Patient Care & Services

Stroke

History of stroke:

Hippocrates, the father of medicine, first recognized stroke over 2,400 years ago. At this time stroke was called apoplexy, which means “struck down by violence” in Greek. This was due to the fact that a person developed sudden paralysis and change in well-being. Physicians had little knowledge of the anatomy and function of the brain, the cause of stroke, or how to treat it.

It was not until the mid-1600s that Jacob Wepfer found that patients who died with apoplexy had bleeding in the brain. He also discovered that a blockage in one of the brain’s blood vessels could cause apoplexy.

Medical science continued to study the cause, symptoms, and treatment of apoplexy and, finally, in 1928, apoplexy was divided into categories based on the cause of the blood vessel problem. This led to the terms stroke or “cerebral vascular accident (CVA).” Stroke is now often referred to as a “brain attack” to denote the fact that it is caused by a lack of blood supply to the brain, very much like a heart attack is caused by a lack of blood supply to the heart. The term brain attack also conveys a more urgent call for immediate action and emergency treatment by the general public.

Today, there is a wealth of information available on the cause, prevention, risk, and treatment of stroke. Although there is no cure, most stroke victims now have a good chance for survival and recovery. Immediate treatment, supportive care, and rehabilitation can all improve the quality of life for stroke victims.

What is stroke?

Stroke, also called brain attack, occurs when blood flow to the brain is disrupted. Disruption in blood flow is caused when either a blood clot or piece of plaque blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

The brain needs a constant supply of oxygen and nutrients in order to function. Even a brief interruption in blood supply can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. The area of dead cells in tissues is called an infarct. Due to both the physical and chemical changes that occur in the brain with stroke, damage can continue to occur for several days. This is called a stroke-in-evolution.

A loss of brain function occurs with brain cell death. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder, eating, emotional control, and other vital body functions. Recovery from stroke and the specific ability affected depends on the size and location of the stroke. A small stroke may result in problems such as weakness in an arm or leg. Larger strokes may cause paralysis (inability to move part of the body), loss of speech, or even death.

According to the National Stroke Association (NSA), it is important to learn the three Rs of stroke:

  • Reduce the risk.
  • Recognize the symptoms.
  • Respond by calling 911 (or your local ambulance service).

Stroke is an emergency and should be treated as such. The greatest chance for recovery from stroke occurs when emergency treatment is started immediately.

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What are the most common symptoms of stroke?

The following are the most common symptoms of stroke. However, each individual may experience symptoms differently. If any of these symptoms are present, call 911 (or your local ambulance service) immediately. Treatment is most effective when started immediately.

Symptoms may be sudden and include:

  • weakness or numbness of the face, arm, or leg, especially on one side of the body
  • confusion or difficulty speaking or understanding
  • problems with vision such as dimness or loss of vision in one or both eyes
  • dizziness or problems with balance or coordination
  • problems with movement or walking
  • severe headaches with no other known cause

All of the above warning signs may not occur with each stroke. Do not ignore any of the warning signs, even if they go away – take action immediately. The symptoms of stroke may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

What are some other symptoms of stroke?

Other, less common, symptoms of stroke may include the following:

  • sudden nausea, vomiting, or fever not caused by a viral illness
  • brief loss or change of consciousness such as fainting, confusion, seizures, or coma
  • transient ischemic attack (TIA), or “mini-stroke”

A TIA can cause many of the same symptoms as a stroke, but TIA symptoms are transient and last for a few minutes to up to 24 hours. Call for medical help immediately if you suspect a person is having a TIA, as it may be a warning sign that a stroke is about to occur. Not all strokes, however, are preceded by TIAs.

Risk Factors for Stroke

Evaluating the risk for stroke is based on heredity, natural processes, and lifestyle. Many risk factors for stroke can be changed or managed, while others that relate to hereditary or natural processes cannot be changed.

Risk factors for stroke that can be changed, treated, or medically managed:

  • High blood pressure – The most important controllable risk factor for stroke (brain attack) is controlling high blood pressure (140/90 or higher). High blood pressure can damage blood vessels called arteries that supply blood to the brain. According to the Centers for Disease Control and Prevention (CDC), reducing the systolic (or top number) blood pressure by 12 to 13 points can decrease the risk for a stroke by 37 percent.
  • Diabetes mellitus – Diabetes is treatable, but having it increases the risk for stroke. People with diabetes have two to four times the risk of having a stroke than someone without diabetes. Talk with your healthcare provider on specific ways to manage your overall health and diabetes care.
  • Heart disease – Heart disease is the second most important risk factor for stroke, and the major cause of death among survivors of stroke. Heart disease and stroke have many of the same risk factors.
  • Cigarette smoking – Apart from other risk factors, smoking almost doubles the risk for ischemic stroke (blockage of a blood vessel supplying blood to the brain). The use of oral contraceptives, especially when combined with cigarette smoking, greatly increases stroke risk.
  • History of transient ischemic attacks (TIAs) – A person who has had one (or more) TIA is almost 10 times more likely to have a stroke than someone of the same age and sex who has not had a TIA.
  • High red blood cell count – A moderate increase in the number of red blood cells thickens the blood and makes clots more likely, thus increasing the risk for stroke.
  • High blood cholesterol and lipids – High blood cholesterol and lipids increase the risk for stroke. High cholesterol levels can contribute to atherosclerosis (thickening or hardening of the arteries) caused by a build-up of plaque (deposits of fatty substances, cholesterol, calcium). Plaque build-up on the inside of the walls of arteries can decrease the amount of blood flow to the brain. A stroke occurs if the blood supply is cut off to the brain. Atherosclerosis is a slow, progressive disease that may start as early as childhood.
  • Lack of exercise, physical inactivity – Lack of exercise and physical inactivity increases the risk for stroke.
  • Obesity – Excess weight increases the risk for stroke.
  • Excessive alcohol use – More than two drinks per day raises blood pressure, and binge drinking can lead to stroke.
  • Drug abuse (certain kinds) – Intravenous drug abuse carries a high risk of stroke from cerebral embolisms (blood clots). Cocaine use has been closely related to strokes, heart attacks, and a variety of other cardiovascular complications. Some of them, even among first-time cocaine users, have been fatal.
  • Abnormal heart rhythm – Various heart diseases have been shown to increase the risk of stroke. Atrial fibrillation (an irregular heartbeat) is the most powerful and treatable heart risk factor of stroke. About 15 percent of strokes occur in people with atrial fibrillation.
  • Cardiac structural abnormalities – New evidence shows that heart structure abnormalities including patent foramen ovale and atrial septal defect increase risk for embolic stroke.

Risk factors for stroke that cannot be changed:

  • Age – For each decade of life after age 55, the chance of having a stroke more than doubles.
  • Race – African-Americans have a much higher risk of death and disability from a stroke than Caucasians, in part because the African-American population has a greater incidence of high blood pressure and diabetes.
  • Gender – Stroke occurs more frequently in men, but more women than men die from stroke.
  • History of prior stroke – The risk of stroke for someone who has already had one is many times that of a person who has not had a stroke.
  • Heredity/genetics – The chance of stroke is greater in people who have a family history of stroke.

Other risk factors of stroke to consider:

  • Where a person lives – Strokes are more common among people living in the southeastern United States than in other areas. This may be due to regional differences in lifestyle, race, cigarette smoking, and diet.
  • Temperature, season, and climate – Stroke deaths occur more often during periods of extreme temperatures.
  • Socioeconomic factors – There is some evidence that strokes are more common among low-income people than among more affluent people.

Statistics of Stroke

More about stroke/brain attack:

Consider the following statistics regarding strokes:

  • Stroke is the third largest cause of death, ranking behind diseases of the heart and all forms of cancer.
  • Almost every 40 seconds in the United States, a person experiences a stroke.
  • Over 4 million US adults live today with the effects of a stroke.
  • The American Stroke Association, a division of the American Heart Association, estimates strokes cost the US $68.9 billion in 2009.
  • Women account for about 6 in 10 stroke deaths.
  • Black males have almost twice the risk of a first-ever stroke compared with white males.
  • Hispanics have an increased risk of stroke compared with non-Hispanic whites.
  • Each year about 795,000 people suffer a new or recurrent stroke in the US.
  • Stroke accounts for about 1 out of every 17 deaths in the US.

What are the different types of stroke?

Strokes can be classified into two main categories:

  • 87 percent are ischemic strokes – strokes caused by blockage of an artery.
  • 13 percent are hemorrhagic strokes – strokes caused by bleeding.

What is an ischemic stroke?

An ischemic stroke occurs when a blood vessel that supplies the brain becomes blocked or “clogged” and impairs blood flow to part of the brain. The brain cells and tissues begin to die within minutes from lack of oxygen and nutrients. The area of tissue death is called an infarct. About 87 percent of strokes fall into this category. Ischemic strokes are further divided into two groups, including the following:

  • thrombotic strokes – caused by a blood clot that develops in the blood vessels inside the brain.
  • embolic strokes – caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to one of the blood vessels in the brain via the bloodstream.

What is a thrombotic stroke?

Thrombotic strokes are strokes caused by a thrombus (blood clot) that develops in the arteries supplying blood to the brain. This type of stroke is usually seen in older persons, especially those with high-cholesterol levels and atherosclerosis (a build-up of fat and lipids inside the walls of blood vessels).

Sometimes, symptoms of a thrombotic stroke can occur suddenly and often during sleep or in the early morning. At other times, it may occur gradually over a period of hours or even days. This is called a stroke-in-evolution.

Thrombotic strokes may be preceded by one or more “mini-strokes,” called transient ischemic attacks, or TIAs. TIAs may last for a few minutes or up to 24 hours, and are often a warning sign that a stroke may occur. Although usually mild and transient, the symptoms caused by a TIA are similar to those caused by a stroke.

Another type of stroke that occurs in the small blood vessels in the brain is called a lacunar infarct. The word lacunar comes from the Latin word meaning “hole” or “cavity.” Lacunar infarctions are often found in people who have diabetes or hypertension (high blood pressure).

What is an embolic stroke?

Embolic strokes are usually caused by an embolus (a blood clot that forms elsewhere in the body and travels through the bloodstream to the brain). Embolic strokes often result from heart disease or heart surgery and occur rapidly and without any warning signs. About 15 percent of embolic strokes occur in people with atrial fibrillation, a type of abnormal heart rhythm in which the upper chambers of the heart do not beat effectively.

What is a hemorrhagic stroke?

Hemorrhagic strokes occur when a blood vessel that supplies the brain ruptures and bleeds. When an artery bleeds into the brain, brain cells and tissues do not receive oxygen and nutrients. In addition, pressure builds up in surrounding tissues and irritation and swelling occur. About 13 percent of strokes are caused by hemorrhage (10 percent are intracerebral hemorrhage and 3 percent are subarachnoid hemorrhage strokes). Hemorrhagic strokes are divided into two main categories, including the following:

  • intracerebral hemorrhage – bleeding from the blood vessels within the brain.
  • subarachnoid hemorrhage – bleeding in the subarachnoid space (the space between the brain and the membranes that cover the brain).

What is an intracerebral hemorrhage?

Intracerebral hemorrhage is usually caused by hypertension (high blood pressure), and bleeding occurs suddenly and rapidly. There are usually no warning signs and bleeding can be severe enough to cause coma or death.

What is a subarachnoid hemorrhage?

Subarachnoid hemorrhage results when bleeding occurs between the brain and the meninges (the membrane that covers the brain) in the subarachnoid space. This type of hemorrhage is often due to an aneurysm or an arteriovenous malformation (AVM).

  • An aneurysm is a weakened, ballooned area on an artery wall and has a risk for rupturing. Aneurysms may be congenital (present at birth), or may develop later in life due to such factors as hypertension or atherosclerosis
  • An AVM is a congenital disorder that consists of a disorderly tangled web of arteries and veins. The cause of AVM is unknown.

What are recurrent strokes?

Recurrent strokes occur in about 25 percent of stroke victims within five years after a first stroke. The risk is greatest right after a stroke and decreases over time. The likelihood of severe disability and death increases with each recurrent stroke. About 3 percent of stroke patients have a second stroke within 30 days of their first stroke, and about one-third have a second stroke within two years.

What are the effects of stroke?

The effects of stroke vary from person to person based on the type, severity, and location of the stroke. The brain is extremely complex and each area of the brain is responsible for a special function or ability. When an area of the brain is damaged, which typically occurs with a stroke, an impairment may result. An impairment is the loss of normal function of part of the body. Sometimes, an impairment may result in a disability, or inability to perform an activity in a normal way.

The brain is divided into three main areas, including the following:

  • cerebrum (consisting of the right and left sides or hemispheres)
  • cerebellum
  • brain stem

Depending on which of these regions of the brain the stroke occurs, the effects may be very different.

What effects can be seen with a stroke in the cerebrum?

The cerebrum is the part of the brain that occupies the top and front portions of the skull. It is responsible for control of such abilities as movement and sensation, speech, thinking, reasoning, memory, sexual function, and regulation of emotions. The cerebrum is divided into the right and left sides, or hemispheres.

Depending on the area and side of the cerebrum affected by the stroke, any, or all, of the following body functions may be impaired:

  • movement and sensation
  • speech and language
  • eating and swallowing
  • vision
  • cognitive (thinking, reasoning, judgment and memory) ability
  • perception and orientation to surroundings
  • self-care ability
  • bowel and bladder control
  • emotional control
  • sexual ability

In addition to these general effects, some specific impairments may occur when a particular area of the cerebrum is damaged.

Effects of a right hemisphere stroke:

The effects of a right hemisphere stroke may include the following:

  • left-sided weakness (left hemiparesis) or paralysis (left hemiplegia) and sensory impairment
  • denial of paralysis or impairment and reduced insight into the problems created by the stroke (this concept is called “left neglect”)
  • visual problems, including an inability to see the left visual field of each eye (homonymous hemianopsia)
  • spatial problems with depth perception or directions such as up/down and front/back
  • inability to localize or recognize body parts
  • inability to understand maps and find objects such as clothing or toiletry items
  • memory problems
  • behavioral changes such as lack of concern about situations, impulsivity, inappropriateness, and depression

Effects of a left hemisphere stroke:

The effects of a left hemisphere stroke may include the following:

  • right-sided weakness (right hemiparesis) or paralysis (right hemiplegia) and sensory impairment
  • problems with speech and understanding language (aphasia)
  • visual problems, including the inability to see the right visual field of each eye (homonymous hemianopsia)
  • impaired ability to do math or to organize, reason, and analyze items
  • behavioral changes such as depression, cautiousness, and hesitancy
  • impaired ability to read, write, and learn new information
  • memory problems

What effects can be seen with a stroke in the cerebellum?

The cerebellum is located beneath and behind the cerebrum towards the back of the skull. It receives sensory information from the body via the spinal cord and helps to coordinate muscle action and control, fine movement, coordination, and balance.

Although strokes are less common in the cerebellum area, the effects can be severe. Four common effects of strokes in the cerebellum include the following:

  • inability to walk and problems with coordination and balance (ataxia)
  • dizziness
  • headache
  • nausea
  • vomiting

What effects can be seen with a stroke in the brain stem?

The brain stem is located at the very base of the brain right above the spinal cord. Many of the body’s vital “life-support” functions such as heartbeat, blood pressure, and breathing are controlled by the brain stem. It also helps to control the main nerves involved with eye movement, hearing, speech, chewing, and swallowing. Some common effects of a stroke in the brain stem include problems with the following:

  • breathing and heart functions
  • body temperature control
  • balance and coordination
  • weakness or paralysis in all four limbs
  • chewing, swallowing, and speaking
  • vision
  • coma

Unfortunately, death is common with brain stem strokes.

Evaluation Procedures for Stroke

How is stroke diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for stroke may include the following.

Imaging tests of the brain:

  • Computed Tomography Scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays; used to detect abnormalities and help identify the location or type of stroke.
  • Magnetic Resonance Imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; an MRI uses magnetic fields to detect small changes in brain tissue that helps to locate and diagnose stroke.
  • Radionuclide Angiography – a nuclear brain scan in which radioactive compounds are injected into a vein in the arm, and a machine (similar to a Geiger counter) creates a map showing their uptake into different parts of the head. The images show how the brain functions rather than its structure. This test can often detect areas of decreased blood flow and tissue damage.
    computed tomographic angiography (CTA) – an x-ray image of the blood vessels. A CT angiogram uses CT technology to obtain images of blood vessels.
  • Magnetic Resonance Angiography (MRA) – - a procedure used to evaluate blood flow through arteries in a noninvasive (the skin is not pierced) manner using MRI technology.
  • Functional Magnetic Resonance Imaging (fMRI) – - a variation of MRI used to determine the specific location of the brain where a certain function, such as speech or memory, occurs.

Tests that evaluate the brain’s electrical activity:

  • electroencephalogram (EEG) – a procedure that records the brain’s continuous, electrical activity by means of electrodes attached to the scalp.
  • evoked potentials – procedures that record the brain’s electrical response to visual, auditory, and sensory stimuli.

Tests that measure blood flow:

  • Carotid Phonoangiography – a small microphone is placed over the carotid artery on the neck to record sounds created by blood flow as it passes through a partially blocked artery. The abnormal sound is called a bruit.
  • Doppler sonography – a special transducer is used to direct sound waves into a blood vessel to evaluate blood flow. An audio receiver amplifies the sound of the blood moving though the vessel. Faintness or absence of sound may indicate a problem with blood flow.
  • Ocular plethysmography – measures pressure on the eyes, or detects pulses in the eyes.
  • Cerebral blood flow test (inhalation method) – measures the amount of oxygen in the blood supply that reaches different areas of the brain.
  • Digital subtraction angiography (DSA) – provides an image of the blood vessels in the brain detect a problem with blood flow. The test involves inserting a small, thin tube (catheter) into an artery in the leg and passing it up to the blood vessels in the brain. A contrast dye is injected through the catheter and x-ray images are taken.
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Treatment for Stroke Medical treatment for stroke:

Specific treatment for stroke will be determined by your physician based on:

  • your age, overall health, and medical history
  • severity of the stroke
  • location of the stroke
  • cause of the stroke
  • your tolerance for specific medications, procedures, or therapies
  • type of stroke
  • your opinion or preference

Although there is no cure for stroke, advanced medical and surgical treatments are now available, giving many stroke victims hope for optimal recovery.

Emergency treatments for stroke:

Treatment is most effective when started immediately. Emergency treatment following a stroke may include the following:

  • Medications used to the dissolve blood clot(s) that cause an ischemic stroke – Medications that dissolve clots are called thrombolytics or fibrinolytics, and are commonly known as “clot busters.” These drugs have the ability to help reduce the damage to brain cells caused by the stroke. In order to be most effective, these agents must be given within several hours of a stroke’s onset.
  • Medications and therapy to reduce or control brain swelling – Corticosteroids and special types of intravenous (IV) fluids are often used to help reduce or control brain swelling, especially after a hemorrhagic stroke (a stroke caused by bleeding into the brain).
  • Medications that help protect the brain from damage and ischemia (lack of oxygen) – Medications of this type are called neuroprotective agents, with some still under investigation in clinical trials.
  • Life support measures including such treatments as ventilators (machines to assist with breathing), IV fluids, adequate nutrition, blood pressure control, and prevention of complications

Other medications used to treat or prevent a stroke:

Other medications that may help with recovery following a stroke, or may help to prevent a stroke from occurring, include the following:

  • Medications to help prevent more blood clots from forming – Medications that help to prevent additional blood clots from forming are called anticoagulants, as they prevent the coagulation of the blood. Medications of this type include, for example, heparin and warfarin (Coumadin®) and enoxaparin (Lovenox®).
  • Medications that reduce the chance of blood clots by preventing platelets (a type of blood cell) from sticking together
    Examples of this type of medication include aspirin, clopidogrel (Plavix®) or dipyridamole (Aggrenox®).
  • Medications to treat existing medical conditions such as diabetes, heart, or blood pressure problems.

Types of surgery to treat or prevent a stroke:

Several types of surgery may be performed to help treat a stroke, or help to prevent a stroke from occurring, including the following:

  • Carotid endarterectomy – Carotid endarterectomy is a procedure used to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help prevent a stroke from occurring.
  • Carotid stenting – A large metal coil (stent) is placed in the carotid artery much like a stent is placed in a coronary artery. The femoral artery is used as the site for passage of a special hollow tube to the area of blockage in the carotid artery. This procedure is often done in radiology labs, but may be performed in the cath lab.
  • Craniotomy – A craniotomy is a type of surgery in the brain itself to remove blood clots or repair bleeding in the brain.
  • Surgery to repair aneurysms and arteriovenous malformations (AVMs) – An aneurysm is a weakened, ballooned area on an artery wall that has a risk for rupturing and bleeding into the brain. An AVM is a congenital (present at birth) or acquired disorder that consists of a disorderly, tangled web of arteries and veins. An AVM also has a risk for rupturing and bleeding into the brain. Surgery may be helpful, in this case, to help prevent a stroke from occurring.
  • Patent foramen ovale (PFO) closure – The foramen ovale is an opening that occurs in the wall between the two upper chambers of a baby’s heart before birth. It functions to provide oxygen-rich blood to the baby from the mother’s placenta while in the womb. This opening normally closes soon after birth. If the flap does not close, blood flows from the right atrium directly to the left atrium. It then flows out to the central circulation of the body. If this blood contains any clots or air bubbles, they can pass into the brain circulation causing a stroke or transient ischemic attack (TIA). PFO closure procedure can be performed through a percutaneous (through the skin) approach. Signs and symptoms of a PFO may not occur until early or middle adulthood and may even go undetected.

Constraint-Induced Therapy (CIT) for arm and hand paralysis after stroke:

Many individuals who have a stroke are left with paralysis of the upper extremities. CIT is a treatment that encourages the use of the stroke-affected limb by constraining the non-affected limb in a mitt, sling, splint or glove. Intense exercises are done using the stroke-affected arm or hand.

  • CIT restraints are worn for up to 90 percent of the waking hours.
  • Restraints can be removed for activities such as bathing.
  • Small steps are used to break down complex tasks such as making a phone call.
  • Verbal and written feedback is used to help motivate and inform persons undergoing CIT.

Rehabilitation for Stroke What is rehabilitation?

Rehabilitation is the process of helping an individual achieve the highest level of independence and quality of life possible – physically, emotionally, socially, and spiritually. Rehabilitation does not reverse or undo the damage caused by a stroke, but rather helps restore the individual to optimal health, functioning, and well-being. Rehabilitate (from the Latin “habilitas”) means “to make able again.”

The stroke rehabilitation team:

The stroke rehabilitation team revolves around the patient and family. The team helps set short- and long-term treatment goals for recovery and is made up of many skilled professionals, including the following:

  • physicians such as a neurologist (a physician who treats conditions of the nervous system such as stroke) and physiatrist (a physician who specializes in physical medicine and rehabilitation)
  • internists and specialists
  • critical care nurses
  • rehabilitation nurses
  • physical therapists
  • occupational therapists
  • speech and language pathologists
  • dietitians
  • social workers and chaplains
  • psychologists, neuropsychologists, and psychiatrists
  • case managers

The stroke rehabilitation program:

The outlook for stroke patients today is more hopeful than ever due to advances in both stroke treatment and rehabilitation. Stroke rehabilitation works best when the patient, family, and rehabilitation staff works together as a team. Family members must learn about impairments and disabilities caused by the stroke and how to help the patient achieve optimal function again.

Rehabilitation medicine is designed to meet each person’s specific needs; thus, each program is different. Some general treatment components for stroke rehabilitation programs include the following:

  • treating the basic disease and preventing complications
  • treating the disability and improving function
  • providing adaptive tools and altering the environment
  • teaching the patient and family and helping them adapt to lifestyle changes

According to the National Institute of Neurological Disorders and Stroke(NINDS), in general, there are five types of disabilities that stroke can cause: paralysis or problems controlling movement such as walking or balance and/or swallowing; sensory (ability to feel touch, pain, temperature, or position) disturbances; difficulty using or understanding language; thinking and memory problems, and emotional disturbances. Stroke rehabilitation can help you recover from the effects of stroke, relearn skills, and new ways to perform tasks and depends on many variables, including the following:

  • the cause, location, and severity of stroke
  • the type and degree of any impairments and disabilities from the stroke
  • the overall health of the patient
  • family and community support

Areas covered in stroke rehabilitation programs may include the following:

  • Self-care skills, including activities of daily living (ADLs): Feeding, grooming, bathing, dressing, toileting, and sexual functioning
  • Mobility skills: Walking, transfers, and self-propelling in a wheelchair
  • Communication skills: Speech, writing, and alternative methods of communication
  • Cognitive skills: Memory, concentration, judgment, problem solving, and organizational skills
  • Socialization skills: Interacting with others at home and within the community
  • Vocational training: Work-related skills
  • Pain management: Medicines and alternative methods of managing pain
  • Psychological testing: Identifying problems and solutions with thinking, behavioral, and emotional issues
  • Family support: Assistance with adapting to life styles changes, financial concerns, and discharge planning
  • Education: Patient and family education and training about stroke, medical care, and adaptive techniques

Choosing a rehabilitation facility:

Rehabilitation services are provided in many different settings, including the following:

  • acute care and rehabilitation hospitals
  • subacute facilities
  • long-term care facilities
  • outpatient rehabilitation facilities
  • home health agencies

When investigating rehabilitation facilities and services, some general questions to ask include the following:

  • Does my insurance company have a preferred rehabilitation provider that I must use to qualify for payment of services?
  • What is the cost and will my insurance company cover all or part of the cost?
  • How far away is the facility and what is the family visiting policy?
  • What are the admission criteria?
  • What are the qualifications of the facility? Is the facility accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF)?
  • Has the facility handled treatment for this type of condition before?
  • Is therapy scheduled every day? How many hours a day?
  • What rehabilitation team members are available for treatment?
  • What type of patient and family education and support is available?
  • Is there a physician onsite 24 hours a day?
  • How are emergencies handled?
  • What type of discharge planning and assistance is available?