1. Stroke Christina M. Allen May 8, 2006

2. Impact of Stroke • Approximately 700,000 Americans suffer from a new stroke or recurrent stroke each year • Strokes kill nearly 157,000 each year • Stroke is the number 3 cause of death • For every 5 stroke deaths, 2 are men and 3 are women • 1/5 of all stroke victims will develop mental disabilities

3. Types of Stroke • Clot (Ischemic) • 83% of all cases • Result of an obstruction within a blood vessel supplying blood to the brain • Due to the development of fatty deposits lining the vessel walls, called atherosclerosis • Fatty deposits can cause cerebral thrombosis or a cerebral embolism

4. Types of Stroke • Bleed (Hemorrhagic) • 17% of all cases • Results from a weakened vessel that ruptures and bleeds into the surrounding brain • Two types of Hemorrhagic strokes: intracerebral and subarachnoid • Two types of weakened blood vessels: aneurysms and arteriovenous malformations

5. Effects of Stroke • If a stroke occurs and blood flow cannot reach a region that works a particular body function, that part of the body will not work as well. • Right Brain • Paralysis on left side • Vision problems • Quick, inquisitive behavioral style • Memory loss • Left Brain • Paralysis on right side • Speech/language problems • Slow, cautious behavioral style • Memory loss

6. Communication Complications • Aphasia • Results from damage to language centers to the brain • Impaired ability to use or comprehend words • Understanding words • Finding words to express a thought • Understanding grammatical sentences • Reading or writing words or sentences

7. Communication Complications • Apraxia • Difficulty initiating and executing voluntary movement patterns necessary to produce speech without paralysis • Difficult to: • Produce desired speech sounds • Using correct rhythm and rate of speaking

8. Communication Complications • Auditory Overload • Many skills are needed to translate sounds and it can sometimes be overwhelming • The brain cannot decipher meaningful speech from noise • Dysarthria • Slurred speech • Affects pronunciation, quality and loudness of voice, and ability to speak at a normal rate

9. Communication Complications • Vascular Dementia • A decline in ability as a result of a stroke or many small strokes • Symptoms: • Memory loss • Confusion • Mood Swings and personality changes • Language problems • Difficulty paying attention or following conversation • Impaired motor skills • Visual problems • Difficulty making decisions and solving problems • Depression

10. Memory Madness • Association • To recall something more easily, associate it with something you already know or remember • Visualization • Form a picture of the thing you want to remember • Repetition and Rehearsal • Repeat new info to yourself several times • Compensation • Write it down!

11. Ways of Communicating • Ask yes/no questions • Paraphrase periodically during conversation • Modify length of conversation • Use gestures to emphasize important points

12. Behavior Interventions • Treat the person with respect • Offer praise • Give the person choices • Be assertive and set necessary limits

13. Personal Experience During my internship in cardiac rehab, we had a patient who had had a stroke prior to her heart attack. When she would come into rehab, she never remembered why she was there. Each day I would tell her to get her folder and I would help her fill out the exercise log. She never wanted to exercise and she had the quickest come backs. Every day we had to help her with her exercise prescription and help her remember what she was to do in rehab.

14. How I Communicated with her… • Slow, clear speech • Repetition • Short explanations but to the point • Short reminders on her folder • Hugs…in order to make her happy to be there 

15. References • American Stroke Association • www.strokeassociation.org • National Stroke Association • www.stroke.org • Stroke, Journal of the American Heart Association • www.stroke.ahajournals.org