Moving on from Stroke

Day Therapy Unit

Outpatient Stroke Service

WELCOME BACK!

Week 2:

Pharmacy

Physiotherapy

Speech Pathology

Neurological Council of

WA

MEDICATION AND

STROKE MANAGEMENT

OBJECTIVES

Goals of medication management

Medications involved in the treatment of stroke

Lifestyle advice

WHAT IS A STROKE?

Lack of blood flow (oxygen) to the brain caused by a clot

or rupture of a blood vessel

Sudden brain damage

Ischaemic = clot are the most common, accounts for 87%

of strokes, embolic vs thrombotic

Haemorrhagic = bleed, bleeding around the

brain or into the brain

RISK FACTORS TIA, age, gender, family history

Irregular pulse – atrial fibrillation

High blood pressure

Smoking

Diabetes

High total cholesterol

Low levels high density lipoprotein (HDL)

Physical inactivity, obesity

Alcohol overuse

STROKE PREVENTION Medication adherence and healthy lifestyle changes

are key to preventing stroke

>50% of older patients sometimes forget to take their

medications

Taking medications as prescribed is central to recovery

after stroke and preventing further strokes

GOALS OF MEDICATION To reduce ongoing brain injury

To decrease long-term disability

Prevent further complications

Prevent stroke recurrence

TREATMENT

Acute treatment of an event ideally managed in hospital

Secondary prevention includes:

Blood pressure lowering medications

Cholesterol lowering medications (with statins)

Antiplatelet therapy (except in patients in whom

anticoagulant therapy is needed)

HIGH BLOOD PRESSURE If you have a clinic blood pressure of 140/90 or more

and a TIA or stroke - blood pressure medication

should be started or increased (Clinical guidelines for stroke

management 2017)

High blood pressure may have no symptoms

Reduction in blood pressure results in 25-30% less

strokes (Benavente, Coffet et al 2014)

Target blood pressure individualised: 130/80- 140/9

CHOLESTEROL Two different types of cholesterol:

LDL (low-density lipoprotein)

Increases risk of heart attack and stroke

Takes cholesterol into the arteries

HDL (high-density lipoprotein)

Acts as a scavenger to promote reverse cholesterol

transport

Takes cholesterol out of the artery and back to the

liver so the body can dispose of it

CHOLESTEROL - STATINS All patients with stroke or TIA are prescribed a

statin regardless of baseline lipids if there is

reasonable life expectancy and possible

atherosclerosis (Clinical guidelines for stroke management 2017)

Medications lower LDL and slightly increase HDL to ↓

risk of stroke by 12% and all vascular events by 25%

Examples: Atorvastatin, rosuvastatin, pravastatin

Seek medical attention if you develop dark urine or have

any unusual muscle pain, weakness or tenderness

CHOLESTEROL - OTHERS Fibrates

Fenofibrate (lipidil)

Seek medical attention if you develop dark urine or have

any muscle pain, weakness or tenderness

More common adverse effects are abdominal pain and

dyspepsia

Ezetimibe (Ezetrol)

Decreases absorption of cholesterol from the diet

Tell your doctor if you are experiencing any muscle

pain, tenderness or weakness. Most common side

effect is headache and diarrhoea

ANTIPLATELETS & ANTICOAGULANTS

No previous AF

Long term antiplatelets

generally used if not

already on anticoagulants (Clinical guidelines for stroke management 2017)

Stroke and AF

DOAC preferred if good

kidney function and non

valvular atrial fibrillation

Other patients use

warfarin

ANTIPLATELET VS. ANTICOAGULANT Antiplatelet Anticoagulant

Prevents platelets from sticking together

as easily ‘thinning the blood’

Stops blood from clotting as easily

Aspirin 100mg daily OR Other conditions determine choice

Aspirin + dipyridamole (Asasantin)

- Should be taken with food

- Can cause headaches

Warfarin

Coumadin or Marevan- do not change

brands

Regularly monitor INR: between 2 -3

Watch for bleeding, keep food choices

similar, food and drug interactions

No more than 2 standard drinks of

alcohol

OR

Clopidogrel (Plavix)

OR Direct Anticoagulants (DOAC)

Pradaxa, Xarelto, Eliquis. No more than 2

standard alcoholic drinks daily

STROKE PREVENTION

GUIDELINES 1. Know your blood pressure. Have it checked at least

annually. If it is high, work with your doctor to control

it.

2. Find out if you have atrial fibrillation (AF); a type of

irregular heartbeat. If you have it, work with your

doctor to manage it.

3. If you smoke, stop. See your pharmacist for

help – nicotine replacement and support services.

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.

STROKE PREVENTION

GUIDELINES 7. Include exercise in your daily routine.

8. Enjoy a lower sodium (salt) diet (to help control blood

pressure) and lower fat diet (to help control cholesterol).

9. If you experience any stroke symptoms, call 000

immediately. Every minute matters!

QUESTIONS?

PHYSIOTHERAPY

Which risk factors for stroke can

be influenced by exercise?

BENEFITS OF EXERCISE

Diabetes– management of raised blood sugar levels

Reduces blood pressure

Reduces stress

Reduces cholesterol

Prevents/ improves obesity

Improves Depression

EXERCISE TIPS

Find something you enjoy: swimming, walking, cycling,

exercise groups…

Make exercise part of your daily routine

Exercise with a friend, meet at set times

Don’t overdo it / Pacing

Ask for assistance

HAVE FUN!

EXERCISE RECOMMENDATIONS-

AEROBIC EXERCISE

E.g. walking, swimming, cycling

IMPROVE: general fitness, heart

and lung function, circulation

30-60 minutes of physical activity on

>5 days per week

E.g. resistance exercise, gentle

weight training

IMPROVE: bone health, ability

to complete day-to-day tasks

2x/week 8-10 exercises of low

load (less than 2kg) and high

reps (10-15 reps)

EXERCISE RECOMMENDATIONS-

STRENGTHENING

EXERCISE RECOMMENDATIONS-

BALANCE

E.g. Tai Chi, Balance

classes

IMPROVE: balance,

reduce risk of falls

2-3x/week (total of 2

hours), gradually

increasing difficulty

FALLS RISK IDENTIFICATION AND

MANAGEMENT

1. Move Your Body

• Build your balance

• Strengthen your body

2. Improve Your Health

• Check your medications

• Keep a healthy mind

• Fuel your body

3. Remove Hazards

• Make your home safer

• Check your eyesight

• Wear safe footwear

Stay On Your Feet

Stay On Your Feet

Case Study:

50yr old Sally suffered a stroke 2 years ago. She has reduced strength on

her left side and poor sensation in her left foot and ankle. She is able to walk

with the assistance of a walking stick.

Sally also suffers from type two diabetes and is on regular medication to try

to stabilise her blood sugar levels.

Sally lives in her own home with her small Jack Russel dog. Sally has two

steps to get inside the front door but once in her home is level.

What risk factors does Sally have for falling?

FALLS RISK IDENTIFICATION AND

MANAGEMENT

MYCLE BRANDY - A 4X STROKE

SURVIVOR’S CAMPAIGN

Walked over 10 000km

across America

Completed 9 full

marathons

All on a walking stick!

QUESTIONS?

SPEECH PATHOLOGY

SWALLOWING AND COMMUNICATING

After a stroke or TIA you may experience:

Difficulty talking

Difficulty understanding others

Difficulty concentrating, especially in noisy and busy

places

Difficulty eating and drinking

QUALITY OF LIFE- COMMUNICATION

For people with aphasia, these factors can affect their

quality of life.

COMMUNICATION - SPEECH

Can be slurred or unclear, mumbly OR sounds can get

jumbled up

A speech pathologist can give you exercises to help

recovery or give you strategies to make you clearer

Talking to others is the best way to improve

SUPPORTING YOUR SPEECH & VOICE

Also known as deep

breathing

Uses your abdominal

muscles to increase the

amount of air inhaled

and exhaled

Helps to power your

voice and make speech

clear

Abdominal breathing

COMMUNICATING

Some ways we can practice speaking:

Find activities that you enjoy doing!

Ask a friend or family member over for a chat.

Join community or social groups.

Being involved in a communication group 1x a week

increases satisfaction and reduces anxiety.

COMMUNICATION - LANGUAGE

It can be difficult to find the right word, make a sentence

or understand what others are saying

A speech pathologist can help you recover your

language or find other ways to help you communicate

COMMUNICATION

There are many ways to communicate including using

gesture, body language, facial expressions and

using props.

Pictures and objects can help others understand what

you want to say and can help you understand too.

Used as an alternative to or add to existing

communication skills

Who can benefit from AAC?

If you are not able to use speech to communicate

effectively in one or more situations

If you are not understood by some people

If you have difficulty with having long conversations

If you have difficulty understanding others

AUGMENTATIVE & ALTERNATIVE

COMMUNICATION (AAC)

COMMUNICATING IN THE COMMUNITY

There are ways you can

engage in the community

if you have difficulty speaking,

reading or understanding

Picture menus

Ordering using a phone

or screen

NATIONAL RELAY SERVICE

www.relayservice.com.au/

Phone:1800 555 660

Internet relay calls

Speak and listen calls

Type and listen calls

HOW TO COMMUNICATE CLEARLY

Take your time Use strategies!

Say one thing at a time

Ask others to slow down

Take extra time in noisy places

If you don’t understand, ask again

SAFE SWALLOWING

Eat small bites of food & chew them well

Drink small sips

Sit upright

Avoid eating and drinking when fatigued

If you are having difficulties with swallowing, a speech

pathologist can help

QUESTIONS?

Community Neurological Nurse -

Janet Rebola

Thank you for attending,

see you next week!