Stroke

Stroke and
Hemiplegia
Stroke and Hemiplegia
 Stroke is the third leading cause of death in the US
and the leading cause of disability
– approx. 700,000 strokes; 160,000 deaths
 Modifiable risk factors include diabetes,

hypertension, atrial fibrillation, substance abuse,
and smoking
 Nonmodifiable risk factors include age, gender,

race, and family history
 Of those who survive the initial onset, the most
frequent presenting problem is hemiplegia (75-
88%)
 During the acute period, there is high incidence of

associated neurological deficits
 One important medical concern is the incidence of

comorbidities that may affect management and
rehab
Types
1. Ischemic
– Can be “silent ischemia” (no sx)
– Caused by atherosclerosis
2. Cerebral thrombosis (most
common)
– blood clot forms in arteries
leading from heart to brain
(carotid)
– blocks blood flow
– Often preceded by TIA
3. Cerebral embolism
– less frequent
– blood clot forms elsewhere
(embolus), travels through
bloodstream, lodges in cerebral
artery
Types
1. Hemorrhagic stroke
– less common than ischemic strokes
– more deadly
– if person survives, better recovery of function
Why?
– Ischemic: Blood supply to brain stopped; tissues die,
do not regenerate
– Hemorrhagic: pressure from blood compresses brain,
affects function, pressure relieved, function returns
Hemorrhage
 subarachnoid hemorrhage
– blood vessel on surface of brain leaks
– bleeding into space between brain & skull
 cerebral hemorrhage (10%)
– Defective artery in brain bursts
 Causes:
– aneurysm (blood-filled pouches that balloon out from
weak spot in artery)
– advancing age, congenital malformation
– aggravated by hypertension
– head injury
 Right-Hemisphere Stroke
– The right hemisphere
controls the movement of
the left side of the body as
well as analytical and
perceptual tasks
 Left-Hemisphere Stroke
– The left hemisphere
controls the movement of
the right side of the body as
well as speech and
language abilities
 Cerebellar Stroke
– The cerebellum controls many of our reflexes
and much of our balance and coordination
 Brain Stem Stroke

– The brain stem is the area of the brain that
controls all of our involuntary, “life-support”
functions as well as abilities such as eye
movements, hearing, speech, and swallowing
Symptoms
 sudden numbness, weakness face, arm, leg
(one side of body)
 sudden severe headache
 difficulty seeing in one or both eyes
 confusion, trouble speaking or
understanding
 dizziness, loss of balance/coordination
Treatment of a stroke
 Getting medical help quickly essential!
 Ischemic stroke:
– "Clot-busters"
– Must give within 3 hours
 Hemorrhagic stroke: correct cause of
hemorrhage
Function Function after Stroke
Time
I
Some residual effects of strokes
 Emotional lability (mood swings, depression)
 Perceptual effects: Difficulty recognizing,
understanding familiar objects
 Difficulty planning, carrying out simple tasks
 Loss of awareness (One-side neglect )
 Dysphagia (difficulty swallowing)
 Aphasia: difficulty putting thoughts into words or
understanding speech
Risk Reduction
 lifestyle changes
 aspirin
 blood thinning medications
 carotid endarterectomy (remove plaque)
 Experimental: neurogenesis (regenerating
affected neurons)
Reactions & Rehabilitation
 social isolation
 grieving process
 physical, occupational, speech therapy
 20% require long-term care
Recovery affected by extent of brain damage,

patient’s attitude, support system, rehab.
team skill
Vocational Rehab and Stroke
 Estimated that 30% of strokes occur in
people under 65
 One study found a 49% RTW rate for

people 21-65 year old
 Physical factors and aphasia play significant

roles and complications in vocational
planning
Voc Rehab and Stroke
 Some strategies for aphasia
– Reduction of working hours or territory
covered
– Selective interaction with customers or
suppliers with whom the person had dealt with
prior to stroke
– Reliance on overlearned behavior and language
in the performance of new tasks
– Initial help from a relative or close friend
– Job carving
Additional Resources and
Information from the Web
 National Stroke Association (www.stroke.org)
 American Stroke Association (
www.strokeassociation.org)
 National Aphasia Association (www.aphasia.org)
 Journal of Stroke and Cerebrovascular Diseases (
www.strokejournal.org)
 The Brain Attack Coalition
 (www.stroke-site.org)

Stroke

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Stroke and

 Modifiable risk factors include diabetes,

 Nonmodifiable risk factors include age, gender,

 During the acute period, there is high incidence of

 One important medical concern is the incidence of

 Brain Stem Stroke

Recovery affected by extent of brain damage,

 One study found a 49% RTW rate for

 Physical factors and aphasia play significant

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