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Your
loved one is showing signs of having a stroke. You call
911 and have him taken to the hospital. He is diagnosed
as having a stroke and is admitted. YOU NEED ANSWERS. This
web site is dedicated to helping stroke survivors and their
families understand and cope with the devastating effects
of stroke.
1.
WHAT IS A STROKE?
A stroke is a BRAIN ATTACK. A stroke causes damage to part
of the brain. It happens when the blood supply to part of
the brain is suddenly stopped. The oxygen and nutrients
that keep the brain healthy are not available and that part
is damaged. The body parts, which are controlled, by that
part of the brain are also affected.
2.
HOW DO STROKES HAPPEN?
Strokes can happen in different ways. The blood supply to
the Brain is stopped suddenly when:
A. The
arteries are narrow and become blocked from the inside.
Arteries are like tubes that carry blood throughout the
body. As we get older the arteries can become narrowed.
Smoking, diabetes, high blood pressure, high cholesterol
or fats can also make arteries narrow.
B. One
of the arteries could burst. This could happen if there
is too much pressure inside. High blood pressure can cause
this. A faulty artery at birth could also be a cause. This
kind of stroke may happen in younger people. When the arteries
burst blood leaks out and damages that area of the brain.
C. Sometimes
a blood clot forms. This happens if you have had previous
problems. This clot may become loose and travel through
the arteries. If it travels to the brain it may get stuck
in a small artery. This would block the flow of blood and
damage to that part of the brain would occur.
D. A
tumour, infection or swelling in the brain. These factors
may cause outside pressure on an artery and may cut off
the blood supply to that area of the brain. All these conditions
have the same result. The blood cannot reach a part of the
brain, nutrients cannot feed the tissue and that part of
the body is damaged.
3.
KINDS OF STROKE
There are three kinds of strokes.
1. Thrombus---A
blood clot forms in a brain artery and blocks the flow of
blood.
2. Embolus---A
blood clot, or other material that moves through the body
and lodges in the brain artery, cutting off the supply of
blood.
3. Haemorrhage---A
weakness in the wall of the brain artery that may rupture
resulting in bleeding into the surrounding area of the brain.
Most strokes are due to blockage of the feeding artery.
This blockage may be the result of local clot formation
[thrombosis] or due to plugging of the artery by a blood
clot, which comes from somewhere else in the body [embolism].
Sometimes the blockage can clear quickly with full recovery
occurring in minutes or hours. When this occurs it is referred
to as a T.I.A or TRANSIENT ISCHEMIC ATTACK. A smaller number
of strokes are due to rupture of the feeding artery causing
artery causing bleeding into the brain [haemorrhage].
4.
IN THE HOSPITAL
You have just been taken to the hospital and have been diagnosed
as having suffered a stroke. You need answers and you really
don't know where to begin. As a stroke victim the hospital
will try to stabilize your condition. They will try to find
out what caused your stroke and will appoint a team of specialists
to undergo your rehabilitation. A total assessment of your
condition will be evaluated and a program will be put in
place to help in your recovery process. Your rehabilitation
in a rehab centre will depend on:
1. Your
attitude [your desire to help yourself recover]
2. Your age and the availability of a bed in the rehab unit
3. Your family and their attitude in helping you to recover
4. Your stroke team and their assessment of you
If you are lucky enough to be given a bed in a rehab unit
do not waste your time it is precious. Do your exercises
and listen to your therapist. You may have only four to
six weeks to learn before you go home.
5.
REHABILITATION
Your family doctor is your key to information about your
condition. Although a number of specialists will be involved
in your recovery the STROKE TEAM will be your best source
of information while in the hospital or rehab unit. The
team consists of SOCIAL WORKERS, RECREATIONAL THERAPIST,
NURSES, NUTRITIONIST, DOCTORS, SPEECH PATHOLOGIST, OCCUPATIONAL
THERAPIST and PHYSIOTHERAPISTS. When you are ready to leave
the hospital you may be assigned a HOME CARE CO-ORDINATOR.
The STROKE TEAMS aim is to minimize the effects of the stroke
and to maximize recovery of the stroke victim. These professionals
are here to help the family understand what has taken place,
what's happening now and what to expect in the future. Make
use of these valuable resources if you have any questions.
Write them down on paper and ask the appropriate "Team Member"
for an appointment to discuss your concerns. You will find
they can be most helpful and it will help you cope better
with the situation by knowing the answers that are of concern
to you.
6.
OUTPATIENT
Depending on your condition you can either be sent home
or go to a rehabilitation centre. There are many factors,
which will determine this of which I will go into at a later
time. If you are being sent home it is the responsibility
of the family or social worker to make sure that the patient
can function adequately in the environment. E.g. the stroke
survivor is in a wheelchair. Can the family get the wheelchair
in the house? Do they need a ramp? Can you use the wheelchair
once you get it in the house? Can the patient function in
the house, in the wheelchair by her self? I could go on
but I think you can understand the magnitude of this problem.
The social worker or occupational therapist will or should
be aware of all problems concerned with sending a person
home then suggest ways of correcting the problems. You as
a family member should have input into all aspects of the
recovery process and convey your concerns to the proper
TEAM MEMBER so a solution can be arrived at before it becomes
a major problem.
7.
ON YOUR OWN
There will come a time when you will be discharged form
the hospital system. Your stay in the hospital rehab unit
or your outpatient care program will cease to exist. There
are only so many beds and funding is limited so you must
make good use of your time. You may qualify for home care
depending on your situation but this is usually for personal
care reasons and has little to do with your recovery process.
Look to your community, your churches and organizations
for further support. I know a lady who took speech therapy
for seven years after the hospital system finished with
her. The church got behind her and various ladies gave their
time to help with her speech until she said "Thank you,"
I've had enough but it was her decision. Get involved with
an organization that you can call on for information friendship
and support they can be a source of great help for family
members as well as the stroke survivors.
DO
NOT OVER LOOK THIS VALUABLE RESOURCE
8.
CHANGES IN PERSONALITY
Stroke affects personality and behaviour. There are two
general reasons why personality can change after a stroke.
The first is a reaction to a serious illness. Having a stroke
is a very frightening experience. Like any sudden and unexpected
illness it can put you face to face with death and turn
your world upside down. People who were independent and
capable begin to feel dependent without control of their
lives. The second reason is because of the direct effect
the stroke has had on the brain function. The brain directs
thinking and feeling as well as movement and perception.
Damage to certain parts of the brain can actually reduce
emotional control and increase fearfulness or irritability.
The stroke survivor may have less control over their emotions.
It may be harder to adjust to change and learning. Relearning
everyday things is often more difficult than expected. Stroke
survivors may seem impulsive, stubborn or insensitive. They
may not be aware of the effect they are having on those
around them. This can be a direct cause of the damage that
has occurred. These changes can be very distressing for
the families of stroke survivors who are trying so hard
to help.
9.
INTIMATE RELATIONS
Will having intimate relations cause another stroke? The
answer is no. Most stroke survivors are able to resume intimate
relations after a stroke. If there is a medical reason why
you cannot continue your doctor will discuss this with you.
Will
a stroke effect my ability to enjoy intimate relations?
Probably not. If there seems to be a problem you should
talk to your doctor. There may be a medical problem that
can be treated.
My partner
seems to have lost interest in intimate relations. Will
this change? Many people need encouragement, support and
patience. People worry about health and the change in their
appearance. As you recover physically and emotionally intimate
relations usually resume as before.
Who
can I discuss intimate relations with on the stroke team?
We recommend that you talk to either your doctor or social
worker. You can talk to any team member with whom you feel
comfortable. The important thing is that you need to let
someone know that you need to discuss intimate relations
so they can help you.
10.
PAIN
Will
I have PAIN after my stroke?
Some people do have pain after a stroke and others do not.
A part of the body that does not move normally can be painful.
For example, the shoulder on the weak side is often painful.
Weakness reduces movement in the arm. It hangs heavily and
stretches the ligaments. This produces pain. The pain usually
goes away as movement returns to your body. Increase activity
in your arm reduces pain even if it does not regain normal
movement. Do not let your joints get stiff or tight. The
paralyzed body part must be exercised. Pain in the shoulder
can get worse if your develop the "shoulder-hand syndrome".
This will cause pain in the whole arm, especially in the
shoulder and the hand. The hand swells and becomes cold
to touch and the skin changes. Shoulder-hand syndrome can
be treated and most patients fully recover. Pain can come
directly from the damage to the brain. Damage to the thalamus
can cause pain. The thalamus is part of the brain that sends
messages about feelings to another part of the brain. Pain
caused from damage to the thalamus is difficult to control.
Tell your doctor about your pain especially if it gets worse.
11.
SWALLOWING PROBLEMS
After a stroke you may have swallowing and feeding problems.
This is called DYSPHAGIA. Dysphagia can make chewing your
food, holding food in your mouth, moving food to the back
of your mouth and moving food through your throat hard to
do. Other signs of swallowing problems are drooling, dry
mouth, feeling of food caught in the back of your throat,
coughing or choking while eating and poor tongue control.
Your stroke team will check out how well you are able to
swallow. This is called a swallowing assessment and is usually
done by a speech-language pathologist and a clinical nutritionist.
12.
STROKE GROUPS
A stroke group can be one of the best investments you can
make on your road to recovery and in the caregiver's quest
for answers. Check and see if there is a stroke group in
your area and go to one of their meetings. The caregiver
can go and talk to other caregivers and find out how one
could cope with a particular problem. Remember they have
gone through what you are going through; will probably have
the answer or give you comfort until you find your own way
through the problem. I have been associated with a stroke
group for 23 years and as a spouse of a stroke survivor
I can tell you it was the best move my wife and I could
have made and we have never looked back. It kept us in focus
and gave us a program in which we could work on TOGETHER
and rebuild our lives TOGETHER. Look in your community for
support. You have a hard enough battle without going it
alone.
13.
RETURNING TO WORK
This is a difficult question to answer.
Returning to work depends on the kind of work you did and the effect of your stroke.
If your stroke changes your ability to do what you did before, you have several choices:
- change the way you work
- change to a different job
- not return to work
We will work with you to help you develop the abilities you have.
If you have to change the way you work, we will teach you what you need to know. This may include such things as:
- learning to do things with one hand
- helping your co-workers understand what has happened to you
- knowing who to contact for advice when specific difficulties arise
You might not have a definite answer to this question by the time you leave the hospital.
Everyone is different.
14.
YOUR SOCIAL LIFE
If you have physical changes, loss of speech or problems thinking,
it may be hard to socialize the way you used to. You will be able to continue your social life with a few changes.
My disability has stopped me from doing an activity that I used to do.
- Although it may b difficult to do certain things with your disability, you may be surprised as to what you can do with special equipment or a change in approach.
- For example, if you were a golfer, you may need to use a motorized cart instead of walking. Your swing may need to be changed to a one handed swing. you may need to tie your weak hand to the golf club to help your grip.
- If you enjoyed needlepoint before, you can buy a holder that allows you to stitch with one hand.
- Activities can be enjoyed from a wheelchair. this includes hiking, sailing and fishing.
- The recreation therapist, occupational therapist, or physiotherapist will help you learn new ways to enjoy hobbies.
15.
GIVING CARE AT HOME
"I am afraid that I will not be able to manage!"
Families often fell this way. Looking after a family member with a stroke causes a big change for everyone. It is important to take one day at a time.
closer to the end of rehabilitation, you will know how much help will have to be given. discuss your feelings with a member of the stroke team.
"What do I need to know?"
It depends on how independent your family member becomes. It varies in each person. You are encouraged to be at the hospital during the times that different activities such as dressing, transferring and walking are being practiced.
If there is something special a team member wishes you to learn, a meeting will be set.
When do I practice what we have been taught?
When your family member is ready, there will be visits home. They begin with short trips such as a car ride. If this goes well, the visits can be for the whole day, then the weekend. This gives you a good chance to see how things are going.
Tell the team about problems as they come up.
"Who is there to help?"
It depends where you live. There may be home care services.
They provide nurses, homemakers, physiotherapists, social workers, occupational therapists and speech therapists who visit in the home. you may need some of the people at one time or another.
Friends and neighbours often offer help. Do allow them to help. It will mean a change for your family member and a rest for yourself.
"I'm so tired! Will it ever end?"
A stroke affects that person who has had it as well as those people who are close to that person. Recovering from a stroke takes a long time. You may have many demands placed on you. We will try to help you deal with problems and plan for the future.
"What about me?"
You might stop doing things that interest you. It may be that you no longer have the time. you may feel what you would like to do is not important now. You need to continue doing things you enjoy. It is important to have a healthy lifestyle. that care you are able to give to the person with a stroke partly depends on how well you care for yourself.
16.
FINANCES
Who can I talk to about finances? Talk to the social worker. He/she can answer questions about pensions, sick benefits, and income.
17.
MEMORY, PROBLEM SOLVING
"Do all stroke patients have memory problems?"
No. Many stroke patients remember everything they knew before the stroke.
They may, however have trouble remembering or learning new things. It may be harder to remember the details of conversations, things to do at a later time or where things are.
Memory may also seem good for some things at some times and not so good at other times. This can be upsetting.
"What causes memory problems?"
How well a person can pay attention, concentrate and understand affects how well they can remember. When things are happening quickly or all at once, they can be much harder to remember. Fatigue can also interfere with memory.
remembering or learning something new often means that a person has to stop doing things in old familiar ways. This can be hard to do.
What stroke patients know may be different from what they do. It is not unusual to have a good memory but still have trouble carrying out old tasks.
"How do you tell if there are problem solving difficulties?"
After a stroke, people often can handle familiar problems easily.
When new problem solving is required, memory for old ways may not be enough. New problems become difficult. It can be hard to get thoughts together, to adjust to change, to figure out how to do something new, or to get organized enough to get started on tasks. Judgement may be inconsistent. frustrations, sadness, anger and stubbornness often result.
"How are thinking and talking related?"
Thinking and talking are usually closely related. Following a stroke, some separation of these abilities can occur.
Stroke patients who are unable to talk may still have fairly good problem solving and learning abilities. Similarly, some people who talk well may have difficulty thinking through unfamiliar problems.
It is not important to watch how each stroke patient handles unfamiliar situations, whether they can talk or not.
18.
COMMUNICATIONS
The speech therapist will help the person. People learn to communicate in many ways. Some use words to speak again while others write, use communication boards, or make use of their non-verbal skills.
19.
CHANGES IN BEHAVIOUR
Stroke patients sometimes change the way they behave or interact with others around them. How they act depends on both the nature of the stroke and their personality before it happened.
20.
DRIVING
"Will I be able to drive again?"
It depends on how the stroke has affected you. you may have difficulty driving if you have:
- Weakness
- Paralysis
- Changes in Vision
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- Difficulty Concentrating
- Changes in Judgement
- Perception Problems
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21.
DEPRESSION AFTER A STROKE
"I cry often. Does this mean I am depressed?"
Crying is part of having a stroke. It just happens. It will get better over time. It does not usually mean that you are depressed. Please talk with one of the team members about crying, if you are worried about it.
"Who can I talk to if I cannot sleep or do not want to eat?"
Your doctor, social worker and therapists can talk to you about these concerns. You may need some medication to help you.
"Will I ever feel like myself again?"
Yes. Your feelings will settle and improve as you become more comfortable with changes in your life.
22.
EATING WELL AFTER A STROKE
Eating a well balanced diet will help your recovery from a stroke. Nutritious foods give you calories for energy and protein to keep your muscles strong. A poor diet can delay your recovery and may make you more likely to get infections.
23.
WHAT IS APHASIA
Aphasia is a difficulty in understanding or expressing language due to some specific form of brain damage. It may affect any or all of the language areas such a s speaking, understanding, reading as well as writing.
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