You may be eligible for a clinical trial that could improve motor function and cognitive status in those who have had strokes! If you are interested in learning more about this FDA-approved clinical trial, please contact the site nearest you, either in Palo Alto, CA or Pittsburgh, PA by visiting www.clinicaltrials.gov or www.san-bio.com.
Archive for August, 2011
Do you find yourself laughing or crying at all the wrong times? If so, you may suffer from Pseudobulbar Affect (PBA). Also called emotional incontinence or pathologic lability, PBA is a common medical problem among stroke survivors. It can cause you to laugh at a funeral or cry at a comedy club. It can even make you cry uncontrollably for little or no reason. For this, it is often confused with depression. But, PBA is not depression.
People with PBA are unable to control their emotional expressions the way they used to. When this happens in social settings, they feel embarrassed, frustrated and angry. They also sense that others are uneasy. They may avoid work, public places and family get-togethers. This can lead to feelings of fear, shame and isolation.
There is no treatment approved by the Federal Drug Administration (FDA) for PBA, though antidepressant drugs can help.
These things may help you cope with PBA:
• Be open about it. Warn people that you cannot always control your emotions. Explain that the emotions you show on the outside don’t always reflect how you feel on the inside.
• Distract yourself. If you feel an outburst coming on, focus on something boring or unrelated. Try counting the number of items on a shelf.
• Note the posture you take when crying. When you think you are about to cry, change your posture.
• Breathe in and out slowly until you are in control.
• Relax your forehead, shoulders and other muscles that tense up when crying.
There is still confusion as to whether a current “email forwarding” fad: “Ask the person to stick out their tongue and see if it is crooked,” is the best way to determine if someone has had a stroke? The tongue test leaves room for multiple interpretations of the results. How crooked is crooked? How far to one side does the tongue have to go before it can be a clear sign of stroke? There are too many variables. What’s more, it’s entirely possible for someone to who has had stroke and be able to stick out their tongue perfectly.
Our answer: Use F.A.S.T. (face, arms, speech, time) FAST does not cover every possible symptom of stroke. However, it is easy to remember and it is estimated that about 8 or 9 in 10 people with a stroke will have one or more FAST symptoms.
FACE – Ask the person to smile. Does one side of the face droop?
ARMS – Ask the person to raise both arms. Does one arm drift downward?
SPEECH– Ask the person to repeat a simple sentence. Are the words slurred? Can the person repeat the sentence correctly?
TIME – If the person shows any symptoms, time is important. Call 9-1-1 immediately
The goals of rehabilitation are to help survivors become as independent as possible and to attain the best possible quality of life. Even though rehabilitation and therapy do not “cure” the effects of stroke in that they do not reverse brain damage, they can substantially help people achieve the best possible long-term outcome.
Rehabilitation helps stroke survivors relearn skills that are lost when part of the brain is damaged. For example, these skills can include coordinating leg movements in order to walk or carrying out the steps involved in any complex activity. Rehabilitation also teaches survivors new ways of performing tasks to circumvent or compensate for any residual disabilities. Individuals may need to learn how to bathe and dress using only one hand, or how to communicate effectively when their ability to use language has been compromised. There is a strong consensus among rehabilitation experts that the most important element in any rehabilitation program is carefully directed, well-focused, repetitive practice—the same kind of practice used by all people when they learn a new skill, such as playing the piano or pitching a baseball.
Rehabilitation should begin as soon as a stroke patient is stable, sometimes within 24 to 48 hours after a stroke. This first stage of rehabilitation can occur within an acute-care hospital; however, it is very dependent on the unique circumstances of the individual patient. Post-stroke rehabilitation involves physicians; rehabilitation nurses; physical, occupational, recreational, speech-language, and vocational therapists; and mental health professionals.
Physicians have the primary responsibility for managing and coordinating the long-term care of stroke survivors, including recommending which rehabilitation programs will best address individual needs. Physicians also are responsible for caring for the stroke survivor’s general health and providing guidance aimed at preventing a second stroke, such as controlling high blood pressure or diabetes and eliminating risk factors such as cigarette smoking, excessive weight, a high-cholesterol diet, and high alcohol consumption.
Nurses specializing in rehabilitation help survivors relearn how to carry out the basic activities of daily living. They also educate survivors about routine health care, such as how to follow a medication schedule, how to care for the skin, how to move out of a bed and into a wheelchair, and special needs for people with diabetes. Rehabilitation nurses also work with survivors to reduce risk factors that may lead to a second stroke, and provide training for caregivers. Nurses are closely involved in helping stroke survivors manage personal care issues, such as bathing and controlling incontinence. Most stroke survivors regain their ability to maintain continence, often with the help of strategies learned during rehabilitation. These strategies include strengthening pelvic muscles through special exercises and following a timed voiding schedule. If problems with incontinence continue, nurses can help caregivers learn to insert and manage catheters and to take special hygienic measures to prevent other incontinence-related health problems from developing.
Physical therapists specialize in treating disabilities related to motor and sensory impairments. They are trained in all aspects of anatomy and physiology related to normal function, with an emphasis on movement. They assess the stroke survivor’s strength, endurance, range of motion, gait abnormalities, and sensory deficits to design individualized rehabilitation programs aimed at regaining control over motor functions. Physical therapists help survivors regain the use of stroke-impaired limbs, teach compensatory strategies to reduce the effect of remaining deficits, and establish ongoing exercise programs to help people retain their newly learned skills. Disabled people tend to avoid using impaired limbs, a behavior called learned non-use. However, the repetitive use of impaired limbs helps reduce disabilities. Strategies used by physical therapists to encourage the use of impaired limbs include selective sensory stimulation such as tapping or stroking, active and passive range-of-motion exercises, and temporary restraint of healthy limbs while practicing motor tasks. In general, physical therapy emphasizes practicing isolated movements, repeatedly changing from one kind of movement to another, and rehearsing complex movements that require a great deal of coordination and balance, such as walking up or down stairs or moving safely between obstacles. People too weak to bear their own weight can still practice repetitive movements during hydrotherapy (in which water provides sensory stimulation as well as weight support) or while being partially supported by a harness. A recent trend in physical therapy emphasizes the effectiveness of engaging in goal-directed activities, such as playing games, to promote coordination. Physical therapists frequently employ selective sensory stimulation to encourage use of impaired limbs and to help survivors with neglect regain awareness of stimuli on the neglected side of the body.
Like physical therapists, occupational therapists are concerned with improving motor and sensory abilities, and ensuring patient safety in the post-stroke period. They help survivors relearn skills needed for performing self-directed activities (also called occupations) such as personal grooming, preparing meals, and housecleaning. Therapists can teach some survivors how to adapt to driving and provide on-road training. They often teach people to divide a complex activity into its component parts, practice each part, and then perform the whole sequence of actions. This strategy can improve coordination and may help people with apraxia relearn how to carry out planned actions. Occupational therapists also help people make changes in their homes to increase safety, remove barriers, and facilitate physical functioning, such as installing grab bars in bathrooms.
Speech-language pathologists help stroke survivors with aphasia relearn how to use language or develop alternative means of communication. They also help people improve their ability to swallow, and they work with patients to develop problem-solving and social skills needed to cope with the after-effects of a stroke.
Talk to your healthcare provider about possible options that are right for you. Repetition of you or your loved one’s therapy is key to a higher quality of life!
A person who has suffered a stroke may experience speech impairment. It is important to remember that a stroke has not impaired the person’s intelligence, but it has affected his or her ability to understand and/or express emotions. The more family and friends understand the problem the more they can help the recovery of the stroke survivor.
Three common problems are aphasia, dysarthria and apraxia. Your loved one may have one or more of these problems at the same time.
-Aphasia is a problem with using and/or understanding language. Aphasia is caused by damage to part of the brain. People with aphasia have a hard time finding the “right” words. They may not be able to say the words they want or the words come out wrong. People with aphasia may have problems understanding words said by others. They may not understand what someone is saying in conversation or on television. Bilingual aphasia affects people who speak two languages and have trouble with both after stroke.
-Dysarthria results from damage to the part of the brain that produces speech. As a result, speech may sound slurred. People with dysarthria may have problems saying sounds correctly.
-Apraxia is a problem finding the “right” sounds to use when speaking. The speech may sound “flat.” The person’s tone may not change. He or she may only say one syllable at a time. Aphasia and apraxia of speech almost always occur at the same time.
Talk to your healthcare provider right away about treatments and referrals. Licensed speech-language pathologists can help stroke survivors regain speech and language skills. They can teach survivors how to learn and use writing, gestures and other forms of communication.
Helpful Tips for Talking with Your Loved One:
-Let them speak for themselves. Allow them the time to find the right words.
-Face them and keep eye contact when you talk together.
-Speak slowly with simple words and phrases they can understand, but avoid “talking down” to them. Always speak with respect!
-Use gestures (nods or hand signals), pictures, signs or key words in writing.
-Ask them to repeat things that are not clear. However, avoid asking them to repeat things many times.
-Ask them questions with “yes” or “no” answers.
-Most of all, be patient! Speech recovery can be a slow process.
A seizure occurs when a particular area of the brain fires spontaneously without voluntary control. It can result in an unexpected sensation (visual image, smell, sound, feeling or taste), motor activity (head, eyes, or limb shaking), and/or change in alertness, ability to speak or understand. Seizures are not uncommon after strokes. Multiple studies have reported approximately 10% of all ischemic stroke survivors suffer at least one seizure by the 5th year after their stroke. The risk for hemorrhagic strokes was higher, as approximately 27% of patients with intracerebral hemorrhage and 34% of patients with subarachnoid hemorrhage suffered at least one seizure during the same time period.
The most common seizures resulting from strokes are those that occur weeks or months after the initial event. When a region of brain tissue dies during a stroke, it begins to degenerate into scar tissue after a few weeks. The presence of this scar tissue acts a provocative irritant to the normal neurons adjacent to it, precipitation a seizure months or even years later. If you or someone you know have been experiencing seizures after a stroke, ask your primary care provider about an epileptologist in your area, a neurologist who specializes in the diagnosis and treatment of seizures.
If you would like to read a personal article about the signs of seizure, please refer to http://www.everydayhealth.com/blogs/survivingastroke/seizures-affect-stroke-recovery
Just-released research from a large national study observed a frightening trend: Rates of stroke in women during pregnancy or soon after giving birth have jumped 54 percent in a dozen years.
The rate of stroke climbed about 47 percent in women before giving birth and about 83 percent in new moms in the postpartum period, 12 weeks after giving birth. The risk of stroke rises in pregnancy in part because of a higher volume of blood, but also because of increased risk of high blood pressure, blood clots and migraine headaches. Dramatic fluctuations in hormones and blood pressure in the weeks after giving birth may increase risk during that time, doctors say.
That’s a troubling rise, even for a condition that remains rare, said Dr. Elena V. Kuklina, the study’s lead author, stroke expert and epidemiologist at the federal Centers for Disease Control and Prevention. Overall, strokes were detected in about 71 of every 100,000 delivery hospitalizations by the end of the study period.
Almost all of the increase in strokes during or soon after pregnancy was explained by higher prevalence of high blood pressure and heart disease during pregnancy, said Kuklina. That’s a worrisome trend in a nation where roughly one in five women is obese when she becomes pregnant, a risk factor for both conditions.
If you would like to read more of the personal stories related to this article, please go to this link: http://today.msnbc.msn.com/id/43918460/ns/today-today_health/t/strokes-spike-pregnant-women-new-moms/