1. RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling
Stroke and Hemiplegia

2. Stroke and Hemiplegia
Stroke is the third leading cause of death in the US and the leading cause of disability
approx. 700,000 strokes; 160,000 deaths
Modifiable risk factors include TIA, diabetes, hypertension, atrial fibrillation, substance abuse, and smoking
Nonmodifiable risk factors include age, gender, race, and family history

3. Stroke and Hemiplegia
Of those who survive the initial onset, the most frequent presenting problem is hemiplegia (75-88%)
During the acute period, there is high incidence of associated neurological deficits
One important medical concern is the incidence of comorbidities that may affect management and rehab

4. Types Ischemic (83%) Cerebral thrombosis (most common)
Can be “silent ischemia” (no sx)
Caused by atherosclerosis
Cerebral thrombosis (most common)
blood clot forms in arteries leading from heart to brain (carotid)
blocks blood flow
Often preceded by TIA
Cerebral embolism
less frequent
blood clot forms elsewhere (embolus), travels through bloodstream, lodges in cerebral artery

5. Types Hemorrhagic stroke Why? less common than ischemic strokes
more deadly
if person survives, better recovery of function
Why?
Ischemic: Blood supply to brain stopped; tissues die, do not regenerate
Hemorrhagic: pressure from blood compresses brain, affects function, pressure relieved, function returns

6. Hemorrhage subarachnoid hemorrhage cerebral hemorrhage (10%) Causes:
blood vessel on surface of brain leaks
bleeding into space between brain & skull
cerebral hemorrhage (10%)
Defective artery in brain bursts
Causes:
aneurysm (blood-filled pouches that balloon out from weak spot in artery)
advancing age, congenital malformation
aggravated by hypertension
head injury

7. Stroke and Hemiplegia Right-Hemisphere Stroke Left-Hemisphere Stroke
The right hemisphere controls the movement of the left side of the body as well as analytical and perceptual tasks
Left-Hemisphere Stroke
The left hemisphere controls the movement of the right side of the body as well as speech and language abilities

8. Stroke and Hemiplegia Cerebellar Stroke Brain Stem Stroke
The cerebellum controls many of our reflexes and much of our balance and coordination
Brain Stem Stroke
The brain stem is the area of the brain that controls all of our involuntary, “life-support” functions as well as abilities such as eye movements, hearing, speech, and swallowing

9. Symptoms sudden numbness, weakness face, arm, leg (one side of body)
sudden severe headache
difficulty seeing in one or both eyes
confusion, trouble speaking or understanding
dizziness, loss of balance/coordination

10. Treatment of a stroke Getting medical help quickly essential!
Ischemic stroke:
"Clot-busters"
tissue plasminogen activator (tPA)
Must give within 3 hours
Hemorrhagic stroke: correct cause of hemorrhage

11. Function after Stroke
Function
Time I

12. Some residual effects of strokes
Emotional lability (mood swings, depression)
Perceptual effects: Difficulty recognizing, understanding familiar objects
Difficulty planning, carrying out simple tasks
Loss of awareness (One-side neglect )
Dysphagia (difficulty swallowing)
Aphasia: difficulty putting thoughts into words or understanding speech

13. Risk Reduction lifestyle changes aspirin blood thinning medications
carotid endarterectomy (remove plaque)
Experimental: neurogenesis (regenerating affected neurons)

14. Reactions & Rehabilitation
social isolation
grieving process
physical, occupational, speech therapy
20% require long-term care
Recovery affected by extent of brain damage, patient’s attitude, support system, rehab. team skill

15. Voc Rehab and Stroke
Estimated that 30% of strokes occur in people under 65
One study found a 49% RTW rate for people year old
Physical factors and aphasia play significant roles and complications in vocational planning

16. Voc Rehab and Stroke Some strategies for aphasia
Reduction of working hours or territory covered
Selective interaction with customers or suppliers with whom the person had dealt with prior to stroke
Reliance on overlearned behavior and language in the performance of new tasks
Initial help from a relative or close friend
Job carving

17. Additional Resources and Information from the Web
National Stroke Association (
American Stroke Association (
National Aphasia Association (
Journal of Stroke and Cerebrovascular Diseases (
The Brain Attack Coalition (