Stroke

A stroke or brain attack (also referred to as a CVA - cerebrovascular accident) occurs due to a disruption of the blood supply to a particular area of the brain, causing damage to that area of the brain. Although the damaged area is often relatively small, there may be considerable effects on bodily function.

There are two types of stroke:

1. ischaemic (blocked artery: embolic or thrombotic)
2. haemorrhagic (brain bleed)

The causes of stroke include:

1. A hardening of the arteries in the neck or the secondary effect of disease, both of which may result in clots or debris breaking away from blood vessels and flowing upwards in the blood stream, blocking one of the arteries within the brain
2. An artery bursts and bleeds within the brain, damaging surrounding tissue. Damage is usually caused by pressure on the brain tissuefrom the released blood
3. A blood vessel ruptures in the space surrounding the brain, which often causes spasm in the blood vessels nearby impairing blood supply to a particular area of the brain

What factors increase the risk of having a stroke?

Factors that have been investigated through research and have been found to increase the risk of having a stroke include:

• An increase in age
• High blood pressure
• Smoking
• Diabetes
• Atrial fibrillation (abnormal heart rhythm)
• Other factors such as a high fat and salt diet, obesity, lack of exercise, stress and heredity

Warning signs: TIA

Some people experience warning symptoms or minor strokes referred to as transient ischaemic attacks (TIAs). These are caused by a temporary cut in blood supply to the brain; blood clot or debris (plaque) can partially block an artery and cause a TIA. They are usually temproary.

Warning signs can include:

• Partial or complete blindness in one eye
• Slurred, hesitant or garbled speech
• Feelings of numbness or weakness in parts of the body
• Dizziness
• Loss of sensation (e.g. pins and needles in the limbs)
• Poor balance

These warning signs will often occur suddenly with a quick recovery. To avoid the onset of a major stroke, such warning signs must be reported to a doctor at once.

FAST test

FAST is an easy way to recognise the most common signs of a stroke or TIA and act.

Facial weakness - can the person smile, has their mouth or eyes dropped?

Arm weakness - can the person raise both arms?

Speech difficulty - can the person speak clearly and understand you?

Time - to act - immediately call 000

The effects of stroke

The functional effects of a stroke will depend on which area of the brain has been injured. The effects of stroke for each person can vary dramatically. Some of the effects of stroke include:

• A loss of consciousness
• A loss of movement on one side of the body
• Muscle weakness on one side of the body
• Poor balance
• Difficulties coordinating movement
• Loss of sensation (this can include a loss of pain, temperature and touch sensation, decreased awareness of body position, a lack of awareness of neglect of one side of the body)
• Difficulty understanding what others are saying and difficulty finding the words to say
• Weakness of facial muscles which may decrease the clarity of speech
• Muscle weakness of the mouth and throat causing problems with swallowing
• Difficulty thinking clearly
• Difficulty interpreting visual information
• Loss of memory
• Visual problems
• Poor bladder and bowel control
• Depression, mood swings and difficulty controlling emotions
• Feelings of loss of control over life

Rehabilitation and recovery from a stroke

It is important to note that many people who have a stroke make an excellent recovery given adequate care and information. As mentioned previously, symptoms will depend on which area of the brain has been injured. Even if a person has had a severe stroke it does not mean that they will be unable to lead a comfortable and satisfying life.

Numerous health professionals may be involved in the assessment, treatment and rehabilitation of a person who has had a stroke. In most rehabilitation settings a team approach is utilised, which may consist of the following team members:

Neurologists - The neurologist makes detailed assessment of the type of stroke and makes recommendations for early medication and treatment.

Nurses - Of all the health professionals nursing staff usually have most contact with the person who has had a stroke. They will provide assistance with tasks such as feeding, bathing and dressing and will monitor the person’s general health status. Once the person has been discharged from hospital the Royal District Nursing Service and Domiciliary Care may provide assistance with medication, bathing etc.

Occupational therapist - Occupational therapists are concerned with the person’s ability to independently carry out daily living activities following a stroke. They will design a training and activity program that will assist the person to independently carry out tasks in the areas of self care, work and leisure.

Physiotherapists - Physiotherapists assess the affects of stroke on movement. By re-educating normal movement patterns, the physiotherapist can assist the person to regain sitting and standing balance, to walk and to gain strength and range of movement in limp or weak limbs etc.

Speech pathologist - Speech pathologists assist the person with problems with speech, understanding, reading, writing, chewing and swallowing. Therapy may include practice in pronouncing words, re-learning the names of objects and the meaning of words.

Social worker - Social workers will look at possible family, social and financial difficulties following stroke and give information as to how help may be obtained.

Useful contacts

There are numerous social and support groups within the community which can be of assistance in the recovery of a person who has had a stroke. For information about these groups refer to the Stroke Support Directory available from:

Stroke SA Inc
23A King William Road, Unley SA 5061
tel. (08) 8373 0570
website: www.stroke.org.au

A number of fact sheets are also available from Stroke S.A., which give further information on living with stroke. These fact sheets cover the following issues:

• Self-care
• Work
• Leisure
• Emotional issues following stroke
• Sexuality
• Caring for someone who has had a stroke
• Stroke and vision

Stroke Foundation
StrokeLine tel. 1800 787 653
www.strokefoundation.com.au