American Stroke Foundation

This presentation is presented by Dipika Aggarwal, MD, Neurologist at University of Kansas Medical Center. In 2018 and 37 years old Dipika was diagnosed with stage four colorectal cancer. After treatments, by 2019 the cancer taken care of. She was back to work.

Shortly after, she suffered from a stroke – a Hemorrhagic stroke because of an unknown aneurysm rupture. Completely weak on the right side she had aphasia which effects speech. She has been doing constant therapies and is able to talk and work again in the neurology clinic.

She has been through the items she is presenting here. This post from the American Stroke Foundation lays out the key points to the video, but we encourage you to watch as well.

Life after stroke
Recovery & Rehabilitation
Role of caregiver, family or friends
There is life – and hope – after stroke.

It’s an event which is caused by the blood vessels (mainly the arteries) in the brain.
It is common. Approx 800K cases per year.
If blood vessels are clogged or blocked.
Tissues of the brain can’t get oxygen and nutrients and the nerve cells (neurons) can’t function.

Ischemic Stroke – 87%
Dry Stroke – occurs because of blocked blood vessels. Lodged blood clot.

Hemorrahagic stroke –
Small blood vessel ruptures – brain tissue is not getting nutrients.
Sometimes the blood vessel forms a balloon called an anurism where the blood vessels become thin.

Transient ischemic attack (“mini-stroke” or warning stroke)
Most important category
short lasting – few minutes or an hour sometimes 24 hours
no permanent damage – but a warning sign – don’t ignore it
Call 911

FAST
Face Drooping
Arm Weakness
Speech Difficutly
Time to call 911
every 40 seconds – someone has a stroke in US
Time is Brain
Sooner it is treated the better the outcome

Weakness or paralysis on one side of the body
Numbness or abnormal sensations on one side of the body
Balance or coordination problems
Speech difficult – slurred speech or aphasia (difficulty in understanding or producing the speech)
Bodily neglect – patient neglects the side affected by the stroke – for example they might not eat on the plate the side where the stroke affected
Attention deficit / cognitive problems
Trouble swallowing

Other:
Fatigue
Bowel and bladder problems
Sexual problems
Personality Changes
Depression

Treatement – admitted to the hospital
Spontaneous recovery
Rehabilitation!!
Return to community living
Preventing another stroke

Greatly influence health outcomes and recovery
First few months – acts like a new born brain – rapid recovery
This phenomena is called neuroplasticity – ability of our brain to learn, make new connections, adapt and adjust in response to brain injury
The good thing is there is no expiration date – few months to few years – no one can predict – how soon – how much – NO PREDICTOR
BE PATIENT – KEEP HOPE – NEVER GIVE UP
KEEP doing your therapies – REPETITION is the key!

What to expect during Rehabilitation
Inpatient Rehabilitation Facility – 3 hours a day / 5 days a week – medically stable
With a team: Physiatrist (rehab doctor), therapists, psychiatrist / psychologist, social worker, recreational therapist, support group

Main goal – all team members assess you, evaluate you, talk amongst themeselves, the patient (stroke survivor) caregiver and family to:
Set rehabilitation goals

Achieve those goeals through Individual therapies, group therapies, psychologogical support, setting routines, educate
Careigver training, community resources

Other Rehab settings

Where: Skilled nursing facility (SNF)
For Whom: Daily skilled nursing or rehabiliataive care but cannot tolerate the intesity of IRF
What to expect: No minimum therapy registered nurses / therapists

Where: Long-term acute care facility (LTAC) –
For Whom:multiple comples chronic medical conditions
What to expect: Hospital level of care

Where: Nursing Home
For Whom:Don’t require skilled nursing
What to expect: Long-term care

Where: Outpatient clinic
For Whom:Don’t require inpatient care
What to expect: Outpatient therapies

Where: Home health agency
For Whom:Homebound
What to expect: Skilled nursing therapists; health aid

Is it certified to care for people with a stroke
Are there team members, do they have experience with stroke

Rehabilitation services available
Intensity – how intense are they
Medical service / physician available
Cardiologist, nephrologist

What other clinicians / therapists do they have
Nutritionst, dietician, spiritual therapist

Their recovery goals match yours

Help / educate caregivers
How involved can caregivers be? Edutate on how they can take care longer term

Location
Close enough

Insurance – is it in-network – what all therapies does it cover?
As of 2018, the former Medicaire caps now are annual thresholds that physical therapists are permitted to exceed when they append claims with the KX modifier for medically necessary services. This change from the earlier “hard” theapy caps is the result of the Bipartisan Budget Act of 2018 (BBA of 2018) which provices for Medicare payment for outpatient therapy services including physical therapy (PT), speech-language pathology (SLP) and occupational therapy (OT) services.

Continue Recovery
Self exercises / home program
Remember – slow process, be patient, don’t give up
Stroke recovery has no timeline or expiration date
Repitition is key

Support to your loved one – encouraging survivor to be involved and go to therapy
Visit and talk – play cards – listen to music – hang out
If the patient has troulbe communicating, ask the speech therapist how you can help
Attend some rehabilitation sessions
Participate in education offered
Encourage and help the patient to practice the skills

Avoid doing things that the patient is able to do. Promote repetition.
Example – if speech is coming back, don’t complete their sentences for them. Let them finish their thoughts.

Promote repetition
Be an advocate for yourself and your love one
Take care of yourself – avoid care taker burn out (something from medicare called respite care – medical provider can apply for it – medicare will pay for it to give you a break and have some me time)

Lifelong commitment
Follow your health care providers
Take your medications regularly
Never stop without talking to your provider – if you’re having side effects, talk to your provider.

Lifestyle modifications –
Heart and Brain Wellness
American Hearth Association’s Life’s Simple 8 – lifestyle modifications
Manage Blood Pressure – Take your medications on time / monitor your BP / write down your numbers / share with your provider

Control cholesterol – HDL is good / LDL is bad
Talk to your HCP what that goal is for you

Reduce Blood Sugar
Diabetic – be on medication / Check regularly

Get Active – AHA – extensive research on how active you should be

Lose weight if you are overweight or instructed by HCP

Eat Better

Stop Smoking

Depression
1/3 to 2/3 of survivors
Early stages of stroke recovery
If untreated, can limit functional recovery
Thoughts of death or suicide – professional help right away

Anxity – so much has happened in life. Finanial. Work. Career changes or family changes.

Pseudobulbar affect (PBA) / emotional lability – storke survivir might have unreasonable crying or laughter – talk to HCP – good treatement
Anger outbursts

All of these can be treated

Do not ignore mental health –
as important as phycsical well being
Don’t hesitate to ask for help
Medication, psychotherapy or both
Mindfulness, mediation
Yoga or thai chi, etc.

Mindfulness meditation is a mental training practice that teaches you to slow down racing throughts, let go of negativity and calm both your mind and body.
Also helps your phycial health – lowers BP, improves sleep, improves memory

Free of cost
No side effects
Improves modd, mental health, memory, sleep, physcial health
several websites – mindful.org
several apps – insight timer, headspace, calm
Go to YouTube – type in mindfulness videos for anxiety / sleep / depression – list of good videos –

All you need for this is time and activate time

Be Patient – Never Give Up
Recovery has no expiration date
Repitition is the key!!
Do not ignore mental health
Don’t look back
There is life and hope after stroke