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

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Presentation on theme: "RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling Stroke and Hemiplegia."— Presentation transcript:

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

2 Stroke is the third leading cause of death in the US and the leading cause of disability 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 Modifiable risk factors include TIA, diabetes, hypertension, atrial fibrillation, substance abuse, and smoking Nonmodifiable risk factors include age, gender, race, and family history 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%) 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 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 One important medical concern is the incidence of comorbidities that may affect management and rehab

4 Types 1. Ischemic (83%) –Can be “silent ischemia” (no sx) –Caused by atherosclerosis 2. Cerebral thrombosis (most common) –blood clot forms in arteries leading from heart to brain (carotid) –blocks blood flow –Often preceded by TIA 3. Cerebral embolism –less frequent –blood clot forms elsewhere (embolus), travels through bloodstream, lodges in cerebral artery

5 Types 1. Hemorrhagic stroke –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 subarachnoid hemorrhage –blood vessel on surface of brain leaks –bleeding into space between brain & skull cerebral hemorrhage (10%) cerebral hemorrhage (10%) –Defective artery in brain bursts Causes: 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 Right-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 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 Cerebellar Stroke –The cerebellum controls many of our reflexes and much of our balance and coordination Brain Stem Stroke 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 numbness, weakness face, arm, leg (one side of body) sudden severe headache sudden severe headache difficulty seeing in one or both eyes difficulty seeing in one or both eyes confusion, trouble speaking or understanding confusion, trouble speaking or understanding dizziness, loss of balance/coordination dizziness, loss of balance/coordination

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

11 Function after Stroke Time Function I

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

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

14 Reactions & Rehabilitation social isolation social isolation grieving process grieving process physical, occupational, speech therapy physical, occupational, speech therapy 20% require long-term care 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 Estimated that 30% of strokes occur in people under 65 One study found a 49% RTW rate for people year old One study found a 49% RTW rate for people year old Physical factors and aphasia play significant roles and complications in vocational planning Physical factors and aphasia play significant roles and complications in vocational planning

16 Voc Rehab and Stroke Some strategies for aphasia 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 (www.stroke.org) National Stroke Association (www.stroke.org)www.stroke.org American Stroke Association (www.strokeassociation.org) American Stroke Association (www.strokeassociation.org)www.strokeassociation.org National Aphasia Association (www.aphasia.org) National Aphasia Association (www.aphasia.org)www.aphasia.org Journal of Stroke and Cerebrovascular Diseases (www.strokejournal.org) Journal of Stroke and Cerebrovascular Diseases (www.strokejournal.org)www.strokejournal.org The Brain Attack Coalition The Brain Attack Coalition (www.stroke-site.org) (www.stroke-site.org)www.stroke-site.org


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