Providing Comprehensive Care to Stroke Survivors
- Stroke is the fourth leading cause of death in America and a leading cause of adult disability.
- More than 7 million people in the United States today have survived a stroke.
- Up to 80% of strokes are preventable; you can prevent a stroke!
The Myths and the Reality
Myth: Stroke is unpreventable
Reality: Stroke is largely preventable
Myth: Stroke cannot be treated
Reality: Stroke requires emergency treatment
Myth: Stroke only strikes the elderly
Reality: Stroke can happen to anyone
Myth: Stroke happens to the heart
Reality: Stroke is a "Brain Attack"
Myth: Stroke recovery only happens for a few months following a stroke
Reality: Stroke recovery continues throughout life
What is Stroke? A general definition
A stroke, previously known medically as a cerebrovascular accident (CVA), is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood). As a result, the affected area of the brain is unable to function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.
Stroke and TIA (Transient Ischemic Attack) are the first cause of acquired disabilities in the world. Watch a Video that explains what a stroke is, and what can be done to accompany the treatment and rehabilitation of stroke victims.
Types of Stroke
In everyday life, blood clotting is beneficial. When you are bleeding from a wound, blood clots work to slow and eventually stop the bleeding. In the case of stroke, however, blood clots are dangerous because they can block arteries and cut off blood flow, a process called ischemia. An ischemic stroke can occur in two ways: embolic and thrombotic strokes.
In an embolic stroke, a blood clot forms somewhere in the body (usually the heart) and travels through the bloodstream to your brain. Once in your brain, the clot eventually travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. The medical word for this type of blood clot is embolus.
In the second type of blood-clot stroke, blood flow is impaired because of a blockage to one or more of the arteries supplying blood to the brain. The process leading to this blockage is known as thrombosis. Strokes caused in this way are called thrombotic strokes. That's because the medical word for a clot that forms on a blood-vessel deposit is thrombus.
Blood-clot strokes can also happen as the result of unhealthy blood vessels clogged with a buildup of fatty deposits and cholesterol. Your body regards these buildups as multiple, tiny and repeated injuries to the blood vessel wall. So your body reacts to these injuries just as it would if you were bleeding from a wound; it responds by forming clots. Two types of thrombosis can cause stroke: large vessel thrombosis and small vessel disease (or lacunar infarction.)
Large Vessel Thrombosis
Thrombotic stroke occurs most often in the large arteries, so large vessel thrombosis is the most common and best-understood type of thrombotic stroke. Most large vessel thrombosis is caused by a combination of long-term atherosclerosis followed by rapid blood clot formation. Thrombotic stroke patients are also likely to have coronary artery disease, and heart attack is a frequent cause of death in patients who have suffered this type of brain attack.
Small Vessel Disease/Lacunar Infarction
Small vessel disease, or lacunar infarction, occurs when blood flow is blocked to a very small arterial vessel. The term's origin is from the Latin word lacuna, which means hole, and describes the small cavity remaining after other cells in the body have removed the products of deep infarct. Little is known about the causes of small vessel disease, but it is closely linked to hypertension (high blood pressure).
Strokes caused by the breakage or "blowout" of a blood vessel in the brain are called hemorrhagic strokes. The medical word for this type of breakage is hemorrhage. Hemorrhages can be caused by a number of disorders, which affect the blood vessels, including long-standing high blood pressure and cerebral aneurysms. An aneurysm is a weak or thin spot on a blood vessel wall. These weak spots are usually present at birth. Aneurisms develop over a number of years and usually don't cause detectable problems until they break. There are two types of hemorrhagic stroke subarachnoid and intracerebral.
- In an intracerbral hemorrhage, bleeding occurs from vessels within the brain itself. Hypertension (high blood pressure) is the primary cause of this type of hemorrhage.
- In a subarachnoid hemorrhage (SAH), an aneurism bursts in a large artery on or near the thin, delicate membrane surrounding the brain. Blood spills into the area around the brain, which is filled with a protective fluid, causing the brain to be surrounded by blood-contaminated fluid.
Life After a Stroke
Like the individuals who experience them, no two strokes are exactly the same. Learn more about the common physical, communication, emotional and behavioral effects that stroke can have on a survivor and find great tips for improving and adapting to make the most of your recovery.
Recovery from stroke is a lifelong process. For many people, recovery begins with formal rehabilitation, which can restore independence by improving physical, mental and emotional functions. It is important for you and your family to know that no matter where you are in your recovery journey, there is always a hope.
Although there is not a one-size-fits-all solution, staying at home could be the most soothing and encouraging way to recover. Look for the right advice and professionals, and embrace the three main steps to recovery:
Improve brain function.Depending on the nature of your stroke and the part of the brain that was affected, you may need professional help to restore your speech, ability to understand when others speak, memory retention and/or concentration, according to the Stroke Rehab Online website. This rehabilitation phase is likely to include counseling to help you come to terms with your stroke. All these efforts are known as cognitive therapy, which includes any rehabilitation that does not involve physical movement.
Restore physical ability.Physiotherapy will usually start with improving your ability to perform basic, daily functions such as feeding and dressing yourself, as well as maintaining personal hygiene according to the Stroke Rehab Online website. Different parts of the brain control different limbs and muscles in the body, so your post-stroke physical impairments will depend on which part of your brain is injured, according to the Patient UK website. But some of the most common symptoms and side effects of a stroke are loss of movement of an arm, leg or both — usually on the same side. A physiotherapist will usually design a physical rehabilitation program tailored to your needs.
Persevere.Every stroke is different, but recovery will almost always take some time, according to the Patient UK website. In the first weeks after a stroke, basic actions you once performed without thinking may take a great deal of concentration and practice, but it is not unusual for some abilities to be restored once the initial swelling in the brain has eased. However, it could take an additional six months to become independent of caretakers, and it is likely that some degree of disability will remain.
Watch the video Living After Stroke – Managing Life at Home and in the Community (Part One and Part Two) created by the National Stroke Association
- Part One teaches about how to make modifications to your bathroom and kitchen and how to choose and access local transportation. The presentation also covers how to tackle the emotional and behavioral journey after leaving the hospital and returning to your daily life.
- Part Two goes into detail about making major home modifications to meet your daily lifestyle needs after stroke.
To start maximizing your independence after a stroke read the Interactive Workbook: Stroke Recovery. Maximizing Independence After Stroke is designed to help stroke patients and their caregivers understand the effects of stroke, how to maximize your recovery and reduce future risk. This workbook is self-guided, so you can learn at your own pace. It includes audio voiceover, video, animations and printable tools and logs.
Stroke can affect self-esteem the same way fire ants can impact a picnic: disastrously. Look at the opinions of two experts about emotional recovery and social reintegration after stroke. They provide valuable insights into the devastating impact stroke may have on the self-esteem of survivors, and how that affects social reintegration, and the crucial role that plays in recovery. Read the article Reclaiming Your Self-Esteem.
The Role of Caregivers and Family
Caregivers/family members play a prominent role throughout the post-stroke recovery process. Caregivers/family members are essential to successful home care and too often are ignored. Caring for stroke survivors at home can cause high levels of emotional, mental and physical stress. In addition to distress, disruption of employment and family life makes caregiving very challenging.
Family members can help their loved one by providing encouragement, celebrating improvements and letting the survivor do as much as possible independently. Caregivers and other family and friends can reassure stroke survivors that they are wanted, needed and important to them.
Family caregivers can promote positive post-stroke recovery outcomes; however, they need to care for themselves as well. Post-stroke recovery varies for each person; even if the stroke survivor returns to work and maintains a large amount of autonomy, family members may play a bigger role in the stroke survivor's live than before the stroke.
Providing care for a loved one after stroke can be an extremely rewarding experience. At the same time, it can be stressful and frustrating when you are suddenly thrust into the position of caregiver without warning. The information here will help you take care of not only the stroke survivor in your life, but yourself.
Learn tips from other stroke family caregivers and valuable information to help ease the day-to-day stresses of caring for a loved one with stroke — American Stroke Association.
Comprehensive Care at Home
Along with the support from family, friends, a professional care team should be in place to help stroke survivors to recover and to avoid family and friends' burnout.
In fact, statistics from the Family Caregiver Alliance indicate that 76% of family caregivers need respite of one kind or another. Respite literally means a rest or break from the demands of caregiving. For example, respite can mean help with transportation, assistance with errands or meal preparation, in-home practical help that eases the daily workload, a few hours away from home to tend to personal needs, or simply a personal visit to lessen the isolation often experienced by stroke families. For many stroke survivors and family caregivers, respite may be a combination of all of these. Support is crucial, and allows stroke survivors and their families to stay focused on the recovery process.
The right care should take into consideration the following:
- Assist with doctor's appointments, medications, and exercises.
- Manage financial matters and transportation.
- Provide the stroke survivor with physical, mental and emotional support. Assist the stroke survivor with daily activities such as personal care and hygiene.
- Plan out the stroke survivor's care, including setting routines and managing the care team.
- Assess stroke survivor's medical needs, communicate with healthcare professionals and advocate (medically) for the stroke survivor.
- Provide wellness activities and engaging tasks to help boost the survivor's sense of wellbeing.
Living Well President, Dr. Doris Bersing says "We believe that though accurate diagnosis of people's cognitive, and physical strengths, and vulnerabilities, we can develop support and programming that appropriately stimulates, offers joy, decreases depression and helps people to maximize independence and attain recovery in their own homes and within their communities. We also believe that a stroke affects everybody who loves the person with the illness — so our programming offers support to the whole family."
- SAFE (Stroke Awareness for Everyone, Inc.) is an international Internet-centered coalition of stroke survivors and their families, in addition to doctors, nurses and therapists involved with stroke.
- Support at the NeuroAid blog
- Look at the Resource Page of the National Stroke Association to help you navigate the challenging post-stroke recovery journey.
- American Stroke Association
- National Alliance for Caregiving
- Support group finder in US