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RCS 6080
Medical and Psychosocial Aspects of
Rehabilitation Counseling
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 TIA, diabetes,
hypertension, atrial fibrillation, substance abuse,
and smoking

Nonmodifiable risk factors include age, gender,
race, and family history
Stroke and Hemiplegia

Of those who survive the initial onset, the most
frequent presenting problem is hemiplegia (7588%)

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
Ischemic (83%)
1.
–
–
Can be “silent ischemia” (no
sx)
Caused by atherosclerosis
Cerebral thrombosis (most
common)
2.
–
–
–
blood clot forms in arteries
leading from heart to brain
(carotid)
blocks blood flow
Often preceded by TIA
Cerebral embolism
3.
–
–
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
Stroke and Hemiplegia

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
Stroke and Hemiplegia

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"
– tissue plasminogen activator (tPA)
– Must give within 3 hours

Hemorrhagic stroke: correct cause of
hemorrhage
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
Voc 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)