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

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

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

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

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

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

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

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

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

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

Function after Stroke Function Time I

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

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

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

Voc Rehab and Stroke Estimated that 30% of strokes occur in people under 65 One study found a 49% RTW rate for people 21-65 year old Physical factors and aphasia play significant roles and complications in vocational planning

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

Additional Resources and Information from the Web National Stroke Association (www.stroke.org) American Stroke Association (www.strokeassociation.org) National Aphasia Association (www.aphasia.org) Journal of Stroke and Cerebrovascular Diseases (www.strokejournal.org) The Brain Attack Coalition (www.stroke-site.org)