Definition of Stroke A sudden onset of neurological impairment caused by rupture or blockage of a blood vessel to the brain Also known as Cerebral Vascular Accident or CVA Commonly known as a "brain attack"
Stroke Facts Stroke is the leading cause of disability in the United States. Stroke is the third leading cause of death in the United States. 50% of individuals experience some level of disability after 6 months 5-14% of people have a second stroke within 1 year of their first Within 5 years, 24% of females, and 42% of males have a second stroke Stroke prevalence is 2.5 higher in African Americans than in Americans of European descent African Americans suffer greater physical impairment from stroke 10% of stroke survivors recover almost completely 25% recover with minor impairments Most recovery from stroke takes place in the first 3 months. Minor additional improvement occurs after the 6 months but improvement can continue long-term.
TIA A focal neurological deficit that occurs secondary to impaired blood flow to brain Symptoms last less than 24 hours Increased chance of having an actual stroke "Warning Stroke"
Ischemic Stroke (clots) A stroke caused by decreased blood flow Fatty plaques or clots cut off or obstructs blood flow to brain cells Accounts for 87% of strokes
Hemorrhagic Stroke (bleeds) A weakened vessel ruptures and bleeds into the surrounding brain. Blood accumulates and compresses the surrounding brain tissue. Hemorrhagic strokes are: intracerebral (within the brain) or - subarachnoid (between brain and thin tissue covering brain) Accounts for 13% of stroke cases
Alterable Stroke Risk Factors High blood pressure Cigarette smoking Diabetes mellitus Carotid or other artery disease Peripheral artery disease Atrial fibrillation Heart disease Sickle cell disease High Cholesterol Poor Diet Sedentary lifestyle Obesity
Unalterable Stroke Risk Factors Age- The older you get the more likely you are to have a stroke Heredity- genetic component Race- African Americans have higher risks of high blood pressure, diabetes and obesity. Gender- Stroke is more common in men than women, but women are more likely to die from stroke Prior Stroke, TIA or Heart Attack increases likelihood
Other Less Known Risk Factors Geographic location Socioeconomic factors Alcohol abuse Drug abuse
Time is Brain! Acute treatment needs to be initiated within 3-4 hours of symptom onset- ideally within 60 minutes of arrival at the hospital! tPA (tissue plasminogen activator) clot-dissolving agents can significantly reduce the effects of stroke and reduce permanent disability. Only 3 to 5% reach the hospital in time for this long-term disability prevention measure Note time any symptoms first appear
5 Cardinal Signs of Stroke Sudden severe headache without cause One-sided weakness One sided numbness Speech disturbance/confusion Visual loss Only 15% of people can name all 5 symptoms
Additional unique stroke symptoms may occur in women Sudden face and limb pain Sudden hiccups Sudden nausea Sudden general weakness Sudden chest pain Sudden shortness of breath Sudden palpitations
Physical challenges after stroke Aphasia What is aphasia?? Broca's Aphasia Vs. Wernicke's Aphasia Vs. Global Aphasia
Wernicke's Aphasia YouTube: Wernicke's Aphasia Video
Broca's Aphasia 0 -> 1:35 From University of Wisconsin/YouTube
How is aphasia treated? 1. Spontaneous recovery 2. Partial spontaneous recovery 3. Aphasia therapy 'Traditional' Therapy, Group Therapy Regional Support Groups Family Involvement
Family members are encouraged to: Simplify language by using short, uncomplicated sentences. Repeat the content words or write down key words to clarify meaning as needed. Maintain a natural conversational manner appropriate for an adult. Minimize distractions, such as a loud radio or TV, whenever possible. Include the person with aphasia in conversations. Ask for and value the opinion of the person with aphasia, especially regarding family matters. Encourage any type of communication, whether it is speech, gesture, pointing, or drawing. Avoid correcting the person's speech. Allow the person plenty of time to talk. Help the person become involved outside the home. Seek out support groups such as stroke clubs. From NIH:NIDCD
Cognitive challenges after stroke Con't: - Stroke in left brain: short-term memory problems - Stroke in right brain: trouble with sequencing, tend to misinterpret or confuse information. - Additional cognitive challenges
Physical challenges after stroke - Hemiparesis - Hemiplegia - Hemianopia - Neglect - Anosognosia - Asomatognosia Right Hononymous Hemianopia:
Seating systems after stroke Correct seating system allows mobility, independence and safety during daily activities allows participation minimizes deformity prevents secondary complications wheelchair fitting and training necessary to reach full functional potential Wheelchair cushions
Pressure Relief Decubitus Ulcer (otherwise known as pressure sore) can develop when a person does not shift body weight due to impaired sensation, motor control or judgment Instruct on pressure relief every 1/2 hour Pressure reducing cushions- gel or air
What can informal caregivers and professional caregivers do? Education- patient and family -written handouts Psychosocial support- patient and family Address modifiable risk factors Recognize emerging symptoms Medication & treatment compliance education
After a stroke, one may or may not need help with: Personal care, including bathing, dressing, and taking care of other aspects of basic hygiene Home-safety assessment and modifications Personal emergency response system Transportation and/or escort to appointments Medication management- to prevent interactions or side effects and ensure that drugs Money management Help with insurance entitlements, SS or SSDI benefits Advisement on legal issues such as power of attorney or advance directives
After a stroke, one may or may not need help with: Advisement on legal issues IE power of attorney or advance directives Management of medical appointment Home safety assessment Evaluate for need of assistive devices such as walkers, canes, reachers, dressing aides, grab bars and more Companionship or respite care, which may allow loved ones a needed break Psychosocial adjustment to disability
Stroke survivors concerns post- stroke Functional dependence Performance of activities of daily life: grooming, self-care, hygiene, driving, cooking, shopping, housework, sexual expression, etc Memory Employment Depression General health Future strokes Money Where they will be placed
Tips for choosing clothing to promote independence Encourage dressing every day, instead of wearing pajamas as this may help promote a positive mood! Choosing Clothing: - Should fasten down the front - Avoid tight fit - Easier to pull pants up/down over nylon underwear - Smooth fabrics - Elastic/velcro fasteners, snaps, elastic wasitbands, rings attached to zipper pulls
Tips for dressing and undressing - Lay out clothes in the order they will go on - Easier to don clothes in sitting rather than laying down - Always dress affected side first when dressing and when undressing, take clothes off of affected side last - Putting on blouses, jackets, cardigans: lay clothing on flat surface, collar away from you, back top facing the ceiling. Bend over, put arms into armholes and lift over your head. - Buttons: Bottom to top so that you can see the holes more easily. Can rest weak arms on a table or chair armrests while doing this. - Consider bra that hooks in front - Dress in front of mirror and allow plenty of time - Equipment: reacher, buttonhook, or dressing stick for dressing/reaching - Ask for help if needed!
Bathing Tips Grooming requires precise movements while holding small objects. Here are strategies: - "wash and wear" hairstyle - Weekly appointment at beauty salon - Equipment/strategies: lighted and angled mirror, electric shaver to decrease nicks, "picks" for flossing, try different toothpaste caps - wash mitts, mounted nail clippers, mounted dental floss designed for use with one hand
Grooming and Hygiene Tips Electric toothbrush Press down pump toothpaste dispensers Toiletries within easy reach Liquid soap in a press down pump Shampoo in a spray bottle for better distribution Deodorant spray Easy load toilet paper holder or "wet wipes"moist towelettes Bidet Aerosol health and beauty products
Grooming and Hygiene tips Applying Toothpaste: - Use strong hand to squeeze paste onto your tongue, and then pick up toothbrush - Hold brush btwn teeth, apply toothpaste with strong hand - Toothbrush btwn thumb and forefinger of weak hand, add toothpaste with strong hand Shaving: - Use an electric shaver if possible. Men: puff out cheeks when you shave. Use disposable razor - Shaving cream: Put cream onto back of weak hand or onto edge of sink. Apply using strong hand - Women should use an electric shaver for legs. Might better reach lower legs if you lie on a bed while doing this
Shopping Make a list of necessary items Plan weekly expenses to decrease ATM/bank visits Categorize items on shopping list according to aisle to decrease walking throughout store Use a pushcart Money/cards in an easily accessible pocket/purse Online, phone, TV or mail catalog shopping if possible Shop when retail and grocery stores are not busy Consider delegating shopping if necessary
Resources F.A.S.T. Mobile phone app http://strokeassociation.org/STROKEORG/WarningSigns/Stroke-Warning-Signs- and-Symptoms_UCM_308528_SubHomePage.jsp National Stroke Association www.stroke.org American Stroke Association www.strokeassociation.org National Stroke Association Hotline Toll-free hotline: 1-888-STROKES or 1-800-787-6537 National Aphasia Association 1-800-922-4622 www.aphasia.orgwww.aphasia.org Stroke support groups http://www.stroke.org/site/PageServer?pagename=support_groups http://rusk.med.nyu.edu/support-groups-1
Local opportunities to participate in clinical trials Columbia University summer stroke camp 2 week intensive therapy: -Contact Glen Gillen or Dawn Nielsen 212-305-5267 Columbia Stroke Research Registry: -Weill Cornell Rehab. Medicine Department, Stroke Research office 212-746-1356 Rusk Institute stroke research: -http://rusk.med.nyu.edu/clinical-trials Kessler Institute for Rehabilitation -www.kessler-rehab.com Top Rated U.S. Stroke Rehab centers in tri-state area Kessler Institute for Rehabilitation, West Orange, N.J. Rusk Institute, NYU Medical Center, New York Mount Sinai Medical Center, New York New York-Presbyterian Hospital, New York