RCS 6080 Medical and Psychosocial Aspects of Rehabilitation CounselingStroke and HemiplegiaSlide 3TypesSlide 5HemorrhageSlide 7Slide 8SymptomsTreatment of a strokeFunction after StrokeSome residual effects of strokesRisk ReductionReactions & RehabilitationVoc Rehab and StrokeSlide 16Additional Resources and Information from the WebRCS 6080RCS 6080Medical and Psychosocial Aspects of Medical and Psychosocial Aspects of Rehabilitation CounselingRehabilitation CounselingStroke and Stroke and HemiplegiaHemiplegiaStroke and HemiplegiaStroke and HemiplegiaStroke is the third leading cause of death in the US Stroke is the third leading cause of death in the US and the leading cause of disabilityand the leading cause of disability–approx. 700,000 strokes; 160,000 deathsapprox. 700,000 strokes; 160,000 deathsModifiable risk factors include TIA, diabetes, Modifiable risk factors include TIA, diabetes, hypertension, atrial fibrillation, substance abuse, hypertension, atrial fibrillation, substance abuse, and smokingand smokingNonmodifiable risk factors include age, gender, Nonmodifiable risk factors include age, gender, race, and family historyrace, and family historyStroke and HemiplegiaStroke and HemiplegiaOf those who survive the initial onset, the most Of those who survive the initial onset, the most frequent presenting problem is hemiplegia (75-frequent presenting problem is hemiplegia (75-88%)88%)During the acute period, there is high incidence of During the acute period, there is high incidence of associated neurological deficitsassociated neurological deficitsOne important medical concern is the incidence of One important medical concern is the incidence of comorbidities that may affect management and comorbidities that may affect management and rehabrehabTypesTypes1.1.Ischemic (83%)Ischemic (83%)–Can be “silent ischemia” (no sx)Can be “silent ischemia” (no sx)–Caused by atherosclerosisCaused by atherosclerosis2.2.Cerebral thrombosis (most Cerebral thrombosis (most common)common)–blood clot forms in arteries blood clot forms in arteries leading from heart to brain leading from heart to brain (carotid) (carotid) –blocks blood flowblocks blood flow–Often preceded by TIAOften preceded by TIA3.3.Cerebral embolism Cerebral embolism –less frequent less frequent –blood clot forms elsewhere blood clot forms elsewhere (embolus), travels through (embolus), travels through bloodstream, lodges in cerebral bloodstream, lodges in cerebral arteryarteryTypesTypes1.1.Hemorrhagic strokeHemorrhagic stroke–less common than ischemic strokesless common than ischemic strokes–more deadlymore deadly–if person survives, better recovery of function if person survives, better recovery of function Why? Why? –Ischemic: Blood supply to brain stopped; tissues die, Ischemic: Blood supply to brain stopped; tissues die, do not regeneratedo not regenerate–Hemorrhagic: pressure from blood compresses brain, Hemorrhagic: pressure from blood compresses brain, affects function, pressure relieved, function returnsaffects function, pressure relieved, function returnsHemorrhageHemorrhagesubarachnoid hemorrhage subarachnoid hemorrhage –blood vessel on surface of brain leaks blood vessel on surface of brain leaks –bleeding into space between brain & skullbleeding into space between brain & skullcerebral hemorrhage (10%)cerebral hemorrhage (10%)–Defective artery in brain burstsDefective artery in brain burstsCauses:Causes:–aneurysm (blood-filled pouches that balloon out from aneurysm (blood-filled pouches that balloon out from weak spot in artery)weak spot in artery)–advancing age, congenital malformationadvancing age, congenital malformation–aggravated by hypertensionaggravated by hypertension–head injury head injuryStroke and HemiplegiaStroke and HemiplegiaRight-Hemisphere StrokeRight-Hemisphere Stroke–The right hemisphere The right hemisphere controls the movement of controls the movement of the left side of the body as the left side of the body as well as analytical and well as analytical and perceptual tasksperceptual tasksLeft-Hemisphere StrokeLeft-Hemisphere Stroke–The left hemisphere The left hemisphere controls the movement of controls the movement of the right side of the body as the right side of the body as well as speech and well as speech and language abilitieslanguage abilitiesStroke and HemiplegiaStroke and HemiplegiaCerebellar StrokeCerebellar Stroke–The cerebellum controls many of our reflexes The cerebellum controls many of our reflexes and much of our balance and coordinationand much of our balance and coordinationBrain Stem StrokeBrain Stem Stroke–The brain stem is the area of the brain that The brain stem is the area of the brain that controls all of our involuntary, “life-support” controls all of our involuntary, “life-support” functions as well as abilities such as eye functions as well as abilities such as eye movements, hearing, speech, and swallowingmovements, hearing, speech, and swallowingSymptomsSymptomssudden numbness, weakness face, arm, leg sudden numbness, weakness face, arm, leg (one side of body)(one side of body)sudden severe headachesudden severe headachedifficulty seeing in one or both eyesdifficulty seeing in one or both eyesconfusion, trouble speaking or confusion, trouble speaking or understandingunderstandingdizziness, loss of balance/coordinationdizziness, loss of balance/coordinationTreatment of a strokeTreatment of a strokeGetting medical help Getting medical help quicklyquickly essential! essential!Ischemic stroke: Ischemic stroke: –"Clot-busters" "Clot-busters" –tissue plasminogen activator (tPA)tissue plasminogen activator (tPA)–Must give within 3 hoursMust give within 3 hoursHemorrhagic stroke: correct cause of Hemorrhagic stroke: correct cause of hemorrhage hemorrhageFunction after StrokeFunction after StrokeTimeFunctionISome residual effects of strokesSome residual effects of strokesEmotional lability (mood swings, depression)Emotional lability (mood swings, depression)Perceptual effects: Difficulty recognizing, Perceptual effects: Difficulty recognizing, understanding familiar objectsunderstanding familiar objectsDifficulty planning, carrying out simple tasksDifficulty planning, carrying out simple tasksLoss of awareness (One-side neglect )Loss of awareness (One-side neglect )Dysphagia (difficulty swallowing)Dysphagia