Cerebrovascular Accident Health Article

Prognosis

The National Institute of Neurological Disorders and Stroke reports that 25% of people who suffer a stroke recover completely, while 20% die within three months after the stroke. Stroke is fatal for nearly twice as many people of African-American heritage as it is for European-Americans. Of the remaining 55% of people who have strokes, 5% will require long-term (nursing home) care. For the rest, rehabilitative and restorative services will be necessary in order for them to regain as much of their former capabilities as possible.

Brain tissue that dies in a stroke cannot regenerate, and stroke survivors may be left with significant deficits. It has been estimated that the most common irreversible damage from stroke is that done to intellectual functions. But as is increasingly shown, emergency treatment and comprehensive rehabilitation can significantly improve both survival and recovery. In some cases, many functions that are lost due to stroke may be performed by other brain regions after a training period, or compensatory actions may be developed to replace lost abilities.

Health care team roles

Rehabilitation is provided by a team of medical professionals, including the services of a neurologist, a physician who specializes in rehabilitation medicine, nurses to both provide care and assist the physician in coordinating the necessary services the stroke patient needs, a physical therapist, an occupational therapist, a speech-language pathologist, a nutritionist, and a social worker. Rehabilitation services may be provided in an acute care hospital, rehabilitation hospital, long-term- care facility, outpatient clinic, or at home.

Several different physicians may be involved, at one time or another, in the care of the stroke patient:

• A primary care physician (PCP) provides basic medical care to patients.
• A physical medicine and rehabilitation specialist assists patients to recover from or overcome disability or impairment. Often physical therapists work under their supervision.
• A neurologist specializes in disease conditions of the nervous system, and may be consulted to evaluate the extent of actual damage from a stroke.
• In the case of cerebral hemorrhage, a neurosurgeon, a specialist in both neurology and the surgical correction of nervous system damage, may be called upon to do surgery.
• Psychiatrists are licensed medical doctors that are often called upon to evaluate cognitive ability and to treat depression.
• Registered nurses (RNs) or licensed practical nurses (LPNs) are the health care provider that deal most often with the person who has had a CVA. Their duties include taking vital signs and monitoring the patient for complications of the stroke. They also educate the patient and family about the nature of strokes, the importance of preventing contractures and maintaining good range of motion, and about adequate nutrition and fluid intake.
• Physical therapists work with disabled stroke patients to maintain and restore range of motion and strength in affected limbs, and to maximize mobility in walking, wheelchair use, and transferring (for instance, from wheelchair to toilet or from standing to sitting). The physical therapist advises on mobility aids such as wheelchairs, braces, and canes.
• A social worker may help coordinate services and ease the transition out of the hospital back into the home, or into an extended care facility, if necessary. Social workers may help counsel the patient and family during the difficult rehabilitation period.
• Nutritionists educate stroke patients about eating nutritious foods and following through on a therapeutic diet as ordered by the physician.
• Occupational therapists help stroke patients to relearn muscular control and coordination in order to carry out normal activities of daily living such as bathing, dressing, and preparing meals.
• Speech-language therapists assist stroke patients who have damage to the speech center in the brain.
• Clinical laboratory scientists draw blood samples or test urine or sputum specimens that are ordered by the physician.
• Radiologic technologists take x rays, CT scans, and MRIs to visualize and monitor the brain or other affected organs after a stroke.

All health care team members are aware that the person who has suffered a stroke and the family members who may care for the person at home will need to learn entirely new sets of skills and adaptations. Both the patient and family often experience stress, anxiety, and depression. They may need to learn about physical and mental symptoms that are common in stroke patients, and the family may even need to learn how to deliver necessary care. Support groups can provide an important source of information, advice, and comfort for stroke patients and for caregivers. For the stroke patient, joining a support group can be one of the most important steps in the rehabilitation process.