Facts About Stroke

Stroke• Stroke kills about 140,000 Americans each year — 1 out of

every 20 deaths• Someone in the United States has a stroke every 40

seconds. Every 4 minutes, someone dies of stroke• nearly 1 of 4 are in people who have had a previous stroke• About 87% of all strokes are ischemic strokes, in which blood

flow to the brain is blocked• Stroke is the fifth leading cause of death for Americans, but

the risk of having a stroke varies with race and ethnicity.• Only 38% are aware of all major symptoms and knew to call

9-1-1 when someone was having a stroke

Signs and Symptoms of Stroke or TIA

• Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body.

• Sudden CONFUSION, trouble speaking or understanding speech.

• Sudden TROUBLE SEEING in one or both eyes.• Sudden TROUBLE WALKING, dizziness, loss of balance

or coordination.• Sudden SEVERE HEADACHE with no known cause.

Signs and Symptoms of Stroke or TIA

Functions of the Brain

Frontal Lobe: Emotional control, self awareness, motivation, judgment, problem solving, talking, movement, initiation

Temporal Lobe: Memory, hearing, understanding, language, processing information

Brainstem: Breathing, heart rate, arousal, consciousness, sleep/wake cycles

Parietal Lobe: Sense of touch, awareness of spatial relationships, academic functions such as reading

Occipital Lobe: Vision

Cerebellum: Balance, coordination, skilled motor activity

Left Vs. Right Brain Stroke

Right Brain Stroke Left Brain StrokeWeakness on the left side of the body

Weakness on the right side of the body

Vision Problems Difficulty SpeakingQuick, Impulsive Behavior Slow, Cautious BehaviorLeft Side Neglect or Inattention

Memory Loss

Memory Loss

Right Hemisphere of the Brain

• Right side of the brain controls the left side of the body• Vision Problems• Quick, Impulsive Behavior• Left side Neglect or inattention• Memory Loss• Loss of Safety Judgment

Left Hemisphere of the Brain

• Left side of the brain controls the right side of the body• Difficulty Speaking• Difficulty swallowing• Slow, cautious behavior• Memory Loss

Types of Strokes

• Ischemic (blood clot in the brain)• Hemorrhagic (bleeding in the brain)• TIA (mini stroke)

Ischemic

• Occurs when there is a blockage in a blood vessel in the brain

• 85% of all strokes• Thrombotic (blood clot)• Embolic (moving blood clot)

Hemorrhagic

• Occurs when there is bleeding in or around the brain• Caused by ruptured or leaking blood vessel which limits

blood flow in or around the brain• 15% of all strokes• 30% of all hemorrhagic strokes result in death

TIA

• Transient Ischemic Attack• Temporary disruption of blood supply to the brain

causing temporary symptoms• Can last a few minutes up to 24 hours• Sometimes called mini-strokes

Stroke Risk Scorecard

Stroke Risk Scorecard Results

Preventing a Stroke

High Blood Pressure

Surgery

• If initial stroke was due to blockage in carotid arteries a surgical procedure known as carotid endarterectomy may be effective.

• Your physician would make this recommendation

Medication Management

• IV t-PA(Activase)- works by helping to dissolve the clot for an ischemic stroke if given within 4.5 hours of onset of symptoms

• Aspirin• Plavix- antiplatelet drug to help prevent blood clots• Coumadin- anticoagulant helps keep blood from clotting• Statins- help to lower high cholesterol levels

Anticoagulants

• Lovenox injections maybe used during inpatient rehab stay as a blood thinner to prevent blood clots in the legs from occurring due to immobility after having a stroke

• Coumadin is used for long-term blood thinning therapy Continued use will require monitoring PT/INR. Patient must also monitor skin for increased bruising, blood in sputum, urine or stool

Bladder Management

• Following a stroke, it may be difficult to pass urine or there may be difficulty with incontinence (control)

• This may be caused by neurological changes from the stroke or due to urological problems, such as infection or obstruction

• Other factors include impaired mobility, impaired cognition or thinking, aphasia, and pre-existing bladder problems

Bladder ManagementThere are many different types of continence problems that can occur as a result of stroke. These may include the following:

– Frequency: pass urine more often– Urgency: sudden urgent need to pass urine– Nocturnal Incontinence: wet the bed asleep– Functional Incontinence: due to the physical effects of the stroke– Stress Incontinence: leakage with coughing, sneezing, or

laughing – Reflex Incontinence: urinating without realizing it– Overflow Incontinence: bladder leaks due to being to full

Bladder Management

• Time voids every 3-4 hours are used to set a regular schedule to empty the bladder

• Medications• Intermittent catheter• Use of an external condom catheter• Use of an adult brief for incontinence

Urinary Tract Infection

• A complication that can occur if bladder management is not maintained

• Bacteria is the source of a UTI which could multiply quickly and lead to infection

Signs of UTI

• Cloudy or foul smelling urine• Increase in mucous or sediment• Blood in urine• Pain or burning upon urination• Bladder spasms• Increase in frequency or urination or urinary incontinence• Fever

Prevention and Treatment of UTI• Maintain healthy fluid intake• Time voids• Routinely empty your bladder• Intermittent catheterization if needed• Keep skin clean and dry, immediately cleaning skin after

incontinence• Regular MD checkups• Antibiotics to treat infections

Bowel Management

• Following a stroke, a person may have difficulty with constipation or diarrhea (incontinence)

• Factors affecting this include decreased mobility, difficulty thinking, difficulty communicating and chronic bowel issues

Bowel Management

Some of the issues you may face include:• Fecal incontinence- uncontrolled bowel movement• Constipation with overflow- large stools get stuck and

block the bowel• Fecal impaction- dry and hard stool collect in the rectum

and make it difficult to go to have a bowel movement

Management of Bowel Problems

• Perform a bowel program using prescribed medications and time management

• Altering diet or fluid intake• Proper body positioning

Skin Management

• Stroke patients are at risk for skin breakdown due to the following- immobility- incontinence- cognition/communication- nutrition status

Post-Stroke Pain

• About 10% of people who experience a stroke eventually develop severe pain that is called post-stroke pain

• It can arise days or years after the stroke• It has been described as burning, aching, and prickling• Many parts of the body can be affected including the

face, arm, leg, trunk, or even an entire half of the body

Post-Stroke Pain

• It is more likely to occur if the stroke occurred on the right side of the brain.

• The pain associated usually gets worse over time and can sometimes be aggravated by temperature changes and movement.

Post-Stroke Pain Treatment

• Ibuprofen is used mostly for post stroke pain• Amitriptyline(Elavil) has been proven to treat the

constant pain• Medications such as Gabapentin(Neurontin) and

Pregabalin(Lyrica) have been used for relief of the stabbing or intermittent pain

Family Involvement in Rehab

• Family plays a critical role in recovery• Family education is essential to comfortable and safe for

return to home• Observe therapy sessions and ask questions• Be organized to get the most out of your interactions with

the health care team