
Strokes affect the nerves and the muscles that control swallowing, and it
can also damage the gag reflex.The gag reflex is essentially a
sensitive area of tissue in the back of the throat that will sense if food,
fluid, or a foriegn body is going into the lungs instead of the esophagus.
If this happens, the gag reflex is initiated and the food, fluid, or foreign
body is expelled with a forceful cough and gag.
Dysphagia is a serious problem. It can affect the person’s hydration and
nutrition status and if the gag reflex is damaged, food, liquids, or foreign
bodies can be aspirated into the lungs and cause pneumonia or worse, a
blocked airway. Patients who have had a stroke will be evaluated, usually by
a speech therapist, to determine if there are any swallowing difficulties.
Treatments for dysphagia include temporary placement of a feeding tube,
controlling size, and consistency of food portions, positioning strategies,
supervision during meal times, and swallowing exercises.
Incontinence
Loss of bladder and bowel control are common complications caused by stroke.
Approximately 30% of stroke victims will have some degree of urinary
incontinence, and for many, the problem will persist. Fecal incontinence is
also common but less so than urinary incontinence.
Treatments for bladder and bowel incontinence can include the temporary use
of a urinary catheter for a period of time, medications that help control
the bladder and the bowels, pelvic floor muscle strengthening exercises, and
behavioral modification techniques such as scheduled toileting.
Pressure Sores
Some patients who have had a stroke will not be able to move, either from
paralysis or the need to be immobile while being treated, and immobility is
the basic cause of pressure sores. The development of pressure sores and the
treatment of pressure sores is a complex subject. Experienced health care
professionals should be familiar with how pressure sores start and how they
are managed.
Pressure sores are caused by unrelieved pressure, applied with great force
over a short period (or with less force over a longer period), that disrupts
blood supply and impedes blood flow, and deprives tissues of oxygen and
nutrients. The most common sites for pressure ulcers are the sacrum, heels,
ischial tuberosities, greater trochanters, and lateral malleoli.
Maximizing Independent Function
A stroke can have devastating effects on someone’s ability to live
independently. As soon as possible after a stroke, occupational therapy,
physical therapy, and speech therapy professionals should become involved.
Physical therapy, occupational therapy, and speech therapy are essential
parts of the recovery process for stroke victims. It has been proven that
these treatments can help people regain some function and independence.
At some point, a psychologist or psychiatrist will probably be asked to
evaluate the patient. Many patients who have had a stroke develop
psychological problems; anger, depression, and fear are common. The patient
has had a significant life change, the future is uncertain, and it is
possible that the patient may never again be able to live independently.
Without counseling and support, the psychological impact of a stroke can be
as crippling as the physical damage.
The therapies that are commonly implemented for patients who have had a
stroke are occupational therapy, physical therapy, psychotherapy, and speech
therapy.
Occupational Therapy:
Occupational therapy is similar to physical therapy but the occupational
therapy activities are designed to be very practical. This therapy is
designed to help people who have had a stroke perform their activities of
daily living (ADL) such as dressing, eating, bathing, and ambulating. The
occupational therapist will use exercises, special tools, and lots of
hands-on practice to simulate these activities so that the patient will
become skilled at real-world, self-care tasks.
Occupational therapy also focuses on how to perform the ADL within the
patient’s specific physical limits.
Physical Therapy:
Physical therapy is an organized program of exercises. It is designed to
strengthen the muscles and keep the joints flexible. Physical therapists can
also help people who have had a stroke learn ways to work with their
disabilities.
Psychotherapy:
Individual counseling, group therapy, and antidepressant medications are
some of the treatment options.
Speech Therapy:
Aphasia is very common in stroke victims. Aphasia is the inability to
understand or express through speech. At least one-third of all people who
have had a stroke have some degree of aphasia. Speech therapy and time can
help approximately 50 percent of these people regain the ability to speak.
Caring for the Stroke Victim
After a stroke, the patient may not be able to move, may not be able to
speak, may not be able to understand oral communication, and may be
confused. Because of these factors, many victims of a stroke need almost
complete care in the first few days and weeks after the event.
A health care professional who is responsible for a stroke patient should
concentrate on the following areas of care.
Communication:
When speaking to the patient, the health care professional should take a
position directly in front of the patient and make eye contact. Initially,
short, simple questions should be used. The health care professional should
make an effort to demonstrate an action or task the patient needs to
perform. It will take time to discover what each person can do and what his
or her style of communication might be.
The health care professional caring for a stroke patient will need to
practice patience. If a health care professional is having a hard time
getting a point across because the patient is having a hard time
understanding, it might be more sensible and less frustrating for everyone
if the health care professional could wait and try again later.
Exercise:
If a patient who has had a stroke cannot move their arms, legs, or other
parts of the body, the joints may become permanently stiff and immovable,
and the patient can develop contractures. A health care professional may be
asked to performrange of motion(ROM) exercises. These consist of
slowly flexing and extending the arms and legs within their normal range.
Skin Care:
When someone is confined to bed or a chair for long periods because of
immobility, constant pressure of the bodyweight can cause skin breakdown,
also known as pressure sores or pressure ulcers. These can
be very serious, and there are many techniques used to prevent skin
breakdown, such as padding pressure points and frequent position changes.
The health care professional should be familiar with these techniques and
will be responsible for performing them.
Assisting with ADL:
People who have had a stroke will often need help dressing, bathing, and
moving. The health care professional will need to encourage the patient to
do as much as possible but only if these tasks can be performed safely.
Falls are one of the biggest causes of injuries. Helping a patient ambulate
is one of the tasks a health care professional must perform.
Nutrition:
A stroke can cause dysphagia and damage the gag reflex.This reflex
prevents food, fluids, or foreign objects from going into the lungs. The
health care professional should supervise eating and never rush someone
through a meal. The size of each piece of food and its consistency will be
determined by the physician and the dietician. The health care professional
should never go outside these guidelines.
Summary
Stroke is the most common neurological emergency. A stroke also called a
cerebral vascular accident (CVA) happens when there is a sudden, significant
disruption of the blood flow to the brain. Because the brain is so
metabolically active and has such a high need for blood, any serious
decrease in blood flow to the brain can cause irreversible damage.
A stroke can be caused by a blood clot that travels from the peripheral
circulation and lodges in a blood vessel in the brain or a ruptured blood
vessel. The first type of stroke is called an ischemic stroke and it is the
more common of the two. The second type is called a hemorrhagic stroke. The
signs and symptoms of ischemic and hemorrhagic stroke are identical but
hemorrhagic strokes tend to be more severe.
The signs and symptoms of a stroke can be mild or severe. The most common
signs of a stroke are confusion, inability to speak, and weakness on one
side of the body. A recommended way to determine if someone is having a
stroke is to use the mnemonic F.A.S.T;
Facial asymmetry, check muscle strength by asking the
patient to hold up one Arm, assess the quality of the
patient’s Speech, and remember that Time
is critical. A person who is having a stroke will need immediate medical
attention.
A stroke may begin relatively mild and improve but it can also progress and
cause irreversible brain damage. Common complications of a stroke include
aphasia, dysphagia, and muscle weakness or paralysis. It is difficult to
predict the level of recovery after a stroke but the outcome for the patient
is worse if the stroke is more severe and if the patient is older. Recovery
depends on the number and severity of a patient’s pre-existing medical
problems. However, the sooner a stroke victim receives medical care, the
better the patient’s chances for survival and recovery of function.
