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November 27, 2012 > Staying on the Leading Edge of Acute Stroke Management

Staying on the Leading Edge of Acute Stroke Management

Getting the Most From Acute Rehabilitation of Stroke

There's no doubt that acute management of stroke saves lives and helps mitigate long-term disability. But stroke care is a constantly evolving field, which means that hospitals and the medical professionals who work in stroke care must stay at the forefront of research in order to best serve patients.

This is part of the reason members of Washington Hospital's Stroke Program recently attended and presented research at the 8th World Stroke Congress in Brazil.

The forefront of stroke care

"We are staying on the leading edge of stroke research in a way that many community hospitals cannot," says Dr. Ash Jain, cardiologist and medical director of the Stroke Program. "Techniques for acute management of stroke are always advancing, and to best serve our patients, we need to stay ahead of the curve, which is exactly what we are doing."

Next Tuesday, Dec. 4, Dr. Jain and Stroke Program Clinical Coordinator Doug Van Houten, R.N., will present a free seminar focusing on Acute Management of Stroke/Chronic Care and Stroke Rehabilitation.

"Attending the World Stroke Congress reaffirmed our goal to treat stroke as quickly as possible once a patient reaches our Emergency Room," according to Dr. Jain. "Acute management of stroke is all about timing, and even small delays can have heavy costs."

Dr. Jain says he is more determined than ever to maximize the use of intravenous (IV) tPA and associated interventional techniques for eligible patients, which requires that patients reach the ER as soon as possible.

"It is in our power to improve our times, which will maximize the number of patients who benefit from advanced treatment options, including interventional techniques in our Cath Lab," he explains. "However, it is very much up to community members to understand stroke so that they know how imperative it is to call 9-1-1."

Because timing, he says, is everything.

"Let's say the patient comes in within four hours of suffering a stroke. At this point, we can get good results with administering tPA intravenously," he explains. "Then, if the patient comes in between four and six hours after the stroke, we would inject the drug directly into the brain and still get fairly good results."

Tissue plasminogen activator (tPA), also known as clot-busting medication, is one of the key tools in acute stroke care. Unfortunately, after six hours, patients are no longer good candidates for clot-dissolving medications. Fortunately, Washington Hospital's Stroke Team can still treat strokes for up to eight hours by inserting a catheter through the groin into the brain to remove the clot.

The goal, in all cases, is to preserve as much brain function as possible. However, after eight hours, most of the damage to the brain has been done, and the window for acute treatment has usually closed.

"With the latest research and best tools at our disposal, we save lives and help reduce the chances of long-term disability from stroke, but it's people in the community who first need to recognize the signs and symptoms and call 9-1-1 immediately," Dr. Jain says.

The way back from stroke

After acute management of stroke is done, when as much brain function as possible has been spared, patients begin the task of acute rehabilitation. And this is the stage, according to Doug Van Houten, when patients can make real strides by working with the professionals he calls the "unsung heroes" of stroke care. Speech therapists, occupational therapists and physical therapists work tirelessly with patients to help them regain lost function, including speech, activities of daily living and mobility.

Van Houten is quick to note, though, that recovery starts with the stroke survivor, who many times is dealing with depression on top of stroke recovery.

"During this seminar of the Stroke Education Series, my emphasis will be on depression, a serious factor that can displace somebody's ability to participate fully in rehab," he explains. "After stroke has occurred, rehab is really the only way back. Based on the research, depression is something that is expected, because it occurs in as many as 30 percent to 40 percent of stroke survivors. It's also something that's pretty treatable."

He says that the kind of depression common after a stroke usually can be successfully treated with medication. Unfortunately, there are challenges that prevent many stroke survivors from getting the help they need in the first place.

"Many still feel a stigma about depression," he says. "They'll say, 'Well, I'm not the kind of person who has mental problems or can't control my emotions.' On the other hand, some people really don't even see depression in themselves; they just know they're not doing well."

Most significantly, by not seeking help for depression, Van Houten says, stroke survivors can jeopardize their recovery.

"Emotional stress leads to behavioral changes like disinterest and apathy," he says. "It's this downward spiral. Despite the fact that rehab can help you, depression makes you less likely to do rehab, which makes it harder to get better, causing you to go down and down and down."

The good news is that there are plenty of resources for stroke survivors. Van Houten facilitates the monthly Stroke Support Group at Washington Hospital, and says it's the perfect opportunity for stroke survivors to get out of the house and talk to other people who understand the challenges they're going through.

"It's very touching in stroke support when you have a new person come to the group," he says. "When you see a person really experienced with stroke talking to someone new, it's great to watch that relationship and the stroke mentorship that takes place. It's encouragement; it's understanding; it's advice."

To learn more about acute management of stroke, as well as rehabilitation and chronic care following stroke, make sure to attend the upcoming free Stroke Education Series seminar Tuesday, Dec. 4, from 6 to 8 p.m. in the Conrad E. Anderson, M.D. Auditorium, Rooms A and B, located at 2500 Mowry Avenue (Washington West) in Fremont.

To register for the upcoming seminar, call (800) 963-7070 or visit and click on Upcoming Health Seminars.

For more information about the Stroke Program at Washington Hospital, visit

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