1. Be Stroke Smart Reduce: stroke risk Recognize: stroke symptoms
We hope your participation in today’s presentation will support you in becoming more Stroke Smart.
We want you to know and understand the 3 R’s of Stroke:
Reduce Risk
Recognize Stroke Symptoms
Respond by Calling 911
Respond: at the first sign of stroke,
Call 911 immediately!

2. Stroke Facts A leading cause of death in the United States
795,000 Americans suffer strokes each year
134,000 deaths each year
6,400,000 stroke survivors
Stroke is a leading cause of death in the United States behind heart disease and all forms of cancer combined.
Approximately 795,000 Americans have a new or recurrent stroke each year.
Stroke kills approximately 134,000 Americans each year.
Amazingly there are more than 6 million stroke survivors living in the United States today, bringing much hope to many stroke victims. Men make up about 2,500,000 of survivors and women make up 3,900,000. Making women more at risk for stroke.

3. Stroke Facts A leading cause of adult disability
Up to 80% of all strokes are preventable through risk factor management
On average, someone suffers a stroke every 40 seconds in America
Stroke is a leading cause of serious, long-term adult disability. Over the course of a lifetime, four out of every five American families will be touched by stroke.
Up to 80% of all strokes are preventable and is why prevention is so important.
Every 40 seconds someone suffers from a stroke, every four minutes someone dies from a stroke.

4. Well-known Stroke Survivors
Mary Kay Ash
Charles Schultz
Harry Caray
Charles Dickens
Ed Koch
Ted Williams
Patricia Neal
President Gerald Ford
Teddy Bruschi
Sharon Stone
Della Reese
Kirk Douglas
Roy Horn of Siegfried & Roy
Bette Davis
Here are some names of people you may be familiar with that have suffered from stroke. Patricia Neal was a famous movie actress who played in ‘The Day the Earth Stood Still’ in 1951 among several other movies you may be familiar with. She suffered from a stroke in She learned to talk and walk again and was even able to continue her career in acting following her stroke. Many of you may have heard of the Patricia Neal Rehab Center at Fort Saunders Medical Center here in Knoxville that was named in her honor. Other famous people you may be familiar with are:
U.S. Presidents Gerald Ford, Thomas Jefferson, Woodrow Wilson, Warren G. Harding, Franklin Delano Roosevelt, Dwight Eisenhower, Richard Nixon
Super Bowl player Teddy Bruschi
Actors Sharon Stone, Della Reese, Kirk Douglas, Robert Guillaume, and Patricia Neal
Entertainers Luther Vandross and Roy Horn of Siegfried & Roy
Cosmetics entrepreneur Mary Kay Ash
Comics artist Charles Schultz
Sports commentator Harry Caray
Novelist Charles Dickens
Former New York City Mayor Ed Koch
Major league baseball player Ted Williams

5. Brain Attack! Stroke is a “Brain Attack.”
Stroke happens in the brain not the heart
Stroke is an emergency. Call 911 for emergency treatment.
The term “Brain Attack” is the most descriptive and realistic description of a stroke. It also provides a powerful call to action.
A brain attack should warrant the same degree of emergency care as a heart attack. After all, your brain is your mind and your body’s most vital and delicate organ.
Immediate response is crucial because every minute matters – from the time symptoms first become noticeable to the time treatment is received, more brain cells die. In other words TIME IS BRAIN. The best thing to do is to call 911 for immediate assistance.
Treatment is available and some options are most effective if administered within the first three hours after experiencing symptoms.
Your chances of walking out of the hospital with little to no disability are greatly improved if you receive appropriate treatments early.
Unfortunately, it takes the average American 12 to 24 hours to get to the hospital after experiencing the first stroke symptom. This is why it’s important that everyone learns how to RECOGNIZE stroke symptoms and how to RESPOND.

6. When stroke happens it can cause different kinds symptoms
When stroke happens it can cause different kinds symptoms. Depending on where in the brain the stroke occurs, there can be a wide range of symptoms. Sometimes these symptoms can be very subtle often causing a delay in treatment. One important thing to remember is, if the symptoms start suddenly this could be a sign of stroke. If you have any of the following symptoms then you need to seek immediate medical attention and Call 911.

7. If you observe any of these symptoms,
Stroke Symptoms
Sudden and severe
headache
Sudden confusion
Trouble speaking
Trouble seeing
in one or both eyes
Sudden numbness
or weakness of
face, arm or leg
Sudden dizziness
Trouble walking
So what are the symptoms of stroke??
The most common stroke symptoms are:
Sudden numbness or weakness of face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause
If you see someone having these symptoms or experience any of these symptoms yourself, Call 911 immediately.
Time is Brain. The sooner someone having a stroke arrives at the hospital, the more likely the brain may be saved.
Appropriate treatment can be more effective if given quickly. Every minute matters!
If you observe any of these symptoms,
call 911 immediately.
Time is Brain!

8. Stroke Strikes F.A.S.T. You Should, Too. Call 9-1-1
F = Face: ask the person to smile
A = Arm: ask the person to raise both arms
S = Speech: ask the person to speak a simple sentence
T = Time: to call 911
Every minute matters!
One way to help remember the symptoms of stroke and what to do, is to learn the Face, Arms, Speech Test, otherwise knows as F.A.S.T.:
F = Face: ask the person to smile – do both sides of the face move equally? (Normal) Or does one side of the face not move at all? (Abnormal)
A = Arm: ask the person to raise both arms – do both arms move equally? (Normal) Or does one arm drift downward compared to the other? (Abnormal)
S = Speech: ask the person to speak a simple sentence – Does the person use correct words with no slurring? (Normal) Or do they slur their speech, use inappropriate words or is unable to speak at all? (Abnormal)
T = Time: to call 911 – if you observe any of these symptoms, call 911 immediately. Every minute matters!

9. TIA (mini-stroke)
Transient ischemic attack (TIA) is a warning sign of a future stroke – up to 40% of TIA patients will have a future stroke
Symptoms of TIAs are the same as stroke
TIA symptoms can resolve within minutes or hours
It is important to seek immediate medical attention if you suspect that you are having or have had a TIA
TIAs or mini-stroke are a serious warning of an impending stroke.
TIA symptoms are the same as for stroke.
TIAs are brief episodes of stroke symptoms that resolve within minutes or hours, unlike stroke symptoms which can last much longer.
Almost half of all people who have a mini-stroke will go on to having a full blown stroke.
It is important to seek immediate medical attention to find out what the problem is and how to prevent a future stroke.

10. The Perceptions of Stroke
Myth
Stroke is not preventable
Stroke cannot be treated
Stroke only strikes the elderly
Stroke happens in the heart
Stroke recovery ends after 6 months
Reality
Up to 80% percent of strokes are preventable
Stroke requires emergency treatment
Anyone can have a stroke
Stroke is a “Brain Attack”
Stroke recovery can last a lifetime
There are many misconceptions about stroke….
Myths vs. Realities:
Stroke is not preventable – up to 80% of strokes are preventable. We’ll discuss steps you can take to reduce stroke risk in a minute.
Stroke cannot be treated - Stroke can be treated, but requires emergency treatment. Call 911 immediately if you experience or see someone with stroke symptoms.
Stroke only strikes the elderly - Anyone of any age can have a stroke.
Stroke is like a heart attack, but occurs in the brain and is sometimes called a “Brain Attack.”
Stroke recovery ends after 6 months - Stroke recovery can continue throughout a survivor’s life.

11. Stroke Prevention Guidelines
Know your blood pressure. Have it checked at least annually. If it is elevated, work with your doctor to control it.
Find out if you have atrial fibrillation (AF) – a type of irregular heartbeat. If you have it, work with your doctor to manage it.
If you smoke, stop.
1. Know your blood pressure. Have it checked at least annually. If it’s elevated, work with your doctor to keep it under control. Having high blood pressure, or hypertension, increases stroke risk four to six times.
2. Find out if you have atrial fibrillation – a type of irregular heartbeat. If left untreated, AF can increase stroke risk four to six times. Should we talk about coumadin being the best treatment if there are no risk factors?
3. If you smoke, stop. Smoking doubles stroke risk.

12. Stroke Prevention Guidelines
4. If you drink alcohol, do so in moderation. 5. Know your cholesterol number. If it is high, work with your doctor to control it. 6. If you are diabetic, follow your doctor’s recommendations carefully to control your diabetes.
4. If you drink alcohol, do so in moderation. Recent studies have suggested that modest alcohol consumption (up to two glasses of wine or the alcohol equivalent) may reduce stroke risk. If you don’t drink, don’t start.
5. Find out if you have high cholesterol. High cholesterol can indirectly increase stroke risk by putting people at greater risk of heart disease. Talk to your doctor if your total cholesterol is higher than 200 mg/dL or if you LDL cholesterol is higher than 100 mg/dL.
6. If you are diabetic, follow you doctor’s recommendation carefully to control your diabetes. People with diabetes have a significantly higher stroke risk. This may be related to circulation problems that diabetes can cause.

13. Stroke Prevention Guidelines
7. Include exercise in your daily routine
8. Enjoy a lower sodium (salt) and lower fat diet
If you have circulation problems, work with your doctor to improve your circulation.
If you experience any stroke symptoms, call 911 immediately. Every minute matters!
7. Incorporate physical activity that you enjoy into your daily routine. Active people tend to have lower cholesterol levels. Regular exercise also seems to slow down or stop clogging of blood vessels.
8. Enjoy a low-sodium (salt) and low-fat diet. Too much salt may contribute to high blood pressure and make it more difficult to control. A diet that is low in fat will likely include vegetables, lean meats such as chicken and fish, low-fat dairy products and a limited number of eggs.
9. Ask your doctor if you have circulation problems which increase your risk for stroke. If you do, work with your doctor to control this condition.
10. If you experience any stroke symptoms, seek immediate medical attention by calling Every minute matters!

14. Why People Don’t Recognize and Respond to Symptoms
Don’t recognize symptoms
Denial
Think nothing can be done
Worry about cost
Think symptoms will go away
Fear or don’t trust hospitals
Many people don’t recognize stroke symptoms. A 2001 National Stroke Association survey reported that many older Americans could not identify stroke symptoms. A 2009 study revealed that despite numerous national stroke public awareness campaigns, public knowledge of stroke symptoms and risk factors has not improved over the last 5 years.
People don’t want their fear of stroke to be confirmed. Stroke is one of the most terrifying medical emergencies because many people would rather die than be disabled. Yet quick confirmation of stroke is the best way to receive the treatments that are proven to greatly reduce disability after stroke.
Of those surveyed, only 40 percent would call 911 immediately if they were having a stroke.
Many people worried about the cost of stroke treatment, especially if they do not have health insurance. Studies show that acute treatment is significantly less expensive than the costs of extensive rehabilitation and long-term care.
The survey also showed that two-thirds of respondents were unaware of the short time frame in which a person must seek treatment. Waiting to see if symptoms disappear can mean the difference between complete recovery and disability.
Fear of hospitals may keep some individuals from calling 911 to get help when they experience stroke symptoms. Those who call 911 immediately when experiencing stroke symptoms are likely to have a much shorter stay in the hospital than those who wait.

15. Acute Stroke Treatments
Ischemic stroke (Brain Clot)
Clot busting medication: t-PA (Tissue Plasminogen Activator)
Clot-removing devices: Merci Retriever, Penumbra
Hemorrhagic Stroke (Brain Bleed)
Clipping
Coiling
There are two types of treatment for ischemic stroke (caused by clots):
The Clot Buster – or t-PA works by dissolving blood clots that are blocking arteries. t-PA, is an enzyme found naturally in the body. The drug was approved by the Food and Drug Administration in June 1996 for treatment of stroke and can improve outcomes but can only be given within the first three hours of symptom onset, one reason it is so important to get to the hospital fast after stroke sxs begin.
The Merci Retriever and Penumbra are both treatments that can be used to surgically go inside the body and remove the clots, restoring blood to the brain.

16. Stroke Recovery 10% of stroke survivors recover almost completely
25% recover with minor impairments
40% experience moderate to severe impairments requiring special care
10% require care within either a skilled-care or other long-term care facility
15% die shortly after the stroke
There’s still so much we don’t know about how the brain can seemingly repair itself from the functional damage caused by stroke. Some brain cells may be only temporarily damaged and may resume functioning. In some cases, the brain can “relearn” what was lost. Sometimes, a region of the brain “takes over” for a region damaged by the stroke. People who have had a stroke sometimes experience remarkable and unanticipated recoveries that can’t be explained. General recovery guidelines show:
10 percent of stroke survivors recover almost completely.
25 percent recover with minor disabilities.
40 percent experience moderate to severe disabilities requiring special care.
10 percent require care within either a skilled-care or other long-term care facility.
15 percent die shortly after the stroke.
Stroke survivors and their families can find workable solutions to most difficult situations by approaching every problem with patience, creativity and tenacity.

17. Types of Stroke Rehabilitation
Physical Therapy (PT)
Walking, range of movement
Occupational Therapy (OT)
Taking care of one’s self
Speech Language Therapy
Communication skills, swallowing, cognition
Recreational Therapy
Cooking, gardening
There are different types of Stroke Rehabilitation
Physical Therapy helps restore skills like walking and range of movement. Physical therapy works on improving partial or one-sided paralysis, faulty balance and foot drop.
Occupational Therapy involves relearning skills needed for everyday living such as eating, using the bathroom, dressing and taking care of oneself.
Speech Language Therapy helps stroke survivors that have problems with aphasia – which is when stroke survivors are able to think clearly but cannot put those thoughts into words. Speech language pathologists can teach the aphasic stroke survivor and caregiver methods for coping with this frustrating condition. Speech therapy also helps stroke survivors cope with memory loss and other “thought” problems caused by stroke. Additionally, speech therapy treats stroke survivors with dysphasia, or swallowing problems, that could result in pneumonia if not appropriately managed.
Recreational Therapy involves regaining enjoyable skills and pastimes such as cooking, gardening, sewing and playing cards. These activities also may help stroke survivors regain some lost thinking abilities and physical capabilities.

18. Lifestyle Changes for Survivors and Caregivers
Daily living skills
Dressing and grooming
Diet, nutrition and eating difficulties
Skin care problems
Pain
Sexuality/Intimacy
Behavior
Depression & Anger
Emotional Liability
One-sided Neglect
Memory Loss
Communication Problems
After stroke, both the stroke survivor and his/her family are often concerned about being on their own at home. Among the common issues are:
Behavior: Stroke survivors’ needs vary depending on what area of the brain has been affected. Care-partners need to be aware of the reasons for the stroke survivor’s behavior, without overlooking the possibility that he or she may also be depressed.
Depression: Many survivors experience a form of depression after stroke. It can be overwhelming, affecting the spirit and confidence of everyone involved. Family can help by trying to stimulate interest in other people, encouraging leisure activities and providing opportunities to participate in spiritual activities. Chronic depression can be treated with individual counseling, group therapy or antidepressant drugs.
Emotional Liability: Sudden laughing or crying for no apparent reason and difficulty controlling emotional responses, known as emotional liability, or Pseudo Bulbar Syndrome, affects many stroke survivors. The “inappropriate” emotional behavior will occur randomly and end as quickly as it started.
Neglect: Some stroke survivors neglect the side of their world opposite the side of their stroke brain injury. This may impact their ability to complete some activities. Examples: eating only on one side of a dinner plate or recognizing only one side of a clock.
Memory Loss: Memory loss  also called vascular dementia  can be so subtle the family may not notice it at first. A stroke survivor may be anxious and cautious, needing a reminder to finish a sentence or follow-through with a behavior.
Communication Problems: If a stroke causes damage to the language center in the brain, there will be language difficulties or aphasia. Communication problems are among the most frightening after-effects of stroke for both the survivor and the family, often requiring professional help.

19. Types of Recovery Services
Rehabilitation unit in the hospital
In-patient rehabilitation facility
Home-bound therapy
Home with outpatient therapy
Long-term care facility
Community-based programs
Rehabilitation Unit in Hospital: Many general hospitals now offer a variety of rehabilitation services. These may include acute rehabilitation (comparable to free-standing rehabilitation facilities) and sub-acute or transitional care units (usually a skilled nursing facility is a long-term care facility.)
In-Patient Rehabilitation Facility: Patients admitted to a rehabilitation hospital must be able to tolerate a minimum of three hours of intensive therapy per day. These hospitals may also offer less intensive programs known as sub-acute rehabilitation units similar to those in long-term skilled nursing facilities.
Home-Bound Therapy: This form of rehabilitation is for patients who cannot leave their homes after discharge from an inpatient setting. A variety of therapies, along with follow-up nursing and social services, may be available. Clinicians can focus on personalized needs and unanticipated concerns for patients in this setting.

20. How Can I Learn More?
Talk to your doctor, nurse or other healthcare professionals.
For more information about stroke call the American Stroke Association at STROKE ( ) or visit us online at StrokeAssociation.org
If you or a loved one has suffered from stroke find a stroke support group in your area. PNRC offers a support group once a month. Call (865) for more information.

21. How Can I Learn More?
If you or someone you know has had a stroke, call the American Stroke Association’s “Warmline” at STROKE ( ) and:
Speak with other stroke survivors and caregivers trained to answer your questions and offer support.
Get information on stroke support groups in your area.
Sign up to get Stroke Connection, a free
magazine for stroke survivors
and caregivers.

22. REVIEW Reduce Risk Factors.
Recognize Stroke Warning Signs and Symptoms.
Respond by calling 911.
Let’s review some important points.
Always Remember: An ounce of prevention is worth a pound of cure! Through staying healthy and managing risk factors such as diabetes, high blood pressure and weight we can help to reduce risk factors.
Learn to recognize stroke symptoms like dizziness, weakness or numbness usually on one side or another and sudden visual changes.
Always respond by calling 911 immediately if you think you or someone else might be having a stroke. It’s always better to be safe than sorry.
Time is Brain.

23. Questions

24. REFERENCES
National Stroke Association. The Complete Guide to Stroke Retrieved from:
National Stroke Association. Explaining Stroke 101. Retrieved from: