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March 29, 2011 > Timing and Hard Work Equal Better Outcomes

Timing and Hard Work Equal Better Outcomes

Making the Difference in Stroke Treatment and Recovery

Timing is everything when it comes to the treatment of stroke. The reason for this is simple. Brain cells die without oxygen. And for patients who have an ischemic stroke-which is caused by a clot-oxygen-carrying blood doesn't flow to affected areas of the brain.

Meeting this fundamental challenge of stroke care head on, Washington Hospital's Stroke Program works fast, but ultimately it's up to community members to understand the necessity behind seeking treatment immediately when confronted with the signs of stroke, according to Ash Jain, M.D., medical director of the program.

To better inform community members about stroke, on Tuesday, April 5, Dr. Jain and Clinical Coordinator Doug Van Houten, R.N., will present the Stroke Program's free monthly Stroke Education Series, focusing on acute management of stroke and stroke rehabilitation and chronic care.

Working fast

When a stroke patient enters the hospital, Washington Hospital's stroke team first 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. Jain.

"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."

After stroke symptoms first appear, Dr. Jain says that the level of stroke care expertise needed to treat a clot goes up exponentially as time passes. Beyond six hours from onset of symptoms, only specialized hospitals like Washington Hospital 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.

Upon arriving at the emergency room at Washington Hospital with stroke symptoms, a patient is evaluated by an on-call neurologist who determines 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."

During this talk, Dr. Jain says audience members will learn exactly why they need to seek help early for stroke, as well as finding out what can be done for them if they have a stroke, including what to expect and treatment methods such as:
* Angiograms
* Echocardiograms
* Treatment for irregular heart beat
* Clot-dissolving medication
* Removal of a clot from the brain
* Surgery for a hemorrhage (bleed)

Helping the brain remap

Following treatment is recovery. And this is where hard work and tenacity can help patients reap sizable rewards, according to Van Houten. However, the brain is a complex organ, so recovery isn't as simple as it is for other parts of the body.

"You can scrape your arm and skin will grow back, but the central nervous system will not regenerate," Van Houten says. "So why do we think that someone can get better after stroke since we know that brain cells don't regenerate?"

The answer is something called neuroplasticity.

"It has to do with remapping the brain," he explains. "Plasticity means remolding. You can remap functions from one area of the brain to another, and that's how people can get better. Neuroplasticity essentially means the ability to change connections after injury so new cells can take over lost functions."

"Recovering from stroke revolves around relearning how to perform an old function," Van Houten says. "This is a unique quality that makes rehab possible. It's why patients at Washington Hospital begin stroke rehab the very first day after stroke."

"Patients who come in today for stroke get an evaluation by a physical therapist, occupational therapist and speech therapist and, if we can, we'll get these patients out of bed and moving. There's really a golden opportunity in the first months to make big improvements with stroke."

Van Houten believes a structured rehabilitation program remains the key to improvement after a stroke.

"I've always called the stroke rehab specialists the unsung heroes of stroke care," he says. "They work slowly and incrementally, and that's how improvement occurs when it comes to stroke. My experience is that if a stroke patient survives, every one of those patients will get better to some extent. Some will improve a small amount, some a tremendous amount; it sort of depends on one's ability to remap and refocus."

The Stroke Program itself functions along the same principal of constant performance improvement.

"We're getting to the point where we've seen-after keeping track of all the strokes since our program began-2,700-plus strokes," Van Houten says. "We've seen a lot of stroke patients and we've had a lot of people improve."

"The rehab process starts here and we have a lot of data to base our care on, helping patients improve every day."

A golden opportunity to learn

During the April 5 seminar, Dr. Jain will share details of stroke treatment while Van Houten will explain in more detail how the human brain can relearn essential functions with the help of acute rehabilitation.

The free seminar will be held from 6 to 8 p.m. on Tuesday, April 5, in the Conrad E. Anderson, M.D. Auditorium, Washington West, located at 2500 Mowry Avenue in Fremont). To register, call (510) 745-6525 or visit

Stroke Support Group

Washington Hospital's Stroke Program conducts a once a month stroke support group for stroke survivors and their caregivers. The group provides social and emotional support and presentations on stroke related topics. The group meets the fourth Tuesday of each month from 1 to 2:30 p.m. at 2500 Mowry Avenue (Washington West) inside the Neuroscience Conference Room located on the 2nd floor. To learn more details, call (510) 745-6525.

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