It’s Just a Stroke…Right?
Highlighting the Importance of
Education Around the Impact of
Strokes to Survivors, Caregivers, and
Professionals
4/11/2013
Sara Lassig, LICSW, PhD
Stroke Team Coordinator
& Social Work Case Manager
VA Medical Center
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75 year old stroke
patient in acute
rehab
George
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Bill
32 year old TBI
patient in acute
rehab
George
Bill
George
Bill
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Traumatic Brain Injury (TBI): Injury to the
brain caused by an external force. Common
causes: MVA’s, falls, striking the head,
gunshot wounds
Acquired Brain Injury (ABI): Includes Cerebral
Vascular Accidents (strokes) and loss of
oxygen to the brain (Hypoxic Brain Injury
Lack of uniformity around the inclusion of TBI
as a part of the more “umbrella” term “ABI.”
TBI  One type of ABI
Stroke is the 3rd leading cause of death in
the United States.
 Stroke is the leading cause of serious, longterm disability in the United States.
 Each year, approximately 795,000 people
suffer a stroke.
 Nearly three-quarters of all strokes occur in
people over the age of 65.
(American Stroke Assoc)
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Left Brain Stroke: - Damage to the left side of
the brain can weaken or paralyze the right
side of the body, and may cause problems
with speech and with the understanding of
spoken and written language.
Right Brain Stroke: - Damage to the right side
of the brain can weaken or paralyze the left
side of the body and may cause lack of
awareness and neglect of the left side of the
body.
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Cerebellar Stroke: -Damage to the
cerebellum can cause lack of balance or
coordination on the same side of the body.
It can also cause slurring of speech.
Brain Stem Stroke: -Damage to this part of
the brain can cause serious impairment in
this life- sustaining functions. Symptoms of
dizziness, slurred speech and double vision
are also common. It may also cause
paralysis on both sides of the body.
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Beyond hemiparesis, aphasia, neglect,
and apraxia…
◦ Emotional reactions
◦ Confusion
◦ Changes in eating, sleeping, and
thinking
◦ Depression
◦ Fatigue
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Severity of impairment
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Extent of emotional reactions and changes
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Family Reactions
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Research
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Pseudobulbar Affect  Emotional lability,
reflect crying
Rapid mood changes
Crying or laughing that doesn’t match mood
Depression **
Anxiety
Frustration
Fatigue
*Based as well on area of the brain affected*
Ambiguous Loss
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Physical absence with psychological
presence.
◦ (Example: severe hemiparesis)
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Psychological absence with physical
presence.
◦ (Example: severe fluent aphasia)
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Ambiguous Losses are most difficult
of all losses.
◦ “Where is he/she?”
Family/caregiver/support system that
is available to stroke survivor
 Level of impairment
 Role in the family prior to the stroke
 Available resources
 “Status” of the stroke survivor
◦ Research on care provision
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Physical age
Body image, “how old I feel”
Perception of stroke survivor vs. perception
of others
Era / Generation – Experience with adversity
Emotional responses linked to age and stage
variations
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Loss of control
Loss of self-image
Loss of Independence
Fear of stigma
Fear of abandonment
Fear of expressing
anger
Fear of isolation
George
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Loss of control
Loss of self-image
Loss of Independence
Fear of stigma
Fear of abandonment
Fear of expressing
anger
Fear of isolation
Bill
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Do we change our care based on age alone?
Do we change our expectations of
patient/stroke survivor behavior based on
diagnosis?
Do we expect more? Less?
Are we more patient?
Are we providing the same quality of
education for the patient and family as we
might for other brain injuries?
Are we as care providers educated?
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Individuals who have experienced a stroke
have a brain injury.
Professionals providing care to stroke
patients have the responsibility to be
educated on the resulting effects of strokes,
in order to:
◦ Provide improved patient and family care
◦ Educate and support stroke survivors and their
families
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Bob – 87
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Joe - 65