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Life After Stroke

Life After Stroke

Therapy and support for stroke patients

By Andrew Morpurgo, M.D.

Strokes can be devastating. They come out of the blue and literally strike people down, usually with no warning. Given their potentially devastating impact, stroke prevention has become a priority within the national medical community. The result is that the incidence of stroke has dropped within the last decade, due to more effective recognition and treatment of stroke risk factors like high blood pressure, diabetes, and atherosclerosis (the build-up of plaque in vessel walls).

Window of opportunity

Even with increasingly positive statistics, 450,000 people in the U.S. suffer strokes every year. When a stroke occurs, recognizing the symptoms and seeking immediate medical care by a neurologist can make a tremendous difference in the recovery process.

New medications, such as the clot-dissolving drug t-PA, can break up blockages that impair blood flow in the brain, thereby reducing the amount of brain cell damage. However, diagnosis of the type of stroke that has occurred must be made within the first three or four hours after the onset of symptoms because t-PA can only be used in the treatment of some, not all, strokes. And in order to be effective, it must be administered as soon as possible after the stroke has occurred.

Types of stroke

There are essentially two categories of stroke. The most common is an ischemic stroke, caused by a blockage (a blood clot) that cuts off the blood supply to the brain. Approximately 90 percent of the people who suffer strokes experience an ischemic stroke. These stroke victims can often be helped with t-PA if they are diagnosed in a timely fashion.

The remaining 10 percent of stroke victims have hemorrhagic strokes, which occur when a vessel in the brain ruptures and blood leaks into the brain. These people should not be treated with t-PA, which is why early and proper diagnosis of the type of stroke is imperative. The neurologists at Cayuga Medical Center utilize state-of-the-art CT scanning of the brain to determine the cause of the stroke symptoms.

Symptoms and signs of stroke

If you or someone you are with experiences these symptoms, seek immediate emergency medical assistance. Get to the nearest medical center as quickly as possible.

  • Sudden clumsiness, loss of balance and coordination, or dizziness.
  • Weakness, numbness, or difficulty moving the face or limbs on one side of the body.
  • Trouble with speech: difficulty talking or slurring of words; the inability to find the right word; not being able to understand what others are saying.
  • Blurred vision or decreased vision.
  • A sudden, intense headache.

Impact and treatment of stroke

If we think of the types of impairments stroke victims suffer, they fall into three general areas. They are motor functioning, which is movement in the legs, arms, and hands; swallowing and speech; and cognitive functioning, which relates to intelligence, reasoning, and emotions. The approach to treatment for each of these areas is different and the recovery process varies. Recovery is most rapid during the first three months. Progress continues, through usually at a slower rate, through the following six months and generally stops at about a year.

Stroke patients at Cayuga Medical Center typically spend up to a week in the acute inpatient setting, after which they often go on to the medical rehabilitation unit for up to 25 days. There, a team of rehabilitation specialists works closely with the patient to restore function and to help the patient prepare to cope with life-style changes. Various types of therapy continue on an out-patient basis after discharge.

Stroke victims often find their lives significantly changed as a result of their illness. Depending on the severity of the stroke, their ability to work, to communicate, even to get around independently can be compromised or disappear altogether. The impact can be devastating for the individual and the family.

In the hospital

Patients who have suffered a stroke often spend up to a week in the medical center on the medical-surgical unit. From there, they are likely to be admitted to the inpatient rehabilitation unit for intensive therapy. There, a team of rehabilitation specialists works closely with the patient to restore function and to help prepare the patient for life-style changes as a result of the stroke.

Speech therapists work with patients who are experiencing problems with swallowing or language. Difficulty speaking, retrieving words, or understanding what is being said are some of the ways in which language can be impaired by stroke. It may take up to a year for speech to come back, if it returns at all. Regaining the ability to swallow also takes time, often three to six months.

Occupational therapists teach the patient and his or her family activities that will improve flexibility, strength, coordination, and visual perception and understanding. Physical therapists help patients with exercises designed to increase range of motion, improve coordination, and regain maximum function and independence. An activity therapist creates a program of leisure activities that will reinforce the patient’s recovery goals. Physicians also work closely with patients and families on cognitive and emotional problems that may be caused by the stroke. Depression, which is a common response to stroke, often responds well to antidepressant medications.

Prior to leaving the hospital, medical social workers and discharge planners help families arrange for continuing therapy and assistance at home. Patients may progress to outpatient therapy depending on their goals and progress.

Hard work begins at home

The real work begins at home because it is there that patients and families come to understand the new realities of life after stroke. People who have suffered a stroke are changed as a result of it.

The ways in which they are different depend on the type and severity of the stroke. People who used to be night owls may find themselves tired and ready for bed by eight o’clock at night. A small cold can knock a stroke victim off his or her feet for days. One glass of wine will have the potency of three or four. People who used to enjoy large social gatherings may now find those events difficult and exhausting. These changes, in addition to new physical limitations, take some getting used to.

With hard work, many stroke victims are able to live relatively self-sufficient lives. They can cook, take care of themselves, even drive. Many can live independently, though they might be walking with a cane or a brace. However, some abilities may never fully return, and adjusting to this can be emotionally challenging for the patient and his or her family.

The active involvement and support of family members can make a world of difference during and after recovery. If a spouse is the primary caregiver, other family members can help with regular visits so the spouse can take a break. Caregivers may also find that participating in a support group of other caregivers is extremely helpful.

Go for it!

People recovering from a stroke should try to do as much as they can safely, and families should encourage patients to strive for a life that is as normal as possible. This sometimes means resisting the urge to lecture or nag recovering stroke victims about changing their life-style habits. Of course it would be better if Uncle Joe used less salt on his food and quit smoking, but Uncle Joe is coping with enough major change already as a result of his stroke. Badgering him to make more adjustments and reminding him about his bad habits will not help in the recovery process. However, if and when he decides to make healthy life-style modifications, loving support from family and friends is invaluable.

Dr. Morpurgo is a physiatrist, specializing in rehabilitation and physical medicine. He is director of rehabilitation services at Cayuga Medical Center. He can be reached at his office at (607) 277-4097.

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