By: Erica Kaplan, OTS
& Kristi Sunde, OTS.
"Hip Hop Stroke"
:48-1:50 (or 2:50)
Definition of Stroke
A sudden onset of neurological impairment
caused by rupture or blockage of a blood vessel
to the brain
Also known as Cerebral Vascular Accident or
CVA
Commonly known as a "brain attack"
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Stroke Facts
Stroke is the leading cause of disability in the United States.
Stroke is the third leading cause of death in the United States.
50% of individuals experience some level of disability after 6
months
5-14% of people have a second stroke within 1 year of their first
Within 5 years, 24% of females, and 42% of males have a second
stroke
Stroke prevalence is 2.5 higher in African Americans than in
Americans of European descent
African Americans suffer greater physical impairment from stroke
10% of stroke survivors recover almost completely
25% recover with minor impairments
Most recovery from stroke takes place in the first 3 months.
Minor additional improvement occurs after the 6 months but
improvement can continue long-term.
Types of Stroke
• Transient Ischemic Attack (TIA) "warning stroke"
• Ischemic Stroke
• Hemorrhagic Stroke
TIA
A focal neurological deficit that occurs
secondary to impaired blood flow to brain
• Symptoms last less than 24 hours
• Increased chance of having an actual stroke
"Warning Stroke"
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Ischemic Stroke (clots)
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• A stroke caused by decreased blood flow
• Fatty plaques or clots cut off or obstructs
blood flow to brain cells
• Accounts for 87% of strokes
Hemorrhagic Stroke (bleeds)
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A weakened vessel ruptures and bleeds into the surrounding
brain.
Blood accumulates and compresses the surrounding brain
tissue.
Hemorrhagic strokes are: intracerebral (within the brain) or
- subarachnoid (between brain and thin tissue covering brain)
Accounts for 13% of stroke cases
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Alterable Stroke Risk Factors
High blood pressure
Cigarette smoking
Diabetes mellitus
Carotid or other artery disease
Peripheral artery disease
Atrial fibrillation
Heart disease
Sickle cell disease
High Cholesterol
Poor Diet
Sedentary lifestyle
Obesity
Unalterable Stroke Risk Factors
• Age- The older you get the more likely you are to have
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a stroke
Heredity- genetic component
Race- African Americans have higher risks of high
blood pressure, diabetes and obesity.
Gender- Stroke is more common in men than women,
but women are more likely to die from stroke
Prior Stroke, TIA or Heart Attack increases likelihood
Other Less Known Risk Factors
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Geographic location
Socioeconomic factors
Alcohol abuse
Drug abuse
Time is Brain!
• Acute treatment needs to be initiated within 3-4
hours of symptom onset- ideally within 60
minutes of arrival at the hospital!
• tPA (tissue plasminogen activator) clot-dissolving
agents can significantly reduce the effects of
stroke and reduce permanent disability.
• Only 3 to 5% reach the hospital in time for this
long-term disability prevention measure
• Note time any symptoms first
appear
How do you know if someone is having a
stroke?
5 Cardinal Signs of Stroke
Only 15% of people can name all 5 symptoms
Additional unique stroke
symptoms may occur in women
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Sudden face and limb pain
Sudden hiccups
Sudden nausea
Sudden general weakness
Sudden chest pain
Sudden shortness of breath
Sudden palpitations
Physical challenges after stroke
Aphasia
What is aphasia??
Broca's Aphasia
Vs.
Wernicke's Aphasia
Vs.
Global Aphasia
Wernicke's Aphasia
YouTube: Wernicke's Aphasia Video
Broca's Aphasia
0 -> 1:35 From University of
Wisconsin/YouTube
How is aphasia treated?
1. Spontaneous recovery
2. Partial spontaneous recovery
3. Aphasia therapy
'Traditional' Therapy,
Group Therapy
Regional Support Groups
Family Involvement
Family members are encouraged to:
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Simplify language by using short, uncomplicated sentences.
Repeat the content words or write down key words to clarify
meaning as needed.
Maintain a natural conversational manner appropriate for an
adult.
Minimize distractions, such as a loud radio or TV, whenever
possible.
Include the person with aphasia in conversations.
Ask for and value the opinion of the person with aphasia,
especially regarding family matters.
Encourage any type of communication, whether it is speech,
gesture, pointing, or drawing.
Avoid correcting the person's speech.
Allow the person plenty of time to talk.
Help the person become involved outside the home. Seek out
support groups such as stroke clubs.From NIH:NIDCD
Cognitive challenges after stroke
Con't:
- Stroke in left brain: short-term memory
problems
- Stroke in right brain: trouble with sequencing,
tend to misinterpret or confuse information.
- Additional cognitive
challenges
Physical challenges after stroke
- Hemiparesis
- Hemiplegia
- Hemianopia
- Neglect
- Anosognosia
- Asomatognosia
Right Hononymous
Hemianopia:
Seating systems after stroke
Correct seating system allows mobility,
independence and safety during daily activities
• allows participation
• minimizes deformity
• prevents secondary complications
• wheelchair fitting and training necessary to
reach full functional potential
• Wheelchair cushions
Pressure Relief
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Decubitus Ulcer (otherwise known as
pressure sore) can develop when a person
does not shift body weight due to impaired
sensation, motor control or judgment
Instruct on pressure relief every 1/2 hour
Pressure reducing cushions- gel or air
Coming Home
What can informal caregivers
and professional caregivers do?
• Education- patient and family
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-written handouts
Psychosocial support- patient and family
Address modifiable risk factors
Recognize emerging symptoms
Medication & treatment compliance education
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After a stroke, one may
or may not need help with:
Personal care, including bathing, dressing, and taking care of
other aspects of basic hygiene
Home-safety assessment and modifications
Personal emergency response system
Transportation and/or escort to appointments
Medication management- to prevent interactions or side
effects and ensure that drugs
Money management
Help with insurance entitlements, SS or SSDI benefits
Advisement on legal issues such as power of attorney or
advance directives
After a stroke, one may
or may not need help with:
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Advisement on legal issues IE power of attorney or advance
directives
Management of medical appointment
Home safety assessment
Evaluate for need of assistive devices such as walkers, canes,
reachers, dressing aides, grab bars and more
Companionship or respite care, which may allow loved ones
a needed break
Psychosocial adjustment to disability
Stroke survivors concerns poststroke
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Functional dependence
Performance of activities of daily life: grooming, self-care,
hygiene, driving, cooking, shopping, housework, sexual
expression, etc
Memory
Employment
Depression
General health
Future strokes
Money
Where they will be placed
Tips for choosing clothing to promote
independence
Encourage dressing every day, instead of
wearing pajamas as this may help promote a
positive mood!
Choosing Clothing:
- Should fasten down the front
- Avoid tight fit
- Easier to pull pants up/down over nylon underwear
- Smooth fabrics
- Elastic/velcro fasteners, snaps, elastic wasitbands, rings
attached to zipper pulls
Tips for dressing and undressing
- Lay out clothes in the order they will go on
- Easier to don clothes in sitting rather than laying down
- Always dress affected side first when dressing and when
undressing, take clothes off of affected side last
- Putting on blouses, jackets, cardigans: lay clothing on flat surface,
collar away from you, back top facing the ceiling. Bend over, put
arms into armholes and lift over your head.
- Buttons: Bottom to top so that you can see the holes more easily.
Can rest weak arms on a table or chair armrests while doing this.
- Consider bra that hooks in front
- Dress in front of mirror and allow plenty of time
- Equipment: reacher, buttonhook, or dressing stick for
dressing/reaching
- Ask for help if needed!
Bathing Tips
Grooming requires precise movements while
holding small objects. Here are strategies:
- "wash and wear" hairstyle
- Weekly appointment at beauty salon
- Equipment/strategies: lighted and angled mirror,
electric shaver to decrease nicks, "picks" for
flossing, try different toothpaste caps
- wash mitts, mounted nail clippers, mounted
dental floss designed for use with one hand
Grooming and Hygiene Tips
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• Electric toothbrush
• Press down pump toothpaste dispensers
• Toiletries within easy reach
• Liquid soap in a press down pump
• Shampoo in a spray bottle for better distribution
• Deodorant spray
• Easy load toilet paper holder or "wet wipes"moist towelettes
• Bidet
• Aerosol health and beauty products
Grooming and Hygiene tips
Applying Toothpaste:
- Use strong hand to squeeze paste onto your tongue, and then
pick up toothbrush
- Hold brush btwn teeth, apply toothpaste with strong hand
- Toothbrush btwn thumb and forefinger of weak hand, add
toothpaste with strong hand
Shaving:
- Use an electric shaver if possible. Men: puff out cheeks when
you shave. Use disposable razor
- Shaving cream: Put cream onto back of weak hand or onto
edge of sink. Apply using strong hand
- Women should use an electric shaver for legs. Might better
reach lower legs if you lie on a bed while doing this
Shopping
• Make a list of necessary items
• Plan weekly expenses to decrease ATM/bank visits
• Categorize items on shopping list according to aisle to
decrease walking throughout store
• Use a pushcart
• Money/cards in an easily accessible pocket/purse
• Online, phone, TV or mail catalog shopping if possible
• Shop when retail and grocery stores are not busy
• Consider delegating shopping if necessary
Resources
F.A.S.T. Mobile phone app
http://strokeassociation.org/STROKEORG/WarningSigns/Stroke-Warning-Signsand-Symptoms_UCM_308528_SubHomePage.jsp
National Stroke Association
www.stroke.org
American Stroke Association
www.strokeassociation.org
National Stroke Association Hotline
Toll-free hotline: 1-888-STROKES or 1-800-787-6537
National Aphasia Association
1-800-922-4622 www.aphasia.org
Stroke support groups
http://www.stroke.org/site/PageServer?pagename=support_groups
http://rusk.med.nyu.edu/support-groups-1
Local opportunities
to participate in clinical trials
Columbia University summer stroke camp 2 week intensive therapy:
-Contact Glen Gillen or Dawn Nielsen 212-305-5267
Columbia Stroke Research Registry:
-Weill Cornell Rehab. Medicine Department, Stroke Research office 212-746-1356
Rusk Institute stroke research:
-http://rusk.med.nyu.edu/clinical-trials
Kessler Institute for Rehabilitation
-www.kessler-rehab.com
Top Rated U.S. Stroke Rehab centers in tri-state area
Kessler Institute for Rehabilitation, West Orange, N.J.
Rusk Institute, NYU Medical Center, New York
Mount Sinai Medical Center, New York
New York-Presbyterian Hospital, New York