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July 29, 2009 > Stroke Education Series: Stroke Treatment - Acute Management, Chronic Care and Rehab

Stroke Education Series: Stroke Treatment - Acute Management, Chronic Care and Rehab

Each year, approximately 160,000 Americans die as a result of strokes, making strokes the third leading cause of death. But the story doesn't end there. Strokes are also the leading cause of long-term disability, with more than 5,800,000 stroke survivors in the United States. Fortunately, improved treatments have made it easier to save lives and limit the brain damage in stroke survivors.

"Acute management of strokes has evolved rapidly over the past several years," says cardiologist Dr. Ash Jain, medical director of the Stroke Program at Washington Hospital. "Now we focus on early and aggressive treatment of strokes, with the goal of treating stroke patients as soon as possible to produce the best results and save brain functionality. The sooner we can treat a stroke patient, the better."

To help ensure the best possible patient outcomes, the Stroke Program at Washington Hospital offers the most current approach to treating stroke patients. When a patient arrives in the emergency room with a potential stroke, a team of doctors and specially trained stroke nurses are ready to 24 hours a day to quickly diagnose and begin treatment.

For stroke survivors, extensive rehabilitation therapy can help them overcome disabilities caused by their strokes. According to the World Health Organization, the goal of rehabilitation therapy is "to return stroke survivors to society with the abilities to function by adapting to stroke deficits that may include deficits in cognition and functional abilities."

"It is possible for stroke patients to get better - sometimes much better," says Stroke Program Coordinator Douglas Van Houten, RN. "We see the most improvement during the first couple of months, but it is important for stroke patients to keep doing rehabilitation exercises. Up to 80 percent of stroke patients are able to go home, rather than stay in a facility such as a nursing home."

To help people learn more about acute management, chronic care and rehabilitation for stroke patients, Jain and Van Houten will be conducting a Stroke Education Series session on Tuesday, August 4 from 6 to 8 p.m. The session will be held in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building at 2500 Mowry Avenue in Fremont. For more information, or to register to attend, call (800) 963-7070.

Acute Management

There are two broad categories of strokes:
* Ischemic strokes - by far the vast majority of all strokes - are caused by decreased blood flow to the brain due to a blocked blood vessel.
* Hemorrhagic strokes - which account for only 10 to 15 percent of all strokes - are caused by ruptured blood vessels bleeding into the brain or the spaces around the brain.

"The first step in dealing with a stroke patient is to perform a CT scan to determine whether the stroke is ischemic or hemorrhagic, since the treatment is very different for each type of stroke," Jain notes.

"Treatment options for ischemic stroke victims now include the use of a clot-busting drug called tissue plasminogen activator, or tPA," he says. "If the patient comes in within three hours of suffering a stroke, we can get good results with administering tPA intravenously. If the patient comes in between three and six hours after the stroke, we would inject the drug directly into the brain and still get fairly good results.

"After six hours, the patient is no longer a candidate for clot-dissolving medications," he adds, "but we can treat strokes for up to eight hours later by inserting a catheter through the groin into the brain to remove the clot. It's a riskier procedure and the results are not as good, but we are still able to preserve a fair amount of brain function. After eight hours, most of the damage to the brain has been done, and we generally are not able to attempt acute treatment."

Treatment for hemorrhagic strokes would not include administering tPA, since it would simply make the bleeding worse. "If a brain artery is bleeding, depending on the circumstances, a neurosurgeon may decide to surgically repair the artery," Jain explains. "In the case of an aneurism - which is a bulge in a weak artery - we could use a catheter to insert coils to close off the bulge."

Chronic Care and Rehabilitation

After acute treatment for strokes, patients' rehabilitation starts in the hospital, followed by a transfer to a specialized rehab facility usually within two to three weeks.

"In rehab facilities, patients spend all day in intensive activities - such as physical therapy, occupational therapy and speech therapy," Van Houten says.
"Then therapy is generally continued at home for several weeks before the patient is ready to go to an outpatient therapy program. After that, patients are mostly on their own, but they need to find the motivation to continue their exercises on their own. If people understand it's truly possible to continue getting better, that is often the best motivation."

Van Houten points out that each stroke patient's situation is different, but there are eight general groups of problems they can face:
1) Emotional problems, particularly depression, can be helped by medications, psychotherapy and stroke support groups.
2) Aspiration pneumonia due to swallowing difficulties. This is the leading cause of death after acute stroke.
3) Sensory deficits that can lead to falls and safety issues.
4) Bowel and bladder incontinence leading to confinement to long-term nursing facilities, skin breakdown and embarrassment.
5) Speech and language impairment leading to social isolation and withdrawal.
6) Motor dysfunction leading to limb paralysis and dependence on others for daily care.
7) Inability to walk independently and get around.
8) Perceived social stigma of disability and loss of independence.

Rehabilitation can effectively help stroke patients overcome these problems through physical therapy, occupational therapy and speech therapy.

At the upcoming stoke education session, Van Houten will also discuss the role of caregivers and how they can help stroke victims recover. "Caregivers are often the spouses of the stroke patients, and they have a very important role to play," he says. "It's important not to make stroke patients feel more helpless than they already are. For example, it takes patience to allow the stroke patient to try to complete his own sentences and to tie his own shoes, even if it takes longer. In the long run, it will be easier for the caregiver if the patient is able to recover more abilities."

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