Recommendations for Stroke Survivors
People who survive a ]]>stroke]]> often suffer serious, long-term disability. Stroke damage can result in paralysis, numbness, imbalance, and difficulty thinking and communicating. While there is no way to reverse the effects of a stroke, it is possible to regain some of the function lost during a stroke.
What Happens During a Stroke?
A stroke occurs when the blood flow to the brain is interrupted, either by a blood clot in a vessel or artery leading to the brain (ischemic stroke), or a break in a blood vessel in the brain itself (hemorrhagic stroke). During a stroke, brain cells quickly die because they no longer have access to the oxygen and nutrients they need.
Treatment During a Stroke
Intravenous (IV) alteplase is a drug that dissolves blood clots during ischemic strokes. To be effective, it must be given within three hours after a stroke begins, which usually means arriving at the hospital within the first 60 minutes after symptoms occur.
If you or someone you know experiences the following symptoms of a stroke, call 9-1-1 immediately:
- Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
- Sudden confusion, trouble speaking, or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, or loss of balance or coordination
- Sudden severe headache with no known cause
Rehabilitation After a Stroke
While stroke rehabilitation cannot “cure” stroke damage, it can help stroke survivors become more independent. What exactly can people do to improve their health and quality of life after having a stroke?
In April 2004, the American Heart Association (AHA) released a statement urging stroke survivors to exercise for at least 20 minutes per day, 3-7 times a week, to reduce the risk of stroke recurrence. Exercise can also strengthen muscles and improve mobility, which can help a stroke survivor perform daily activities, such as dressing, bathing, walking, and doing household chores.
A study, published in the April 22, 2004 issue of Stroke , found that a resistance-training program significantly improved lower extremity strength, as well as function and disability in older stroke survivors. The 12-week resistance-training program consisted of a variety of exercises designed to strengthen the lower body.
Before beginning an exercise program, stroke survivors should consult their physician, who may recommend adding handrails or harnesses to exercise equipment in order to make exercising safer.
Exercise sessions can be divided into 10-minute intervals and should include stretching, cardiovascular exercises, and strength training.
Physical, Occupational, and Speech Therapy
After a stroke, physical therapy can help restore some of the function lost in a stroke. Physical therapy for stroke survivors may include stimulating impaired limbs, stretching, and practicing motor tasks (ie, walking up or down stairs). People too weak to bear their own weight can perform physical therapy exercises in the water, supported by a harness. Goal-oriented activities, such as games, are often used to promote coordination. A new technology, called transcutaneous electrical nerve stimulation (TENS), generates an electrical current and stimulates nerve activity in impaired limbs.
Similar to physical therapy, occupational therapy is utilized in stroke patients to help improve motor abilities. Occupational therapy specifically targets improving motor skills that will help the stroke survivor perform activities such as housecleaning, gardening, arts and crafts, and even driving.
Speech therapy is often helpful for stroke survivors who are generally able to think clearly, but have problems speaking or understanding speech or written words.
A study in the March 4, 2004 issue of Stroke indicated that repetitive sensorimotor training of the arm during the first weeks after a stroke significantly improves motor function up to five years later. In this study, the participants were seated in a rocking chair for 30-minutes each day for six weeks, while an inflatable splint pushed them forward; they had to use their arm strength to actively push themselves backward.
Stroke patients should begin stimulation of their weakened arms soon after a stroke. Repetitive stimulation can result in significant improvements in future functioning.
Treatment of Anxiety and Depression
A study in the February 12, 2004 issue of Stroke found that depression and anxiety, which are common after a stroke, were associated with handicap two years after a stroke. The study’s authors suggest that treating depression and anxiety may help reduce the level of handicap in stroke survivors. A mental health professional can help determine the best way to treat anxiety and/or depression.
The Future of Stroke Rehabilitation
According to the author of an article published in the December 11, 2003 issue of Stroke , “Brain recovery after stroke is the area of scientific discovery with the largest potential for advances far into the next century.” As researchers gain a better understanding of how the brain is organized and how brain cells communicate with one another, they will be able to develop new rehabilitation therapies to help reverse post-stroke damage.
Prevention of Further Strokes
Persons who have had a stroke remain at increased risk of suffering a further stroke at some time in the future. Fortunately, and depending on the cause of the initial stroke, a variety of treatments can be employed to significantly reduce that risk. Be sure you discuss with your doctor how to reduce your stroke risk in the future.
American Stroke Association
National Institute of Neurological Disorders and Stroke
American Heart Association scientific statement: American Heart Association urges regular exercise after stroke. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3021462 . Accessed May 6, 2004.
Broderick JP. William M. Feinberg lecture: stroke therapy in the year 2025. Burden, breakthroughs, and barriers to progress. Stroke . 2003;35:205.
Feyes H, De Weerdt W, et al. Early and repetitive stimulation of the arm can substantially improve the long-term outcome after stroke: a 5-year follow-up study of a randomized trial. Stroke . 2004;35:924.
Know stroke. Know the signs. Act in time. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/knowstroke . Accessed May 6, 2004.
Morgenstern LB, Bartholomew LK, Grotta JC, Staub L, King M, Chan W. Sustained benefit of a community and professional intervention to increase acute stroke therapy. Arch Intern Med. 2003;163:2198-2202.
NINDS stroke information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/health_and_medical/disorders/stroke.htm . Accessed May 13, 2004.
Ouelette MM, LeBrasseur NK, et al. High-intensity resistance training improves muscle strength, self-reported function, and disability in long-term stroke survivors. Stroke . April 22, 2004.
Post-stroke rehabilitation factsheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/health_and_medical/pubs/poststrokerehab.htm . Accessed May 13, 2004.
Sturm JW, Donnan GA, et al. Determinants of handicap after stroke: The North East Melborne Stroke Incidence Study (NEMESIS). Stroke . 2004;35:715.
Last reviewed October 2006 by ]]>Lawrence Frisch, MD, MPH]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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