Download Research Results | Chronic Disease | Stroke

Research Results | Chronic Disease | Stroke
Topic
Prevention and treatment of stroke and its effects in seniors living in rural China.
Objectives
To understand stroke in the elderly.
To understand current stroke treatment and prevention methods.
To prevent or lessen the impact of a stroke for seniors and their families living on a dollar-a-day in
rural China.
Questions
What are the causes of stroke?
A stroke is an interruption of the blood supply to any part of the brain. “Basically stroke is an injury
to the brain.” (Purdie, 00:48) It is usually caused by heart disease or other vascular problems such as
high blood pressure, or a clot.
o
Cerebral hemorrhage (blood vessel break in one's brain)
o
Cerebral infarction (blood vessel blocked in one's brain)
Risk factors for stroke include:
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Advanced age
o
Hypertension (high blood pressure)
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Previous stroke or transient ischemic attack (TIA)
o
Diabetes
o
High cholesterol
o
Cigarette smoking
o
Atrial fibrillation.
High blood pressure is the most important modifiable risk factor of stroke. If you have very high
blood pressure or any of the conditions that might eventually lead to stroke, then becoming overly
emotional may hasten the onset of stroke.
What are the effect and consequences of having a stroke?
These are the major physical and emotional side effects of a stroke.
o Physical effects usually occur immediately, during the stroke or within seconds after. They may be
irreversible over time if left untreated.
o Loss of fine motor control: may be able to grasp large objects briefly, but cannot manipulate
small items easily or sometimes at all.
o Complete lack of control of parts of the body: usually only effects one side of the body or the
other - rarely affects both
o Inability to walk
o Inability to form sentences or the complete loss of verbal communication: may be able to speak
very clearly, but what they say is nonsense or they may not even be able to form words. They will
however know what it is they want to say
o Inability to perform simple everyday tasks: sitting up, walking to the bathroom, taking a bath,
brushing your teeth, holding a fork, zipping your jacket, walking to the kitchen, holding a glass,
brushing your hair.
o Loss of part of physical function, but has conscious mind and thought, trapped in their head
almost
o Unconsciousness, coma, or death may also occur
o Emotional problems resulting from stroke can result from direct damage to emotional centers in
the brain or from frustration and difficulty adapting to new limitations. Post-stroke emotional
difficulties include anxiety, panic attacks, flat affect (failure to express emotions), mania, apathy,
and psychosis.
30 to 50% of stroke survivors suffer post stroke depression, which is characterized by lethargy,
irritability, sleep disturbances, lowered self-esteem, and withdrawal. Depression can reduce
motivation and worsen outcome, but can be treated with antidepressants.
o Emotional lability, another consequence of stroke, causes the patient to switch quickly between
emotional highs and lows and to express emotions inappropriately, for instance with an excess of
laughing or crying with little or no provocation. While these expressions of emotion usually
correspond to the patient's actual emotions, a more severe form of emotional lability causes
patients to laugh and cry pathologically, without regard to context or emotion.
Some patients
show the opposite of what they feel, for example crying when they are happy. Emotional lability
occurs in about 20% of stroke patients.
Rehabilitation can be long, difficult, and at times, humiliating. Physical therapy can be uncomfortable
or even painful. Combine these issues with the fact that patients are having to “re”-learn what they
have known most of their lives, and it is no surprise that patient may become frustrated, despondent,
irritable and depressed.
What are the preventative measures to reduce the likelihood of having a stroke?
Early warning signs:
TIA = Transient Ischemic Attacks
Cause symptoms that usually last about ½ hour.
This is where a small clot, as it moves through the brain, causes oxygen deficits to those areas. A
patient may loss their sight or their ability to grip tightly, but because these symptoms subside
relatively quickly they are often ignored. The first thing they will do if a doctor thinks you are
having a TIA is to put you on aspirin.
Early Recognition System:
FAST:
Face – the person’s face is dropping on one side or displays muscle weakness
Arm – when asked to raise both arms, involuntarily lets one arm drift downward
Speech – speech is abnormal, they are speaking nonsense or cannot speak
Time – must act quickly to get medical assistance
Testing:
Neurological examination:
CT scans, MRI scans, Doppler ultrasound, and arteriography.
The diagnosis of stroke itself is clinical, with assistance from the imaging techniques. Imaging
techniques also assist in determining the subtypes and cause of stroke.
No blood test for stroke diagnosis itself, though blood tests may help in finding out the likely
cause of stroke.
Lifestyle:
Reduce your blood pressure if it is too high.
Hypertension accounts for 35-50% of stroke risk. Epidemiological studies suggest that even a
small blood pressure reduction would result in 40% fewer strokes. Lowering blood pressure has
been conclusively shown to prevent both ischemic and hemorrhagic strokes. It is equally
important in secondary prevention. Even patients older than 80 years and those with isolated
systolic hypertension benefit from antihypertensive therapy. Studies show that intensive
antihypertensive therapy results in a greater risk reduction. The available evidence does not show
large differences in stroke prevention between antihypertensive drugs —therefore, other factors
such as protection against other forms of cardiovascular disease should be considered and cost. Wiki
o
Reduce stress
o
Shouldn’t work too hard
o
Eat healthy, don't drink too much
o
Shouldn’t be too excited or angry
The European Society of Cardiology and the European Association for Cardiovascular Prevention
and Rehabilitation have developed an interactive tool for prediction and managing the risk of
heart attack and stroke in Europe. HeartScore is aimed at supporting clinicians in optimizing
individual cardiovascular risk reduction. The HeartScore Program is available in 12 languages and
offers web based or PC version.
What are the current treatments to lessen the impact a stroke may have on the elderly?
Chinese Traditional Medicine:
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Acupuncture
o
Moxibustion
o
Medical compress
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Massage
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Diet therapy
o
Other special treatment: music, poem, drama performance, book, taiji
Medications and Herbal Remedies:
o
Anticoagulation drugs: Oral anticoagulants such as warfarin have been the mainstay of
stroke prevention for over 50 years. However, several studies have shown that aspirin and
antiplatelet drugs are highly effective in secondary prevention after a stroke or transient
ischemic attack.
o
Low doses of aspirin (for example 75–150 mg) are as effective as high doses but have
fewer side effects; the lowest effective dose remains unknown. Aspirin prevents against
first stroke in patients who have suffered a myocardial infarction or patients with a high
cardiovascular risk. The first thing a doctor will do if they think you are having a TIA is to
put you on ASPIRIN.
o
Antihypertensive (high blood pressure) medications
Therapies:
Stroke rehabilitation is the process by which patients with disabling strokes undergo
treatment to help them return to normal life as much as possible by regaining and relearning
the skills of everyday living. It also aims to help the survivor understand and adapt to
difficulties, prevent secondary complications and educate family members to play a
supporting role.
Therapy should begin immediately after a stroke. The patient does not need a “recovery”
period following a stroke, and to postpone rehabilitation can cause permanent setbacks to
recovery. “The earlier you start the earlier you begin to reconnect these synapses in your
brain.” (Purdie 05:10)
Most return of function is seen in the first few days and weeks, and then improvement falls
off with the "window" considered officially by U.S. State Rehabilitation Units to be closed after
six months, with little chance of further improvement. However, patients have been known to
continue to improve for years, regaining and strengthening abilities like writing, walking,
running, and talking.
Daily rehabilitation exercises should continue to be part of the stroke patient's routine.
Complete recovery is unusual but not impossible and most patients will improve to some
extent: a correct diet and exercise are known to help the brain to self-recover.
REPETATIVE MOTION can be done even while lying in bed: lifting your arms, squeezing your
hand, rolling and unrolling towel. Family members can help the patient by supporting their
arms or legs while they do stretching exercises
REPETATIVE “Point and Name” exercises can help a patient recover speech, which can relieve
a great deal of stress. Even young children can play it with them.
What kinds of support currently exist for those who have suffered a stroke?
Ideally, people who have had a stroke are admitted to a "stroke unit", a ward or dedicated
area in hospital staffed by nurses and therapists with experience in stroke treatment. It has
been shown that people admitted to a stroke unit have a higher chance of surviving than
those admitted elsewhere in hospital, even if they are being cared for by doctors with
experience in stroke.
Epidemiology
Stroke could soon be the most common cause of death worldwide. Stroke is currently the second
leading cause of death in the Western world, ranking after heart disease and before cancer, and
causes 10% of deaths worldwide. Geographic disparities in stroke incidence have been observed,
including the existence of a "stroke belt" in the southeastern United States, but causes of these
disparities have not been explained.
The incidence of stroke increases exponentially from 30 years of age, and etiology varies by age.
Advanced age is one of the most significant stroke risk factors. 95% of strokes occur in people age
45 and older, and two-thirds of strokes occur in those over the age of 65. A person's risk of dying if
he or she does have a stroke also increases with age. However, stroke can occur at any age, including
in fetuses.
Family members may have a genetic tendency for stroke or share a lifestyle that contributes to
stroke. Higher levels of Von Willebrand factor are more common amongst people who have had
ischemic stroke for the first time. The results of this study found that the only significant genetic
factor was the person's blood type. Having had a stroke in the past greatly increases one's risk of
future strokes.
Men are 25% more likely to suffer strokes than women, yet 60% of deaths from stroke occur in
women. Since women live longer, they are older on average when they have their strokes and thus
more often killed. Some risk factors for stroke apply only to women. Primary among these are
pregnancy, childbirth, menopause and the treatment thereof. – via wiki
Deliverables
Stroke prevention and recovery narrative design experience:
We are working on the idea of a booklet that will encompass several key areas of concern.
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To facilitate in the physical rehabilitation of stroke survivors.
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To reduce the stress of long-term care of stroke survivors on their families.
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To reduce the likelihood of stroke survivors experiencing additional strokes.
First we will show people how to modify the items they may already own to work better for someone
with limited mobility, such as a stroke survivor. This would include designs as easy as cutting out a
convex shape in their drinking cup to accommodate someone who has difficulty tilting their head
back to swallow. There are many beautifully designed devices that make simple everyday functioning
much more possible for stroke survivors and their families. We would like to demonstrate (by
creating examples) and instruct (by creating visual diagrams) people in how they can make their own
less elegant but much more affordable “knock-offs.”
Secondly, throughout the booklet we will also instruct in and emphasize the importance of repetition,
in relearning motor and cognitive skills.
For example, we can show how a game can be made out of
the stroke survivor naming objects that a caregiver may indicate. (this is particularly helpful to
caregivers with small children, who can “play” with the patent, keeping both occupied for a time.)
Simple stretches and exercises can be illustrated as well; such as the trick of slowly rolling and
unrolling a towel.
Third, we will emphasis the importance of recognizing risk factors and us the booklet as a reminder
to take one baby aspirin a day.