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Group 14- Stroke

• 1. Jessica Kremble
• 2. Jennifer Martin
• 3. Holly Vlasov
• 4. Krystin Piedl

What is it?

> - Types of stroke > - Prevalence > - Causes >

Effects of a Stroke on Survivors

Strokes affect each individual differently in terms of the outcomes and difficulties they have post stroke. The outcomes are affected by how severe the stroke is as well as what type of stroke the individual has.

Communication

Communication is an area of struggle for individuals who have suffered strokes. Aphasia is a disorder in which the individual has difficulty comprehending speech or understands it but cannot produce what they want to say. Dysarthria is characterized by an individual knowing what they want to say but being unable to produce them, and therefore find other ways of communication such as drawing or writing the words. Communication with other people is often very stressful and time consuming, so much so that it affects social relationships ^[1]. People who suffer from aphasia have half the social network size post stroke in relation to pre stroke ^[1]. This difference in social network size may be due to social isolation because of the difficulty communicating ^[1]

Aphasia

Dysarthria

• Motor Movement

Paralysis is the loss of motor movement of an area of the body. It can occur post-stroke, and is on the side of the body opposite of where the stroke occurred. Balance and gait is also affected by stroke. Post-stroke, individuals walk slower and have poor balance compared to other elderly individuals ^[2]. Hypokinetic movement disorders are those which have slower or reduced movements ^[3]. A hyperkinetic movement disorder occurs as an increase in motor movements ^[3].

• Quality of Life

Depression affects the quality of life of stroke survivors, especially within the first six-month period post stroke ^[4]. Every stroke survivor experiences depression two weeks after their stroke ^[4]. This onset of depression can sometimes lead to death in stroke patients because of the impact it has on the psyche of the individual ^[4]. Quantitatively, stroke survivors are satisfied with their quality of life ^[5] . Qualitatively, with the effects of dependency on others, loss of movements, inability to perform usual activities, stroke survivors are dissatisfied with their quality of life ^[5]. Returning to work post stroke often affects the life of the survivor. Even though many stroke patients are older, some are young and also many are working before their stroke. Work situations may have been stressful and one of the causes of their stroke, so return to work may not be a good idea for stroke survivors because could increase chance of another stroke ^[6] . Working individuals find it important to work because it allows for stability with money and the home ^[6]. Stroke survivor's return to work is dependent on recovery, and the barriers caused by the stroke that they deal with ^[6].

Effects of Stroke on Caregivers

• Relationship with Survivor

Strong relationships are important in the recovery of the stroke survivor; excess stress placed by the caregiver could be detrimental ^[7]. Loss of a partner as who they used to be is a common result of a stroke ^[7]. Caregivers are often overprotective and fearful of the survivor having another stroke, which could cause the survivor to feel like they are being treated as a child ^[7]. Intimacy is a very important factor in a relationship, this is often lost post stroke, due to loss of mobility in the survivor ^[7]. Familial roles change after stroke, the caregiver must now be the provider, caretaker, and strong individual ^[7]. This is increasingly difficult if the stroke survivor is the dominant male of the household. Family roles can often change with other members of the family; children and grandchildren for instance may become less important to the carer in relation to the stroke survivor ^[7]. This can be detrimental to all of the emotional lives of everyone in the family, and everyone affected by the stroke. Burden is a common feeling of caregivers due to the need to spend many hours of their days and weeks caring and aiding the survivors in their recovery and daily activities ^[8].

• Changes

Work is an important way of supporting a family, caregivers often experience changes in their employment with either now having to work, working more hours or having to cut back due to care taking responsibilities ^[7]. All of the work changes can affect the caregiver; some often report it helped keep them sane throughout the recovery process ^[7]. Friends are often put on hold during recovery leading to isolation being felt by the caregiver ^[7]. Stress can affect the social relationships as well because they feel they are abandoning the survivor and cannot enjoy themselves when they go out ^[7]. It is not all bad changes; caregivers can often feel more self-worth and see their life in a more positive direction because of the new roles taken on.

Prevention

Primary Prevention

There are many factors which increase the risk of a stroke. It is important to know these factors so that preventative measures can be taken, to reduce the occurrence stroke. Some of these factors can not be controlled by the individual, including ethnicity, gender, age, and family history (Romero). However there are many factors which increase the risk of a stroke, including hypertension, atrial fibrillation, use of preventative drugs, presence of diabetes, smoking, and obesity that can be controlled (Romero). The following section will discuss these controllable risk factors in isolation, but it should be noted that most people who suffer from a stroke have a combination of the risk factors (Romero).

Hypertension

Hypertension, commonly known as high blood pressure, significantly increases the risk of both hemorraegic and ischaemic strokes ^[9] (Chalmers&Chapman). Unfortunately, less than 25% of the world’s hypertensive population strictly monitors their blood pressure levels (Chalmers&Chapman). However, by lowering blood pressure levels to a normal range, patients can reduce their risk of stroke by 30-40 % ^[9] (Luders)! Blood pressure levels can be lowered by healthy lifestyle modifications, such as not smoking, increasing the amount of exercise, and implementing a healthy diet (Chalmers&Chapman). The most effective medications to lower hypertension include some ACE inhibitors, and diuretics, and angtiotensin receptor blockers ^[9] (Chalmers&Chapman). There is no definitive data as of yet which clearly states when it is most appropriate to begin antihypertensive treatment (Luders), and when it is safe to stop treatment. People with a family history of hypertension should be very careful to monitor their blood pressure levels, as a preventative measure of stroke ^[9]. The primary preventative measure to of stroke is to maintain normal, healthy blood pressure levels (LINK) (Luders). Reducing hypertension is important for the prevention of both primary and secondary strokes (esp sukol ALL REFERENCES) ^[9].

Atrial Fibrillation

Atrial fibrillation), occurs from an irregular beating of the heart, that causes blood to collect in one of the heart's chambers. That blood clot can dislodge and lead to a stroke. It is a disorder characterized by a common, persistent, irregular heart rhythm, and accounts for 15% of all strokes ^{[9] [10]}. Persons with AF are at least five times more likely than persons with normal heart rhythms to have strokes ^[10]. In persons over age forty, it is estimated that every one out of four persons will have AF ^[10], and the international population of persons with AF is expected to double, at minimum, due to the ageing populace by year 2050 ^[10]. Strokes caused by atrial fibrillation are more likely than non atrial fibrillation induced strokes to be fatal ^[10].

^[9]

Clinicians are responsible for assessing individuals who have AF, and determining whether it is most advantageous for the individual to leave the AF untreated, or to the go on medications. The most effective treatments for persons with AF are anticoagulants (i.e. warfarin, dibigatran, or antrithrombotic (i.e. aspirin) therapies ^[10]. The clinician will decide which treatment plan to use depending on the individuals medical history and age ^[10]. Typically, individuals with AF who are at a higher risk of having a stroke are put on a warfarin treatment plan, which reduces the likelihood of a stroke by 66%, compared with the likelihood reduction of 20% for aspirin ^[10]. However, the complications associated with warfarin are greater than aspirin, in that warfarin holds a high propensity for reactions to both food and other medications ^[10].

Antiplatelet drugs/aspirin

Physicians have commonly prescribed aspirinas a preventative measure for strokes, in the elderly population. It has been effective for both men and women in reducing the number of people affected by cardiovascular disease (Wolff), including myocardial infarction and ischemic stroke (Raju et al OR wolff is fine too). However, individuals who have taken aspirin as a preventative measure for strokes have an increased likelihood of major bleeding events (most commonly bleeding in the gastrointestinal tract) (WOLFF). Research has found that men who take aspirin prior to a stroke are more likely to have a hemorrhagic stroke (LINK), whereas aspirin was not seen to significantly affect the type of stroke women have (Woff).

Diabetes

Data compiled from Stats Canada recorded that in 2010, 1,841,527 Canadians, 6.4 percent of Canada's population have diabetes (Reference Stats canada). The percentage increases with age, with 17.7% of the population over 65 years old having diabetes (21.2% risk in males, and 14.9% risk in females). The prevalence of diabetes is increasing every year, and in the past five years the population of people with diabetes has increased by 1.5%.(Sats canada). Diabetes increases the likelihood of cardiac diseases, and significantly increases the risk of stroke ^[9]. Most people with diabetes often have it in conjunction with other cardiovascular risk factors; for example, an estimated 60% of diabetics have hypertension as well (Romero). The most effective prevention method for strokes in diabetics is lifestyle changes ^[9].

Smoking

An estimated 20% of Canadians report to be smokers (Stats Canada) . Smoking more than doubles the risk of having a stroke ^[9]. This risk increases proportional to the number of cigarettes smoked daily - so increasing the amount of cigarettes smoked daily, increases the risk of stroke to the individual. The day a smoking person decides to stop smoking, their risk of stroke immediately starts to decrease. Five years from the day the individual stops smoking, their risk of stroke is the same as someone who’s never smoked before ^[9].

Obesity

Lifestyle Changes

The most beneficial measure any individual can take to reduce the risk of stroke, is by making healthy lifestyle changes. A good start is to make sure that enough exercise is being done. Increasing exercise will help the individual lose excess weight and decrease cholesterol. Even as little as half an hour a day can be helpful to prevent stroke and other cardiovascular diseases. In conjunction with more exercise, it is important to implement a healthy diet - rich in a variety of nutrient packed foods, eaten in moderation. Research shows that drinking alcohol, in moderation, can decrease the risk of stroke. For most men, this could mean two glasses of wine a day, and for women, one glass of wine per day. Individuals who are at risk of stroke should monitor their cholesterol levels, both amount of LDL (LINKS) and HDL, to ensure that their cholesterol levels are being balanced. ^[9] (REFERENCES) ]]

Treatment

• Medication

• Surgery

• Non-surgical procedures

Rehabilitation

.

Notes and References

1. ↑ ^{1.0 1.1 1.2} Vickers, C. (2010).Social networks after the onset of aphasia: The impact of aphasia group attendance. Aphasiology, 24:6-8, 902-913.
2. ↑ Hyndman, D., Ashburn, A., Yardley, l., & Stack, E. (2006). Interference between balance, gait and cognitive task performance among people living with stroke in the community. Disability and Rehabilitation, 28:13-14, 849-856
3. ↑ ^{3.0 3.1} Ghika, J. (2005). In Recovery after stroke, edited by Barnes, Michael, Dobkin, Bruce H., Bogousslavsky, Julien, 259-285. New York, NY, US:Cambridge University Press.
4. ↑ ^{4.0 4.1 4.2} Gbiri, C.A., Akinpelu, A.O., & Odole, A.C. (2010) Prevalence, pattern, and impact of depression on quality of life of stroke survivors. International Journal of Psychiatry in Clinical Practice, 14:3, 198-203.
5. ↑ ^{5.0 5.1} Tariah, H.A., Hersch, G., & Ostwald, S.K. (2006) Factors associated with quality of life: Perspectives of stroke survivors. Physical & Occupational Therapy in Geriatrics, 25:2, 33-50.
6. ↑ ^{6.0 6.1 6.2} Alaszewski, A., Alaszewski, H., Potter, J., & Penhale, B. (2007) Working after a stroke: Survivors’ experiences and perceptions of barriers to and facilitators of the return to paid employment.Disability and Rehabilitation, 29:24, 1858-1869.
7. ↑ ^{7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9} Buschenfeld, K., Morris, R., & Lockwood, S. (2009) The experiences of partners of young stroke survivors. Disability and Rehabilitation, 31:20, 1643-1651
8. ↑ Tooth, L., McKenna, K., Barnett, A., Prescott, C., & Murphy, S.(2005) Caregiver burden, time spent caring and health status in the first 12 months following stroke. Brain Injury, 19:12, 963-974
9. ↑ ^{9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11} Romero, J. (2007). Prevention of Ischemic Stroke: Overview of Traditional Risk Factors. Current Drug Targets, 8(7), 794-801. doi:10.2174/138945007781077373
10. ↑ ^{10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8} Westerby, R. (2011). Stroke and TIA. Practice Nurse, 41(13), 30-37. Retrieved from EBSCOhost.