Rehabilitation

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Stroke
Life before and after
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(No Transcript)
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Index

• WHO facts
• What is a stroke?
• Risks
• Health prevention and health promotion
• What is rehabilitation?
• New therapies
• Quality of life
• Topic for discussion

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• An estimated 17 million people die of strokes and
  heart disease every year.
• The majority of strokes are preventable and
  controllable. However, millions are dying in
  middle age.
• Stroke affects individuals in their peak mid life
  disrupting the future of the families dependant
  on them and undermining the development of
  nations by depriving valuable human resources in
  their most productive years.
• The fact that strokes occur earlier today, is due
  to smoking, psychological and social problems.

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• Stroke is the 2nd leading cause to death.
• 2/3 occur among people living in developing
  countries.
• Because of the ageing of many populations,
  projections to year 2020 suggest that stroke will
  remain the second leading cause to death.
• Stroke is among the five most important causes of
  disability.
• A small reduction in average population levels of
  blood pressure will reduce the stroke occurrence
  by about one third!
• Year 1999 WHO declared that in 2005 the
  percentage of people dying of strokes should be
  under 20 percent.

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What is a stroke?

• The blood supply to a part of the brain is
  suddenly cut off
• There are two main types of stroke
• Ischaemic stroke
• Haemorrhagic stroke

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Ischaemic stroke

• About 80 of stroke cases
• an obstruction of cerebral blood in a vessel
• Underlying condition atherosclerosis
• two types of obstruction

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• Cerebral thrombosis

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• Cerebral embolism

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Haemorrhagic stroke

• About 20 of stroke cases
• Ruptures of weakened blood vessel
• Two types of weakened blood vessels

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• Aneurysm

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• Arteriovenous malformations

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Risk factors

• What do you think are risks for getting a stroke?

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Cases

• Mister A is an African-American man, he is 63
  years old and weights 80 kg.
• Mister B is original from America, is also 63
  years old and weights 80 kg.
• Which of these 2 men has the biggest risk for
  getting a stroke?
• Mister A is in a bigger risk. People from
  African-American backgrounds have a bigger risk
  for getting diabetes and hypertension and
  because of the socioeconomic factors.
• Mrs. C is 75 years old and every evening she
  drinks a glass of red wine before she goes to
  bed. Is drinking each day 1 glass of alcohol a
  risk for getting a stroke?
• No this is not a risk for an ischaemic
  stroke, because it makes the blood thinner.
• Yes it is a risk for a haemorrhagic
  stroke, because it weakens the bloodvessels.

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Cases

• Mrs. D is a 32 year old woman, she takes oral
  contraceptive pills since she was 18. Do you
  think this is a risk?
• Yes, this is a risk, contraceptive pills make
  the blood more likely to clot and also raise
  the blood pressure.
• Mister E is a 60 year old man, he smokes about a
  pack of cigarettes a day. He also has a high
  blood pressure. He has medicines for it, but he
  doesnt take them. Has he the risks for getting a
  stroke?
• Yes of course, smoking in combination with
  high blood pressure is a very big risk for
  getting a stroke. Smoking and high blood
  pressure are the two highest risk for getting a
  stroke.

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Prevention

• Exercise
• Healthy diet
• Keep blood pressure low
• Lower cholesterol
• Maintain weight
• Quit smoking, reduce alcohol and caffeine
• Control diabetes
• Control arterial fibrillation

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Health prevention and health
promotionDefinitions

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• Prevention is when you want to get rid of a
  certain disease or the risks for getting the
  disease.
• Primary prevention is when you want to prevent
  the disease to occur.
• Secondary prevention is when you have the risks
  for developing a certain disease.
• Tertiary prevention is taken place in cases
  where the disease has already occurred.

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• Promotion
• The planned and managed process of
  encouraging and assisting improvement in the
  health population, (WHO 1998)

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Promotion is

• to increase individuals ability to take care of
  themselves.
• to increase or maintain their good health and
  quality of life.
• to give people a feeling of context, meaning and
  the ability to act and control their own health.

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Contrasts

• Prevention is carried by FEAR
• Prevention is a question about avoiding
  undesirable conditions

• Promotion is carried by HOPE
• Promotion is to augment health in a broad
  perspective

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Rehabilitation is

• to improve the patients health and quality of
  life.
• To give the patient a feeling of context, meaning
  and the ability to act.
• To maintain his good health and give him a
  feeling of controlling his own health.

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• Can we as health workers practice health
  prevention and health promotion at the same time?
• Does rehabilitation have elements of health
  promoting?
• The question is up to YOU!

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What is rehabilitation?

• to help the patient regain his/her mental and
  physical function

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Rehabilitation

• Doesnt reverse the effects of a stroke.
• The goals are to build the patients strength,
  capability and confidence so the patient can
  continue his/her daily activities despite the
  effects of the stroke.

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Professionals who work in a stroke team

• Doctor
• Nurse
• Physiotherapist
• Occupational therapist
• Speech-language pathologist
• Psychologist / Neuropsychologist
• Social worker
• Recreational therapist
• Dietitian
• Pharmacist
• Family and friends

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When does rehabilitation begin?

• When your doctor determines that you are medical
  stable and able to benefit from it.

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New therapies

• Rehabilitation centers are using innovative
  advances in rehabilitation science. These
  therapies can either supplement or replace
  traditional therapy.
• Traditional therapy is intended to progress
  slowly. The new therapies are aggressive,
  focusing on forced movement, repetition and
  intensity. They also can rely on technological
  advances.
• The more intensive the therapy the better

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Examples

• Virtual reality interactive games
• The technology appears to have helped reorganize
  brain functions, allowing survivors to regain
  some walking ability.

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Quality of lifeafter strokeHow can we
improve QOL through rehabilitation?
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Definitions of quality of life

• A state of complete PHYSICAL, MENTAL, SOCIAL
  wellbeing and not merely the absence of disease
  or infirmity
• Its very individual (low QOL is not the same as
  being ill)
• Its variable changes from days to weeks

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How the life and QOL has been effected?

• Physical impairments (paralysis)
• Psychological (depression, stress)
• Cognitive ( aphasia, memory, concentration)
• Social (loosing independence, friends and job)

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Patient view and rating

• Support from the family and friends
• Health and social care services offered
• Be accepted
• Continue with premorbid activities (adaptations
  or different activities with similar purpose)
• Be in contact with former colleagues
• Money -support from the state

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Case

• A 47 years old man is hospitalized in a stroke
  rehabilitation unit. He has got right side
  paralyse problems with gait, aphasia, and he is
  depressed. He is clear about his own situation.
  His wife is very upset, but she wants to follow
  and participate in the process of rehabilitation.

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Multidisciplinary workMultidisciplinary
workHow can we improve QOL as a

• Nurse
• Physiotherapist
• Occupational therapist
• Other?

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How can we improve the QOL through
rehabilitation?

• Communication
• Multidisciplinary co-operation
• Include families and friends in caring of
  patients
• To help the patient to fit into the normal life
  
• Let the patient decide as much as possible
• Make the patient as active as possible
• To make patient as independent as possible
• Motivate
• Use the most effective methods of rehabilitation
• Inform the patient about facilities outside the
  hospital

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?
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DiscussionDo you think that provoking and
shocking advertisements have any effect on
peoples lifestyle?
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• Within the primary prevention, how can we
  decrease the number of people with hypertension?

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Take care of yourself!!
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References

• Heart and stroke foundation http//ww2.heartandstr
  oke.ca/Page.asp?PageID24
• WHO http//www.who.int/en/
• American stroke association http//www.strokeassoc
  iation.org/presenter.jhtml?identifier1041
• National stroke association http//www.stroke.org/
  
• Scottish Intercollegiate guidelines network
  http//www.sign.ac.uk/
• Health information, patient UK
  http//www.patient.co.uk/showdoc/23068830/
• Stroke association http//www.strokeassociation.o
  rg/presenter.jhtml?identifier1014
• Stroke information http//www.stroke-information.
  net/giant20aneurysm.jpg
• Stanford stroke center http//strokecenter.stanfo
  rd.edu/guide/what_is_stroke.html
• Columbia university http//cumc.columbia.edu/dept
  /neuro-icu/images/fig4.jpg
• Adam Healthcare Center Adam.about.com/reports/000
  045_4.htm
• Belgian Stroke Counsel www.beroerte.org
• Medical center medicalcenter.osu.edu
• Nederlandse hartstichting www.hartstichting.nl
• Dansk sygeplejerad http//www.sikkerportal.dk
• www.nickfaldo.33.above.com