by Stephanie
Davis, Undergraduate Student, University of Florida
"Annually,
700,000 people in the United States suffer from a stroke,
or 1 person every 45 seconds, and nearly one third of these
strokes are recurrent (Gordon, Gulanick, Costa, Fletcher,
Franklin, Roth, Shephard, 2004, p1)." Strokes
are temporary blockages of air and blood to the brain. Currently,
75 percent of strokes
occur in people over the age of 65. The incidence of stroke
is likely to increase due to the growing elderly population.
Some common risk factors for strokes are hypertension,
smoking,
high total cholesterol,
diabetes (type
1) (type
2), family history, age, gender, obesity,
diet,
ethnicity, regular heavy
drinking, and a sedentary lifestyle (HSC4579). Once a
stroke occurs, it can cause a survivor immense physical, mental,
and emotional distress. This paper will discuss the different
types of strokes (slideshow),
the areas of the brain that are affected, the signs and symptoms
of a stroke, and the adapted physical activities that can
be implemented to increase their quality of life.
There are four general types of stokes. Strokes are either
caused by a hemorrhage or clot. The strokes caused by a clot,
ischemic
and embolisms
are the most common and account for around 80 percent of all
strokes (UT Medical Center, 2011). Hemorrhages are caused
by ruptured vessels and are less common, but much more fatal.
Either a blood vessel on the actual brain will rupture, called
a subarachnoid
hemorrhage, or an artery in the brain will rupture because
of an aneurysm
or a head injury, called a cerebral
hemorrhage (UT Medical Center, 2011).
The most common type is an ischemic
stroke. This occurs when an artery that is carrying blood
to your brain is blocked. This can cause temporary or permanent
damage to parts of the body. The second type is a hemorrhagic
stroke, which occurs when a weakened blood vessel in the brain
ruptures. A transient
ischemic attack is known as a “mini-stroke.”
This stroke typically only last for a few hours and is a good
predictor that a serious stroke will occur in the victim's
future. While they aren't as serious, they can be fatal if
a person has a series of them. Lastly, an embolic stroke occurs
when a clot forms in another body part, typically the heart,
and travels to one of the brain's arteries (UT Medical Center,
2011).
When any of these stokes occur the brain is temporarily deprived
of blood and oxygen, which will kill an area in the brain.
If a person has a stroke that affects the right hemisphere
of the brain, the left side of the body may be impaired. The
person may have hemiplegia
of the left side, or hemiparesis
of the left arm or leg. This means that the person can also
be visually impaired on the left side and may not see objects
or people in their left field of vision. Facial weakness on
the left side may also result in slurred speech and dysphagia,
which leads to trouble swallowing (UW Dept. Nursing, 2012).
"Over 80% of people who experience damage to the right
side of their brain due to stroke will show something rather
strange; they will behave as if the left half of the world
simply isn't there. They might fail to respond to someone
approaching them from the left, or completely ignore one side
of their body. Similarly, about 60% of patients with damage
to the left side of their brain will experience these problems
on their right (Smith, 2004, p1)." This is known as unilateral
spatial neglect (Smith, 2004).
The right side of the brain is correlated with judging distances,
speed, and position. If a person has a right brain stroke
they may misjudge distances. For example, he may be getting
into a car. As he attempts to step into the vehicle he may
misjudge the distance from the foot ledge to the ground, misstep,
and fall (UW Dept. Nursing, 2012).
A person with damage to this side of the brain may also struggle
in making decisions. They become very impulsive, which can
be dangerous. They may make a decision without fully thinking
through the consequences. They also have trouble understanding
that they are impaired from the stroke. They may think that
they can easily do the same tasks they did before the stroke
happened, and not fully understand damages that the stroke
has caused to their bodies (UW Dept. Nursing, 2012).
The right side of the brain is also associated with short-term
memory. A person who has suffered from a stroke damaging the
right hemisphere can remember things that happened to them
many years ago, but may not remember what they had for their
last meal or what they did ten minutes ago. This will also
affect their ability to learn new things and affect their
attention span (UW Dept. Nursing, 2012).
A left-brain stroke will affect the right side of the body,
sometimes causing right hemiplegia. People may also have problems
with comprehending language and speaking problems, commonly
known as aphasia.
Unlike a right-brain stroke, a left-brain stroke causes cautious
and slow behaviors, which can make it very difficult for the
person to complete tasks on their own. People who have suffered
from a left-brain stroke may require a considerable amount
of help from a caregiver (Wexner Medical Center, 2012).
Learning new things and certain subjects is particularly
hard for people suffering from a right-brain stroke. They
may not have the ability to analyze, organize, and reason.
They also may have long and short-term memory loss, making
it hard for them to recall old and new information (Wexner
Medical Center, 2012).
The cerebellum
is located in the back portion of the brain behind the right
and left hemispheres. It primarily controls coordination,
fine movements, and balance. Damage to this area can cause
an inability to walk, balance, and coordinate movements, commonly
known as ataxia.
This leads to dizziness that is so extreme that it can cause
nausea, vomiting, and headaches (Wexner Medical Center, 2012).
The first step to treating someone that has suffered from
a stroke
is being aware of the signs and symptoms for early diagnosis.
Some common symptoms include tingling in the face, slight
to severe headache, numbness or weakness in the face, leg,
or arm (typically on one side), dizziness, problems swallowing,
trouble speaking, and vision difficulty. One easy acronym
to remember to test a person for stroke-like symptoms is FAST
(HSC4579):
F - Face - Ask the person to smile. Look
for drooping on one side of the mouth. A - Arms - Ask the person to raise both arms.
Look for one arm that drifts down. S - Speech - Ask the person to recite and
easy sentence or song like the 'ABCs.' Look for slurred or
abnormal speaking. T - Time is critical!! Call 9-1-1 immediately!
If any of these signs or symptoms are present, call 9-1-1
or provide appropriate care if you are trained to do so. The
victim will benefit most from immediate treatment.
Treatment of a stroke depends on its severity. Many times
doctors will prescribe medications to control blood pressure
and make sure that the condition is stable. The good news
is that the brain is capable of changing through rehabilitation
in some cases. Remarkably, brain cells can regenerate and
repair themselves within weeks of the stroke. New blood vessels
can form, and neurons can travel to the locations where the
brain is damaged in order to aid in the restoration process.
Other areas of the brain will also begin to take over the
jobs that the damaged areas provided for the body prior to
the stroke (University of California, 2006).
Once the patient is given the proper medication and is stable,
it is important to choose a rehabilitation program that will
help the patient regain their independence. Regular physical
activity will improve heart function, lower cholesterol, and
reduce hypertension. These are most likely reasons that the
stroke occurred in the first place, thus reducing the risk
for another incidence. There can be a variety of specialists
involved in this process such as occupational therapists,
physiotherapists, speech and language pathologists, psychologists,
and many more.
These specialists will have adapted physical activity and
exercise therapy recommendations. "Early onset of active
and moderately vigorous rehabilitation, especially of weight-bearing
activities, could be expected to influence not only the rate
and extent of physical recovery, but also to have a role in
minimizing cognitive deterioration, depression, and anxiety
(Carr & Shepherd, 2011, p2)."
At first, the patient may need to start with small activities,
such as sitting up and getting out of bed. Mastering daily
activities is key because the ultimate goal is to allow independence
for the individual. These activities include grasping a utensil,
brushing hair or teeth, unzipping or buttoning clothes, practicing
facial expressions, cooking, and cleaning (Carr & Shepherd,
2011).
Once daily activities are mastered, therapists should work
on the patient walking certain distances while supporting
his body weight. A common adapted physical activity to achieve
this goal is using a treadmill with a body weight support
harness secured overhead. This allows the individual to walk
independently and eventually be able to support his own weight
while doing so. This will also improve aerobic and muscular
endurance (Carr & Shepherd, 2011).
The American Heart Association also recommends two to three
days a week of resistance exercises to improve strength. The
patient could lift weights, use weight machines, or use resistance
stretch bands (Gordon, et al., 2004).
Many people who have had a stroke struggle with their balance,
flexibility, and coordination. Because of this, patients always
need to remember to practice stretching exercises at least
two to three days a week. Adapted yoga or propriceptive
neuromuscular facilitation (PNF) stretching, which uses
a partner to apply resistance during stretching in order to
release muscles, are some physical therapy activities that
can be used to improve balance and coordination (Gordon, et
al., 2004).
Stephanie Davis was born in 1991 in Saint Petersburg, Florida.
She is currently attending the University of Florida, anticipating
her Bachelor of Science in Health Education in May 2014. She
is fascinated with the medical field and loves working with
children. After graduation, she plans to attend nursing school.
She was a lifeguard and swim instructor for three years for
the City of Saint Petersburg. She volunteers at Shands hospital,
Sidney Lanier, and Camp Boggy Creek. Currently she is employed
as a camp counselor for Gladden Park Recreation Center in
Saint Petersburg. Stephanie enjoys swimming, playing tennis,
and all outdoors activities.
"Annually,
700,000 people in the United States suffer from a 