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A GUIDE FOR PATIENTS AND CAREGIVERS LIFE AFTER STROKE Our Path Forward Encompass Health is a national sponsor of Together to End Stroke. TABLE OF CONTENTS 04 What is a stroke? 24 Rehabilitation setting options 06 About my stroke 25 Tips for choosing a rehabilitation facility 07 Diagnosis and early treatment 26 What to expect in rehabilitation 10 Common physical changes after a stroke 29 My rehabilitation goals 13 Common communication and cognitive changes 30 Preventing another after stroke stroke 18 Common emotional and 33 Signs and symptoms of personality changes after stroke stroke 34 Resources 22 Why rehabilitation is important INTRODUCTION THERE IS LIFE – AND HOPE – AFTER STROKE. WITH TIME, NEW ROUTINES WILL BECOME SECOND NATURE. REHABILITATION CAN BUILD YOUR STRENGTH, CAPABILITY AND CONFIDENCE. IT CAN HELP YOU CONTINUE YOUR DAILY ACTIVITIES DESPITE THE EFFECTS OF YOUR STROKE. If you are the caregiver, family member or friend of a stroke survivor, your role is vital. You should know the prevention plan and help your loved one to comply with the plan. With a committed health care team and a rehabilitation plan specific to their needs, most stroke survivors can prevent another stroke and thrive. We hope this guide will help you and your loved ones understand the effects of stroke and how to maximize your rehabilitation and recovery. 03 WHAT IS A STROKE? Stroke is an event that affects the arteries of the brain. A stroke occurs when a blood vessel bringing blood to the brain gets blocked or ruptures (bursts). This means that the area of the brain the blocked or ruptured blood vessel supplies can’t get the oxygen and nutrients it needs. Without oxygen, nerve cells can’t function. Your brain controls your ability to move, feel, think and behave. Brain injury from a stroke may affect any of these functions. Several factors affect the ways people experience a stroke. They include: • THE LOCATION OF THE BLOOD VESSEL THAT IS AFFECTED • THE AREA AND EXTENT OF THE BRAIN INJURY • THE TYPE OF STROKE (ISCHEMIC VS. HEMORRHAGIC) 04 TYPES OF STROKE Ischemic stroke occurs when a clot Hemorrhagic stroke happens when blocks a vessel supplying blood to the a blood vessel bursts (ruptures) in the brain. The artery becomes narrowed or brain. This type of stroke may affect clogged, cutting off blood flow to brain large arteries in the brain or the small cells. Ischemic strokes are the most blood vessels deep within the brain. The common type of stroke. rupture keeps the surrounding areas of the brain from getting needed oxygen. Hemorrhagic strokes are less common than ischemic strokes. Lodged Blood Clot Cerebral Atherosclerosis Hemorrhage Transient ischemic attacks (TIAs) are often called “warning strokes.” TIAs produce symptoms just like stroke, but typically last a shorter amount of time. They don’t usually cause lasting damage. But they are major predictors of future stroke. If you suspect you’ve had or are having a TIA, don’t ignore it! Call 9-1-1. Get immediate medical attention, even if the symptoms go away. 05 ABOUT MY STROKE Talk with your health care team to learn where in the brain your stroke happened and mark it on the image below. You can learn how stroke in different areas of the brain may affect the survivor at strokeconnection.org/about-our-brains. Frontal Lobe controls 02 Parietal Lobe personality, controls speech reasoning, 01 and sensation parts of speech, (touch and pressure) and muscle movement 03 Occipital Lobe Temporal Lobe 04 controls vision controls hearing, speech, and short- term memory My stroke was: The cause of my stroke was: Right side of the brain Left side of the brain Due to blockage in a blood vessel (ischemic) The exact cause of my stroke isn’t known, but it may have Due to a damaged blood been because of: vessel bleeding into brain tissue (intracerebral hemorrhage) Due to a damaged blood vessel bleeding into the area between the brain and its lining (subarachnoid hemorrhage) 06 DIAGNOSIS AND EARLY TREATMENT When someone has symptoms of Diagnostic tests you may have a stroke or a TIA, a doctor will gather fall into three categories. information and make a diagnosis. They will review the events that have Imaging tests give occurred and will: a picture of the brain like • Take a medical history X-rays (CT scan or MRI). • Do a physical and neurological examination Electrical tests record • Have certain laboratory (blood) the electrical impulses tests done of the brain. • Order a CT and/or MRI scan of the patient’s brain Blood flow tests show • Study the results of other any problem that may diagnostic tests that might cause changes in blood be needed flow to the brain. Diagnostic tests examine how the brain looks, works and gets its blood supply. They can identify the injured brain area. Most of them are safe and painless. 07 EARLY TREATMENT Early treatment Early treatment of of ischemic stroke hemorrhagic stroke Ischemic stroke happens when a blood Hemorrhagic stroke happens when clot blocks a vessel supplying blood a blood vessel bursts (ruptures) and to the brain. It’s the most common type, bleeds within or around the brain. accounting for 87% of all strokes. The treatment goal is to dissolve or remove Blood vessels can become weak due the clot. to a ballooning of part of the vessel (aneurysm). Other times there may To dissolve a clot, a medicine called be a tangle of blood vessels within alteplase (tPA) is given through an the brain that didn’t form normally, IV (intravenous line). It works by making them weak (arteriovenous dissolving the clot so blood can flow malformation or AVM). When high again. Alteplase can save lives and blood pressure isn’t controlled, it reduce the long-term effects of stroke. puts strain on weakened blood It needs to be given within three hours vessels that can lead to the ruptures of the start of stroke symptoms (up to that cause stroke. The treatment 4.5 hours for some eligible patients). goal is to stop the bleeding. To remove a clot involves a procedure For some patients, a small tube called mechanical thrombectomy. (catheter) with a camera is threaded Doctors use a wire-cage device called through a major artery in an arm a stent retriever to remove a large blood or leg and guided to the area of clot. They thread a catheter through the bleed in the brain. The camera an artery in the groin up to the blocked gives the surgeon a detailed view artery in the brain. The stent opens of the area to help fix the problem. and grabs the clot, allowing doctors to Once the catheter is guided to the remove the stent with the trapped clot. source of the bleeding, it leaves Special suction tubes may also be used a mechanism, such as a coil, to to remove the clot. prevent further rupture. This type of procedure is less invasive than This procedure must be done within standard surgical treatment. up to six to 24 hours of stroke symptom onset and after the patient has received Sometimes surgery is required alteplase, if eligible. Patients must to secure a blood vessel at the meet certain criteria to be eligible base of the aneurysm. for this procedure. 08 Talk with your health care team to learn about the diagnosis methods used and the early treatment you received for your stroke: About my diagnosis About my early treatment My health care team ran these I received these treatments tests to diagnose my stroke for my stroke (note specific (note specific tests): treatment names): Imaging tests Clot-busting medication Electrical impulse tests Clot removal procedure Blood flow tests Bleed-stopping procedure 09 COMMON PHYSICAL CHANGES AFTER A STROKE Physical changes that follow a stroke are the result of injury to the brain and may include one or more effects. Weakness or paralysis to become tight or stiff. This makes on one side of the body stretching the muscle much more difficult. If not treated, the muscle If the stroke occurs on the brain’s can freeze into an abnormal and right side, the left side of the body often painful position. If you have and face will be affected. It’s the spasticity, talk to your doctor opposite for a stroke that occurs on about the best treatments for you. the left side of the brain. Physical therapy and medications can help. Fatigue After a stroke, it’s common to feel Seizures tired at some point. This is known as Seizures are brain malfunctions fatigue. Fatigue often starts to lessen that alter a person’s awareness. a few months after the stroke. But for A seizure may last only a few some people, tiredness may continue seconds or minutes. It may trigger for years. If you’re experiencing post- involuntary body movements, stroke fatigue, talk to your health strange sensations or blackouts. care team about ways to reduce it. Studies vary greatly about how often seizures happen after stroke. Spasticity Seizures are painless. But they can be upsetting and disorienting. When you try to move a limb, the Often, seizures can be treated with muscles contract (shorten or flex). medications. If you think you may This creates stiffness and tightness, have had a seizure, let your health which is referred to as “spasticity.” care team know. Spasticity also causes the tendons and soft tissue around the muscle 10 PATIENT PERSPECTIVE “EVEN IF YOU’RE TAKING BABY STEPS, YOU’RE MOVING TOWARD YOUR GOAL OF GETTING HEALTHY” Stephen Bishop began rehabilitation in the hospital using a walker, which he nicknamed “Cordell” — after Chuck Norris’ character on Walker, Texas Ranger.
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