RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling - PowerPoint PPT Presentation

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RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling

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Stroke is the third leading cause of death in the US and the leading cause ... blood vessel on surface of brain leaks. bleeding into space between brain & skull ... – PowerPoint PPT presentation

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Title: RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling


1
RCS 6080Medical and Psychosocial Aspects of
Rehabilitation Counseling
  • Stroke and Hemiplegia

2
Stroke and Hemiplegia
  • Stroke is the third leading cause of death in the
    US and the leading cause of disability
  • approx. 700,000 strokes 160,000 deaths
  • Modifiable risk factors include TIA, diabetes,
    hypertension, atrial fibrillation, substance
    abuse, and smoking
  • Nonmodifiable risk factors include age, gender,
    race, and family history

3
Stroke and Hemiplegia
  • Of those who survive the initial onset, the most
    frequent presenting problem is hemiplegia
    (75-88)
  • During the acute period, there is high incidence
    of associated neurological deficits
  • One important medical concern is the incidence of
    comorbidities that may affect management and rehab

4
Types
  • Ischemic (83)
  • Can be silent ischemia (no sx)
  • Caused by atherosclerosis
  • Cerebral thrombosis (most common)
  • blood clot forms in arteries leading from heart
    to brain (carotid)
  • blocks blood flow
  • Often preceded by TIA
  • Cerebral embolism
  • less frequent
  • blood clot forms elsewhere (embolus), travels
    through bloodstream, lodges in cerebral artery

5
Types
  • Hemorrhagic stroke
  • less common than ischemic strokes
  • more deadly
  • if person survives, better recovery of function
  • Why?
  • Ischemic Blood supply to brain stopped tissues
    die, do not regenerate
  • Hemorrhagic pressure from blood compresses
    brain, affects function, pressure relieved,
    function returns

6
Hemorrhage
  • subarachnoid hemorrhage
  • blood vessel on surface of brain leaks
  • bleeding into space between brain skull
  • cerebral hemorrhage (10)
  • Defective artery in brain bursts
  • Causes
  • aneurysm (blood-filled pouches that balloon out
    from weak spot in artery)
  • advancing age, congenital malformation
  • aggravated by hypertension
  • head injury

7
Stroke and Hemiplegia
  • Right-Hemisphere Stroke
  • The right hemisphere controls the movement of the
    left side of the body as well as analytical and
    perceptual tasks
  • Left-Hemisphere Stroke
  • The left hemisphere controls the movement of the
    right side of the body as well as speech and
    language abilities

8
Stroke and Hemiplegia
  • Cerebellar Stroke
  • The cerebellum controls many of our reflexes and
    much of our balance and coordination
  • Brain Stem Stroke
  • The brain stem is the area of the brain that
    controls all of our involuntary, life-support
    functions as well as abilities such as eye
    movements, hearing, speech, and swallowing

9
Symptoms
  • sudden numbness, weakness face, arm, leg (one
    side of body)
  • sudden severe headache
  • difficulty seeing in one or both eyes
  • confusion, trouble speaking or understanding
  • dizziness, loss of balance/coordination

10
Treatment of a stroke
  • Getting medical help quickly essential!
  • Ischemic stroke
  • "Clot-busters"
  • tissue plasminogen activator (tPA)
  • Must give within 3 hours
  • Hemorrhagic stroke correct cause of hemorrhage

11
Function after Stroke
Function
Time
I
12
Some residual effects of strokes
  • Emotional lability (mood swings, depression)
  • Perceptual effects Difficulty recognizing,
    understanding familiar objects
  • Difficulty planning, carrying out simple tasks
  • Loss of awareness (One-side neglect )
  • Dysphagia (difficulty swallowing)
  • Aphasia difficulty putting thoughts into words
    or understanding speech

13
Risk Reduction
  • lifestyle changes
  • aspirin
  • blood thinning medications
  • carotid endarterectomy (remove plaque)
  • Experimental neurogenesis (regenerating affected
    neurons)

14
Reactions Rehabilitation
  • social isolation
  • grieving process
  • physical, occupational, speech therapy
  • 20 require long-term care
  • Recovery affected by extent of brain damage,
    patients attitude, support system, rehab. team
    skill

15
Voc Rehab and Stroke
  • Estimated that 30 of strokes occur in people
    under 65
  • One study found a 49 RTW rate for people 21-65
    year old
  • Physical factors and aphasia play significant
    roles and complications in vocational planning

16
Voc Rehab and Stroke
  • Some strategies for aphasia
  • Reduction of working hours or territory covered
  • Selective interaction with customers or suppliers
    with whom the person had dealt with prior to
    stroke
  • Reliance on overlearned behavior and language in
    the performance of new tasks
  • Initial help from a relative or close friend
  • Job carving

17
Additional Resources and Information from the Web
  • National Stroke Association (www.stroke.org)
  • American Stroke Association (www.strokeassociation
    .org)
  • National Aphasia Association (www.aphasia.org)
  • Journal of Stroke and Cerebrovascular Diseases
    (www.strokejournal.org)
  • The Brain Attack Coalition
  • (www.stroke-site.org)
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