What Happens During a Stroke
A man finds himself in familiar surroundings. He goes about his usual business doing what he typically does, whether it is completing work, chores, or playing some golf, when all of a sudden; the world around him no longer makes sense. His surroundings appear as if they have been cut in half. He begins to experience a severe pounding headache. His vision becomes blurry and he is disoriented. He has no movement. No feeling. No sensation. He experiences numbness and loses complete control over one side of his body. He falls to the ground. His arms and legs are paralyzed and no matter how hard he struggles to get up, it seems impossible. He makes an attempt to call for help but the words coming out of his mouth sound like gibberish. He tires to scream but his voice sounds distant because his mouth is too dry and he cannot move his lips. If he is alone, fear and hopelessness might overwhelm him and he will wonder if anyone will ever find him in his helpless state. This is the nightmare that stroke victims face, a frightening scenario that leaves a person wondering whether or not they will live.
The technical term for stroke is cerebrovascular accident or CVA. The name for this condition is most fitting since it is sudden and violent. Without warning, it seems to appear out of nowhere. One minute, a person can be perfectly healthy and then, out of the blue, the individual is left devastated by the paralyzing effects of CVA. Contrary to popular belief that it is a condition commonly seen among the elderly, it is important to note that it can happen at any age. The majority of those who experience a CVA episode survive, but many are left with varying degrees of physical incapacities. The effects can range from mild to severe and can include paralysis, problems with thinking, problems with speaking, and emotional problems (Wiebers, p. 14). In fact, CVA is the main cause of serious disability. Not only do CVA patients have to contend with physical problems but the shock of what has happened to them only adds to their anger and frustration. Fortunately, it is one of the most preventable neurological disorders. Many forms of CVA can be prevented by learning the risk factors and incorporating healthy lifestyle changes.
Pathology of CVA:
Cerebrovascular accident (CVA) is a “brain attack” that results the same way a heart attack does due to blockage of blood flow. The only difference is that instead of dealing with blood flow problems to the heart, CVA deals with blood flow problems to the brain (Burkman, p. 4). More specifically, it is the destruction of brain tissue caused by the lack of blood supply. When blood flow to the brain is impeded, oxygen and vital nutrients cannot be delivered to the brain, causing brain cells to suffocate and die from oxygen starvation within minutes. This sudden disruption of blood supply to a part of the brain triggers disruption of certain body functions controlled by that area of the brain.
In order to understand the cause and impact CVA has on the brain, it is necessary to understand how the brain functions and how blood flows to the brain. The brain operates in a holistic manner. Although certain parts of the brain perform certain functions, all of these parts are interconnected and thus no specific area works alone (Tanner, p. 24). It is noted that the brain utilizes 20 percent of the total blood supply to get the oxygen and nutrients that it needs (Senelick, Rossi, & Dougherty, p. 27). When blood moves from the heart to the brain, it does so by passing through the carotid arteries. The carotid arteries are located at the neck traveling up along the windpipe. Upon reaching the skull the arteries divide and branch out in various areas of the brain where they supply oxygen and nutrients to those areas (Burkman, p. 11).
Different regions of the brain work to control high mental functions as well as sensory and motor skills. These regions are composed of nerve cells, or neurons, that have specific functions. Each neuron consists of three parts: dendrites, cell body, and axon. These three components work together to receive and relay messages to the rest of the body. In a CVA episode, if this mechanism gets interrupted due to lack of oxygen, then the entire electrochemical process fails and the functions these brain regions control no longer work properly (Buckman, p.11). The individual would lose consciousness within five to ten seconds and if persisted long enough, brain damage will occur (Senelick, Rossi, & Dougherty, p. 26).
What Happens in a CVA Episode?
When CVA strikes, after about 4 minutes without blood and oxygen the brain cells become damaged. The damage spreads during the following hours. The body tries to restore blood and oxygen to the cells by enlarging other blood vessels or arteries near the area. If the blockage is in a large blood vessel, such as the carotid artery, the body may be able to supply blood to the affected area through other blood vessels. If blood supply is not restored within one hour, permanent brain damage usually occurs (Rogers, 2003). When brain cells are damaged or die, the body parts controlled by those cells lose their ability to function. The loss of function may be mild or severe, temporary or permanent. This all depends on where and how much of the brain is damaged, the age and general health of the patient, what part of the brain the CVA occurred in, and how fast the blood supply can be returned to the affected cells. Consequently, this is why every minute counts when someone is experiencing a CVA. While every CVA occurrence has different consequences, the longer blood flow is cut off to the brain, the greater the damage. In any case of CVA, immediate treatment is crucial since not only can it save the person’s life but it can also enhance their chances for successful recovery (Wiebers, p. 222).
Causes of CVA:
There is no single cause of CVA; it is brought on by a combination of factors. However, there are some commonly associated conditions which include high blood pressure, smoking, diabetes, irregular heartbeat, arterial disease, and ageing. These conditions can lead to the pathologic causes of CVA. The chains of events that occur in a CVA episode are commonly caused by blood clots found in the artery. This blockage is medically referred to as thrombosis. Typically, clots in the blood vessels form due to long-term, damaging effects of high blood pressure, which are referred to as hypertension. In other situations, CVA occurs as a result of artherosclerosis, commonly known as hardening of the arteries. This is due to the accumulated deposit of fat into the walls of the arteries, eventually becoming large enough to obstruct blood flow. Alternatively, in some instances, the accumulation of fat deposits, known as plaque, can break off in a large artery, such as the carotid artery found in the neck, and travel down to a smaller vessel in the brain where they get lodged. This process is called embolism and when that happens; the flow of oxygen-rich blood is hindered leading to CVA (Cicala, p. 67).
Cerebral hemorrhage, bleeding within the brain, is a different cause of CVA. It takes place when a blood vessel in the brain ruptures, causing bleeding inside the skull. Aneurysm, or abnormal ballooning out of the wall of the vessels, take place and the bleeding can tear through the delicate connections within the brain, eventually compressing brain cells to the point where they die (Cicala, p. 71).
Furthermore, hypotension is an another major cause of CVA. It occurs when blood pressure falls to dangerously low levels because an insufficient amount of blood is pumped to the brain. The brain damage which results from this condition is referred to as anoxic encephalopathy. Patients with this condition differ from all other CVA patients in that all, not just part, of the brain may lose its blood supply. This can happen in cases of severe heart failure, certain abnormal heart rhythms, and in some heart attacks when the heart fails to adequately pump blood (Burkman, p. 7).
Types of CVA:
About 80 percent of all CVA occurrences are ischemic strokes. If the blood supply is interrupted only briefly and the symptoms vanish within twenty-four hours, the CVA is referred to as a transient ischemic attack or TIA. These types of CVA are often referred to as short-term strokes or mini-strokes (Wiebers, p. 18-19). TIAs leave no permanent brain tissue damage. The oxygen supply to the brain is restored quickly, and symptoms disappear completely. However, TIAs are often a red flag warning of serious risk of a major stroke and thus prompt medical attention is essential. Without treatment, about 30 percent of those who suffer a TIA are at high risk of having a major CVA episode within the next three years (Buckman, p. 14).
Cerebral thrombosis is another type of CVA. It occurs when cholesterol build-up causes a blood clot to form in an artery or blood vessel supplying blood to the brain. This form of CVA is commonly due to the accumulation of fat deposits into the arterial walls. The clot interrupts the blood supply and brain cells are starved of oxygen (McMurdo, 2003).
The third type of CVA is cerebral embolism. It is a blood clot that forms in larger, open blood vessels before traveling through the smaller blood vessels and lodging in the brain. The middle cerebral artery, located in the middle portion of the brain, is most often affected by emboli. When a clot is lodged in a blood vessel, it causes the brain cells to become starved of oxygen. Sometimes clots will break up into smaller pieces quickly enough to restore the blood flow (Burkman, p. 5). In diagnosis, a physician may perform a transthoracic or transeophageal echocardiogram to help determine whether an abnormality inside the heart is responsible for emboli (Burkman, p. 6).
Cerebral hemorrhage, a dangerous type of CVA, occurs when a weakened blood vessel ruptures inside the brain and bleeds or hemorrhages. Hemorrhages can be caused by aneurysms in which weakened blood vessels form bubble-shaped projections then break. Usually, this event takes place without warning, except an acute or severe headache (Senelick, Rossi, & Dougherty, p. 50). Hemorrhagic CVA can either be a subarachnoid hemorrhage or intercerebral hemorhage. A subarachnoid hemorrhage results from bleeding in the deeper cavities of the brain. An intracerebral hemorrhage occurs when a blood vessel bursts. With a hemorrhage, the force of blood that escapes from the blood vessel can damage surrounding brain tissue by the blood that seeps into it (Cleveland Clinic Health System, 2003). Pressure from the bleeding can pinch blood vessels, shutting off more blood flow and producing further stroke effects.
Cerebral hemorrhagic strokes are the most deadly, due to the pressure they can produce on vital parts of the brain. They are typically brought on by hypertension as a result of poorly controlled high blood pressure.
Signs & Symptoms of CVA:
The symptoms of CVA vary depending on the type and severity. The effects of a CVA are primarily based on the location where the obstruction occurs and the extent of damage incurred on the brain tissue. When blood flow is obstructed to a particular region of the brain, that part of the brain will malfunction. In other words, since the right side of the brain controls the left side of the body and the left side of the brain controls the right side of the body, a CVA that occurs on one side of the brain will result in neurological complications on the side of the body it affects (American Stroke Association: Effects of Stroke, 2004). Generally, the most common symptoms include:
· Numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body; depending on which side of the brain is afflicted.
· Vision problems such as dimness, blurring, double vision, or loss of vision.
· Difficulty with walking, dizziness, loss of balance or coordination.
· Sudden severe headache with no known cause.
· Confusion, speech, and language problems. Aphasia is a condition that results when the individual has trouble understanding what is being said to them or, they may understand what is being said but may not be able to think of the words to respond. On the other hand, a person with dysarthria has speech problems in which the person knows the right words but has trouble with articulation and cannot speak clearly (Burkman, p. 28-31).
The right hemisphere of the brain controls visual organization, perception, and attention. It is also responsible for non-verbal communication, ability to perceive space, understand where we are, what we are doing, and why various objects are placed where they are. If an individual suffers from a CVA occurrence in the brain's right side of the brain, the left side of the face and body could produce any or all of the following: Paralysis on the left side of the body, difficulty in performing daily tasks, perception difficulties, neglect of left side, visual impairment, excessive talking, short attention span, poor judgment, time disorientation, loss of left visual field, Impaired abstract thinking, extreme emotional highs and lows, lethargy, and impulsiveness (Senelick, Rossi, & Dougherty, p. 67).
The left hemisphere of the brain controls language skills. If the CVA occurs in the left side of the brain, the right side of the face and body could produce any or all of the following: Paralysis on the right side of the body, partial or complete loss of speaking or understanding language due to aphasia or dysarthria, confusion between left and right, loss of visual field on the right, decreased memory, slowness, and depression (Senelick, Rossi, & Dougherty, p. 77).
Not every CVA is found in the right or left hemisphere of the brain. Although most CVA episodes happen in the right or left, there are less common occurrences of CVA that are localized in the brain stem or in the cerebellum. These CVA occurrences may affect movement, balance, and basic body functions, such as swallowing and breathing (Senelick, Rossi, & Dougherty, p. 64). Of course not every symptom is manifested in every person who suffers a CVA. Nor are every person’s symptoms the same. In spite of this, when a CVA strikes a specific area, there are enough similarities to make pinpointing the location a help in diagnosis and, ultimately, in the rehabilitation outcome.
Epidemiology of CVA:
Every 45 seconds someone in America experiences a CVA episode, while every three minutes, someone dies from CVA (American Stroke Association: Impact of Stroke, 2004). It is the third leading cause of death in the United States, ranking behind diseases of the heart and all forms of cancer. It is also the leading cause of serious, long-term disability in adults. About 700,000 CVA incidents are reported in the U.S. each year. 500,000 of them are new attacks while 200,000 are recurrent (Internet Stroke Center, 2004). Today, there are about 4.8 million CVA survivors in the U.S. (American Stroke Association: Impact of Stroke, 2004).
Based on medical statistics and research, the most common risk factors that most frequently cause CVA include hypertension, diabetes, smoking, carotid or other artery diseases, certain blood disorders such as sickle cell disease, heart diseases such as atrial fibrillation, high blood cholesterol, physical inactivity, obesity, and excessive alcohol and drug use. For the most part, some of these are factors result from lifestyle choices which can be appropriately changed to reduce the risk of CVA. Factors which are not controlled by lifestyle choices include increasing age, sex, and heredity or family history. Most who suffer CVA are over the age of sixty-five (Burkman, p.105). Out of every 5 deaths from CVA, 2 are men while 3 are women (American Stroke Association: Stroke Facts 2004) and for those who have a family member who suffered from CVA, their chances of getting CVA increases. The risk also increases for those who had a previous episode of CVA to experience a recurrent one (American Stroke Association: Impact of Stroke, 2004).
As the third leading cause of death in the United States, CVA kills nearly 164,000 people each year (American Stroke Association: Stroke Facts, 2004). An individual who experiences CVA loses thousands of dollars in revenue per year. It costs the healthcare system thousands of dollars to care for each individual CVA patient. For the families of CVA patients, the loss of revenue is even more overwhelming. Each year, several billion dollars in revenue is lost as a result of families having to change their lifestyles in order to care for a family member who has suffered from CVA (Harris, 2002).
Psychosocial Aspects of CVA:
For patients of CVA, the quality of life is never really the same as it was before the stroke episode. Their lives are changed drastically and the methods they use to cope with the change can either make or break their rehabilitation. According to one study, although many CVA survivors eventually gained back 76 percent of their past physical functioning skills, they were only able to regain 33 percent of their past social functioning skills (Senelick, Rossi, & Dougherty, p. 173).
After a CVA, both the CVA survivor and the family often are uneasy about being on their own at home. They have many apprehensions and anxieties for what the future holds. They fear that another CVA incident might happen again. They worry that the CVA survivor may be unable to accept the disabilities or that the survivor might be placed in a nursing home. They have concerns that the caregiver may not be prepared to face the responsibility of caring for the CVA survivor. There are also fears that friends and family will abandon the CVA survivor (National Stroke Association 2002).
It is very difficult for many CVA patients to come to terms with the change in their abilities and personal appearance. Their intellect is lowered. They can no longer go to the bathroom by themselves. They have problems controlling their bladder and bowel movements. They have difficulty swallowing foods and have trouble speaking due to slurred speech. They also face sexual dysfunction which leads to feelings of inadequacy (Senelick, Rossi, & Dougherty, p. 181). Because of the devastating change and sudden loss of skills that were once second nature to them, the quality of life for survivors of CVA is severely deteriorated. They constantly feel tired and lose interest in hobbies and activities they once enjoyed.
The major emotional impact that CVA has on a person can also cause them to cry easily, often for no apparent reason. It could be the sight of a grandchild or even something on the TV such as the news for example. Slightly less common is uncontrollable laughter. Either way, these displays of exaggerated emotions appear as if the CVA patient has a lower emotional threshold than normal, in which almost anything can trigger an amplified emotional response (Tanner, p. 80). This is possibly due to damage to the parts of the brain that control emotions, which can lead to personality changes. When the ability to control emotions is lost, patients may display emotionally extreme behaviors. Naturally, this together with certain physical disabilities and communication difficulties can lead to irritability, anxiety, frustration, and sometimes deep sadness. A typical manifestation seen with CVA survivors is depression. They suffer from intense feelings of hopelessness and helplessness (Burkman, p. 25).
It is important to remember that the inability to button a blouse or the inability to use a fork and knife does not mean low intelligence. It is simply a loss of function. Unfortunately, the loss of function is often associated with low intelligence. Society tends to falsely depreciate the value of those who are not physically whole. Thus, it is common for CVA survivors to experience feelings of guilt and worthlessness, shame, significant reduction in self-esteem and self-value, and an unwillingness to be seen by others (Tanner, p.121-127). However, humans are social beings and the sooner a CVA patient starts to socialize, the faster they will start to recover. This is the most crucial time where the husband or wife, family, and friends are so important in assuring the patient that he or she is still loved and wanted, and that there are those who care and want to help. Some friends and family members may start to grow distant either because they do not know how to cope or they no longer have any mutual interest. The best solution in this case is simply to move on and form new friends (Buckman, p. 52-53).
For the survivors, family members, friends, and caregivers, everyone is affected by CVA both directly and indirectly, and the impact can be devastating. It causes a great deal of anxiety for everyone involved with the CVA survivor. The financial impacts also play an important role in regards to the level of care available and affordable for the CVA patient. For patients who were previously responsible for looking after the family’s finances, the problem is even more detrimental. If the patients were previously employed, they must face the possible reality that their jobs are at risk. They must ask themselves how long it will be before they can get back to work again, or if they will even have a job to go back to (Buckman, p. 66).
There are many issues that family members must consider in regards to their employment while caring for the CVA patient. They must ask themselves whether or not they can take a prolonged leave of absence or if they must completely give up their jobs. On the other hand, do their jobs pay well sufficiently or do they have insurance that can allow them to hire a full time care-giver? Depending on the degree of disability on the CVA patient, the family member looking after the patient may or may not be able to take over the care-giving by the time they get back home from work. The demands of full-time work and overnight care-giving may take a huge toll on them (Buckman, p. 66).
Economic Impacts of CVA:
CVA is an expensive problem. On the national scale, the direct and indirect costs of CVA in the United States are estimated at $53.6 billion a year (American Stroke Association: Stroke Facts 2004). In a population study of stroke costs within 30 days of an acute event, the average cost for mild ischemic strokes was $13,019 and $20,346 for severe ischemic strokes (American Heart Association: Heart Disease and Stroke Statistics, 2004). These figures should not come as a surprise when taking into the consideration the effect that CVA has on the grand scale. This is a condition that leaves many patients with disabilities that prohibit them from resuming their previous lifestyle or employment. Plus, the financial cost for the care, diagnosis, and treatment of CVA patients at home and in hospitals is quite alarming.
The cost of cardiovascular diseases and stroke in the United States in 2004 is estimated at $368.4 billion. This figure comprise health expenditures which include the cost of physicians and other professionals, hospital and nursing home services, the cost of medications, home health care and other medical durables; plus the lost productivity resulting from morbidity and mortality. By comparison, in 2003 the estimated cost of all cancers was $189 billion. That is $64 billion in direct costs, $16 billion in morbidity indirect costs and $109 billion in mortality indirect costs). In 1999 the estimated cost of HIV infections was $28.9 billion. That is $13.4 billion in direct costs and $15.5 billion in indirect costs (American Heart Association 2004). This makes the social and economic impact of CVA one of the most devastating in medicine.
Impacts of CVA on the Medical System:
Like any other severe disease, CVA is a major problem and has serious impacts on the medical system. Consequently, today’s technological advancements in medicine have enabled physicians to utilize more sophisticated methods of evaluation for early diagnosis. Initially, the physician will promptly review the patient’s medical history and run a computed tomography (CT) scan. The CT scan allows the physician to determine if the cerebrovascular disease is a cerebral hemorrhage or a transient ischemic attack. It also helps to determine the best course of action for treatment and provides the location of where the damage is (Petrossian, 2001). Other technological instruments physicians use for diagnosing CVA include:
- Carotid ultrasound: used to detect the presence of plaque.
- Magnetic resonance angiography (MRA): used to assess the degree of blockage in the carotid arteries. The MRA is a variation of the magnetic resonance imaging (MRI) scan, which is also very important in diagnosing CVA.
- Electrocardiogram (EKG): used to identify any cardiac problems that may have led to the CVA, such as a prior heart attack (Petrossian, 2001).
Tests used to assess overall brain function include:
- Electroencephalogram (EEG): uses small metal devices (electrodes) that are attached to the scalp. The electrodes are connected by wires to an electroencephalograph machine that charts the electrical activity of the brain.
- Evoked-potential study: used to test and measure the brain’s response to sight, hearing and touch.
In the aspects of CVA treatment, the future looks bright. Scientists are continuously exploring new methods of treating CVA and preventing recurrent cases of CVA. Current research is ongoing in several areas. Studies are being done on additional drugs that dissolve clots. These drugs are administered either in the veins or directly into the clogged artery. The goal of these studies is to determine which CVA patients might benefit from this new and aggressive form of treatment (MedicineNet.com, 2002). New medications are also being tested that help slow the degeneration of the nerve cells that are deprived of oxygen during a CVA episode. These drugs are referred to as "neuroprotective" agents. These agents attempt to rescue brain cells from injury caused by an ischemic stroke. Some agents attempt to increase the flow of blood to the region of brain experiencing CVA. Other agents may prevent damage caused by blood returning to the affected area of the brain. One example of a neuroprotective agent is sipatrigine. Another example is chlormethiazole, which works by modifying the expression of genes within the brain (Petrossian, 2001).
Studies have found that atherosclerotic plaque can harbor bacteria, which, in turn, may increase the tendency for plaquerupture. Researchers are investigating whether antibiotics, specifically penicillin, can exert any effects against such bacteria. This would lead to an increase in the stability of the plaque and reduce the risk of it breaking off and causing a CVA (Petrossian, 2001).
Mechanical thrombolysis is also being investigated in its use to treat CVA. It involves devices that use catheter-delivered tools to break up or remove blood clots. Currently, clot-busting drugs are currently the only method available to break up an existing blood clot in the brain. However, they can take up to an hour to be effective. Devices currently being tested use lasers, sound waves, suction, spinning blades and snares to remove clots (Petrossian, 2001). Some evidence suggests that transcranial magnetic stimulation or TMS, in which a small magnetic current is delivered to an area of the brain, may possibly increase brain plasticity and speed up recover of function after CVA (Pharma-Help, 2003).
Another concept that scientists are exploring is hypothermia or “cool therapy.” Researchers are currently studying whether lowering a patient’s body temperature can decrease the amount of damage that occurs during a severe CVA. Interesteingly enough, one study found that lowering a person's body temperature by about one degree within a few hours of a CVA can significantly reduce brain damage and risk of death (Rogers, 2003).
Finally, stem cells, which have the potential to develop into a variety of different organs, are being used in attempts to replace brain cells damaged by a previous CVA. Stem cells are basic cells that have the ability to develop into many different types of cells. They start out very similar to each other, but depending on where they develop, the cells become highly specialized to their individual functions. Researchers are investigating a variety of methods in which stem cell transplants could be used as a treatment for CVA damage and other conditions involving damaged brain cells (MedicineNet.com, 2002). In many academic medical centers, some of these experimental agents are offered in the setting of a clinical trial.
While new therapies for the treatment of patients after CVA are on the horizon, they are not yet perfect and may not restore complete function to a CVA patient. More investigation is needed to determine the safety and effectiveness of these potential treatments, and to determine the best method of administering these treatments to patients.
Recovery & Rehabilitation:
In the first twenty-four hours, recovery is much faster following a CVA when immediate damage to the brain is repaired. Unfortunately, after the twenty-four hours the rate of recovery begins to slow down dramatically, becoming less rapid afterwards. There is usually further improvement over time, but not at the same pace as before. It is important to understand this process and not get disheartened as recovery apparently slows down. Recovery from CVA depends on the extent and location of the brain injury, the person's general health, his or her personality and emotional state, the support and cooperation of family and friends, and the care the person receives.
With neurological recovery, it is difficult to determine with precision how long the recovery process will take because of the uncertainty of how much neurological damage might have resulted from the CVA. There is still a great deal that remains to be a mystery in regards to how the brain compensates for the damage caused by CVA. Some brain cells may be only temporarily damaged, not killed, and may resume functioning. In some cases, the brain can reorganize its own functioning. Sometimes, a region of the brain "takes over" for a region damaged by the CVA (National Stroke Association, 2004). In this process, undamaged brain tissue assumes some of the functions of the dead tissue. The potential of these living nerves is unveiled to help with recovery. Another process also used by nerves in healing is what could be referred to as sprouting. When nerve connection is lost, nerve cells may send out new signals in search of new connections. Still, some connections may not be able to reestablish old ones if large portions of the brain are damaged or in the old nerve pathways are trapped in scar tissue (Burkman, p. 73).
In the case of functional recovery, it is affected by both neurological recovery and rehabilitation. Rehabilitation actually starts in the hospital as soon as possible after the CVA. In patients who are stable, rehabilitation may begin within two days after the CVA has occurred, and should be continued as necessary after release from the hospital. Although some people recover from a CVA spontaneously, most people need rehabilitation to relearn previous skills and learn new skills (Burkman, p. 79). The goal of rehabilitation is to help the person who has suffered from CVA make the most of his or her physical and mental capabilities while adapting to any limitations resulting from the CVA. This must be accomplished in a way that preserves dignity and promotes motivation in the patient.
Rehabilitation consists of physical therapy, occupational therapy, and speech and language pathology. For the CVA patient, the physical therapist's aim is to get back as much movement as possible by means of a range of exercises, and to prevent complications arising as a result of the way in which limbs are positioned. Occupational therapists, on the other hand, are concerned with helping individuals to achieve as much independence as possible. They help the patient find ways to do again what used to be the simplest of things from everyday tasks like brushing teeth to taking up new leisure activities as well as rediscovering old ones (Burkman, p.83). Finally, with speech and language therapists they understand how CVA often leaves people with communication difficulties and problems with swallowing. That is why speech and language therapists assess the problems, work with the patient on the best ways to overcome them and improve communication skills (Burkman, p. 84).
Reducing the Risk of CVA:
Preventive measures achieved by adopting a healthier lifestyle are the best way to reduce the risks of CVA and promote better circulation of blood flow to the brain. Although preventive measures may not fully protect an individual against having a CVA, they can still go far to reduce the risks of such an event. Many of the preventive measures involve lifestyle changes that are similar to those that can help prevent heart disease. One of the lifestyle measures includes controlling high blood pressure or hypertension. Blood pressure abnormalities must be continually monitored and controlled because they are a chief contributor to CVA. Getting treatment for atrial fibrillation or atrial flutter is another preventive measure. Irregular heart beats can affect heart function and allow blood to collect in the chambers of your heart. The blood which collects there can clot and most likely lead to CVA. Additionally, reducing cholesterol levels, perhaps by taking cholesterol-reducing drugs also helps. Periodic blood cholesterol tests can help monitor the risk of artherosclerosis.
Other preventive measures that should be considered as well are increasing one’s level of exercise, maintaining an ideal weight, refraining from or quitting smoking, limit use of alcohol to about one glass of wine or one beer per day, which may help in the prevention of strokes, and controlling diabetes (Wiebers, p. 90). These small changes can greatly reduce the risks of CVA and decrease its damages making them less severe.
Personal Reflections on CVA:
The team of health care professionals including nurses, physical therapists, occupational therapists, and speech and language therapists are there to devise a program designed for the needs of the CVA survivor. They are there every step of the way to help them cope and start to learn new ways of carrying out everyday tasks. However, there is no doubt that the determination of the person who has experienced the CVA episode, along with a positive attitude, plays a great part in their recovery, though of course they will have help from their caregiver, family, friends and health care professionals.
After the initial shock of a CVA comes adjustment. He or she is going to face many new challenges, and a positive outlook certainly helps. The best approach is to take each day as it comes, and live it to the fullest extent possible. Setting small achievable goals can help. For example, relearning to do something as simple as tying a shoelace can be the first step to a greater goal such as learning how to drive. Independence is the ultimate aim and self-sufficiency brings enormous rewards. Nevertheless, what is equally important is to be realistic. The extent and rate of recovery from CVA is different for everyone and learning new ways to cope is tiring both physically and mentally. The best way to handle it is to do things at a comfortable pace, take adequate amounts of rest, and to keep a regular routine.
People who have had CVA say that no matter how much they improve, they always feel the stroke with them. As the months progress they begin to learn just how much recovery is possible, and how to get the most out of life within those restrictions. Someone who has just been stricken with CVA is entering a new phase of life. With a positive attitude it is possible for them and for their loved ones to face the challenges and go on to live fully satisfying lives.
American Heart Association (2004). Heart Disease and Stroke Statistics – 2004 Update. Retrieved on April 8, 2004 from website: http://www.americanheart.org/downloadable/heart/1075102824882HDSStats2004UpdateREV1-23-04.pdf
American Stroke Association (2004). Impact of Stroke. Retrieved on April 8, 2004 from website: http://www.strokeassociation.org/presenter.jhtml?identifier=1033
American Stroke Association (2004). Stroke Risk Factors. Retrieved on April 8, 2004 from website: http://www.strokeassociation.org/presenter.jhtml?identifier=4716
American Stroke Association (2004). Stroke Facts 2004: All Americans. Retrieved on April 8, 2004 from website: http://www.americanheart.org/downloadable/heart/1073974411867Stroke%20Facts%202004.pdf
Buckman, R. (2000). What You Really Need to Know About Caring for Someone After a Stroke. New York: Lebhar-Friedman Books.
Burkman, K. (1998, May). The Stroke Recovery Book. Independent Publishers Group.
Cicala, R. S. (1999). The Brain Disorders Sourcebook. Los Angeles: Lowell House.
Cleveland Clinic Health System (2003). Understanding Stroke. Retrieved on April 8, 2004 from website: http://www.cchs.net/health/health-info/docs/0900/0992.asp?index=5601
Senelick, R. C., Rossi, P. W., & Dougherty, K. (1999, June 1). Living with Stroke: A Guide For Families: Help and New Hope for All Those Touched by Stroke (1st ed.). New York: McGraw-Hill.
Harris, J. T. (2002). Epidemiology of Stroke. Retrieved on April 8, 2004 from website: http://www.hcstrokefoundation.org/epidemiology.html
Internet Stroke Center (2003). Stroke Statistics. Retrieved on April 8, 2004 from website: http://www.strokecenter.org/pat/stats.htm
McMurdo, M. (2003). Stroke (Cerebrovascular accident). Retrieved on April 8, 2004 from website: http://www.netdoctor.co.uk/diseases/facts/stroke.htm
MedicineNet.com (2002, April 15). Stroke. Retrieved on April 8, 2004 from website: http://www.medicinenet.com/script/main/art.asp?articlekey=489&pf=3&track=qpa489
National Stroke Association (2002). Life After Stroke: Survivor and Caregiver. Retrieved on April 8, 2004 from website: http://22.214.171.124/NationalStroke/HadAStroke/Life+After+Stroke+-+Survivor+and+Caregiver.htm
Petrossian, G. A. (eds.) (2001, May 14). Stroke. Retrieved on April 8, 2004 from website: http://www.heartcenteronline.com/Stroke.html
Pharma-Help.com (2003). Cerebrovascular Accident. Retrieved on April 8, 2004 from website: http://pharma-help.com/cerebrovascular-accident
Rodgers, E. (2003, May 30). Stroke (Cerebrovascular accident). Retrieved on April 8, 2004 from website: http://www.peacehealth.org/kbase/topic/major/hw224638/descrip.htm
Tanner, D. C. (1999). The Family Guide to Surviving Stroke and Communication Disorders. Needham Heights, MA: Allyn & Bacon.
Wiebers, D. (2001). Stroke-Free for Life: The Complete Guide to Stroke Prevention and Treatment. New York: HarperCollins.