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November 25, 2009 > Every Second Counts When It Comes to Stroke Care

Every Second Counts When It Comes to Stroke Care

Stroke Rehabilitation: The Golden Opportunity for Improvement

If you or a loved one is experiencing stroke symptoms, timing is everything - because the faster a stroke patient makes it to the hospital for acute care, the more effective treatment will be.

On Tuesday, Dec. 1, from 6 to 8 p.m., members of Washington Hospital's Stroke Program will present the latest information about acute management of stroke, as well as stroke rehabilitation and chronic care after stroke. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium, located at 2500 Mowry Avenue in Fremont.

The clock is running

So why is timing so important when it comes to stroke care?

In the case of ischemic strokes, which are caused by a clot that impedes blood flow to the brain, Washington Hospital's Stroke Team evaluates the need for clot-busting medication called tissue plasminogen activator (tPA), which must be given within a certain window of time, according to Dr. Ash Jain, medical director of the Stroke Program.

"When patients arrive in the ER within four and a half hours, tPA can be administered intravenously," Dr. Jain explains. "Previously, we had to give tPA inside a three-hour window, and now we can administer it within four and a half hours of stroke. From four and a half hours to six hours of stroke symptoms, we can give tPA arterially. And within six to eight hours, we can go into the brain and pull out the clot."

Dr. Jain points out that the level of stroke care expertise needed to treat a clot goes up exponentially as time passes after stroke symptoms first appear. Beyond six hours from onset of symptoms, only specialized hospitals possess the skill set and tools necessary to extract the clot from the brain.

"When patients realize they are experiencing stroke symptoms, they need to come to the hospital as soon as possible so that they can be treated accordingly," Dr. Jain emphasizes.

When a patient comes to the emergency room at Washington Hospital with stroke symptoms, an on-call neurologist will evaluate the need for tPA.

"It is important to select tPA candidates appropriately because tPA can cause bleeding issues in some cases," Dr. Jain says. "To make the decision whether the patient is going to receive tPA or not, the Stroke Program involves emergency responders because they are the first point of contact and can get the history of when stroke symptoms began - the clock starts at that point. Based on that history, we decide if the patient is a candidate for tPA. When the patient arrives in the hospital, blood tests, computed topography (CT) scans, nursing evaluation, ER doctor evaluation and radiologist evaluation of the imaging occurs very quickly so that the neurologist can then decide if the patient is a candidate for tPA."
Each stage of the acute care process for stroke management is streamlined and expedited in order for patients to receive the timeliest treatment possible, Dr. Jain says.

"During this talk, audience members will learn exactly why they need to seek help early for stroke," he adds. "Secondly, they will find out what can be done for them if they have a stroke, what the treatment methods involve and what they can expect. Angiograms, echocardiograms, treatment for irregular heart beat, clot-dissolving medication, removal of a clot from the brain, surgery for a bleed - these are all things we will discuss."

What happens after a stroke?

The story doesn't end after a patient is treated in the emergency room for stroke, according to Doug Van Houten, R.N., clinical coordinator of the Stroke Program. In fact, the journey is just beginning.

"Almost all stroke survivors get better and improve function," Van Houten points out. "The really big gains come in the first few months, but for a lot of people, improvement comes over some time. Those first few months after a stroke are important. Survivors are a little dazed right after stroke - often a little sleepy and depressed - and we need to prod them to work on rehabilitation."

"We start rehab right away. They come into the ER on day one, and on day two they see speech, occupational and physical therapists, who perform an assessment and formulate a multi-stage plan. I'm always prodding patients to get involved and be an active part of their rehabilitation because this is where they can make the big gains."

Van Houten says the rehabilitation therapists who work with patients immediately after stroke make up a vital piece of the Stroke Program at Washington Hospital.
"It is really the rehab folks that are the true heroes for stroke survivors," Van Houten says. "They are the ones that make the big different in the lives of stroke survivors. I call them the 'unsung heroes' of stroke care. Rehab professionals are the ones that are really going to turn that case around. It can be quite amazing."
But always at the center of the story is the stroke survivor, who must work hard to make progress, Van Houten points out.

"If a stroke survivor has a positive attitude and takes responsibility for working on these exercises on their own, they can continue to make progress," he says. "I often tell the story about a guy who was confined to a wheelchair after a stroke. He ended up learning how to walk, but it took him three years to get there, and there was a lot of physical therapy in that process."

There are more than five million stroke survivors dealing with similar issues, according to Van Houten. During his portion of the seminar, he will address the chronic problems that stroke survivors must overcome, including:
* Depression
* Safety, including risk of falls due to weakness, numbness or vision issues
* Difficulty swallowing
* Constipation
* Problems with dependency on others

Van Houten also will discuss chronic care, the stage after acute rehabilitation, as well as the toll stroke takes on caregivers, who are most often spouses.
"Having a good caregiver at home is what allows stroke survivors to go home," he says. "Something like 60 to 80 percent of people with stroke goes home, often because there is someone at home to help take care of them. It's remarkable how important caregivers are to stroke survivors."

After a stroke, sometimes it's important for survivors to simply see that other people are facing the same issues and many have overcome them with creativity and hard work. Washington Hospital's Stroke Support Group, which welcomes stroke survivors and caregivers, meets the fourth Tuesday of each month from 1 to 2:30 p.m. The next meeting is Tuesday, Dec. 22. For more information, call (510) 745-6525.

To learn more about the acute management of stroke at Washington Hospital and the rehabilitation process, make sure to attend the seminar on Tuesday, Dec. 1, from 6 to 8 p.m., in the Conrad E. Anderson, M.D. Auditorium, located at 2500 Mowry Avenue in Fremont.

To register for the seminar, call (800) 963-7070 or visit

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