Early treatment key for stroke victims

CORRESPONDENT
Posted Dec 22, 2008 @ 10:22 AM

Tracy Green realizes he is among the fortunate.

Green had a stroke on Nov. 10, 2007 but didn’t make it into the emergency department until almost two days later, since he lives alone and has no family in town.

Green finally was taken to Memorial Medical Center by his best friend and spent 14 days in the hospital while he was treated successfully through Memorial’s Stroke Center.
Memorial’s Stroke Center refers to the continuum of care a stroke patient receives from the minute they arrive at the emergency department to the last therapy session they receive in the rehabilitation center.

From emergency room physicians to neurologists to therapists, Memorial offers a comprehensive level of care for patients affected by stroke, as well as their family members.

A stroke occurs when a blood clot blocks an artery or a blood vessel breaks, interrupting blood flow to an area of the brain, according the National Stroke Association. Stroke is the third leading cause of death in America and the No. 1 cause of adult disability.

A quick response to a stroke is essential, and there are several symptoms of a stroke that the public should be aware of in order to act fast, said Jennifer Boyer, director of Emergency Medical Services at Memorial.

Signs and symptoms of a stroke include sudden numbness of the face, arm or leg, especially on one side of the body, confusion, difficulty walking, difficulty with speech and sudden dizziness or headaches.

“Once a patient or family member notices any of these symptoms, they need to call 911 or get to emergency care immediately,” Boyer said.

“Care for a blood clot needs to happen within the first three hours.”

Once a patient arrives at the emergency department, Memorial has “stroke protocol,” Boyer said. The patient sees a physician immediately and then is taken for a CT scan to determine whether there is bleeding or a clot. The neurology department also is consulted after the scan results come back; Memorial has a radiologist in-house 24 hours a day.

Later, after a patient’s clot or bleeding is treated, the recovery process begins. Memorial’s Regional Rehabilitation Center provides comprehensive inpatient rehabilitation services and has received accreditation from the Commission on Accreditation of Rehabilitation Facilities in five program areas — including stroke specialty — which is a level achieved by only four rehab centers worldwide.

Rehabilitation for a stroke is a very “intense and acute program,” said Sonali Bhole, stroke rehabilitation program coordinator.

“Every patient has different needs, depending on what part of the brain was affected,” Bhole said. “We require three hours of therapy, and that is spread between occupational, physical and speech therapy.”

Memorial’s rehab department sees about 400 patients a year, and about half of those are stroke survivors, Bhole said.

In addition to the therapists, the multidisciplinary rehab team is comprised of rehab nurses, healthcare psychologists, a therapeutic recreational specialist and social workers.
Green said he underwent one hour of occupational therapy, one hour of physical therapy and two hours of speech therapy for 10 days as an in-patient and continued out-patient therapy until June.

“I had problems with my right hand and right shoulder, but it was mainly my speech; I couldn’t say my own name,” he said. “They worked with me on my name; they tried to get me to tell them what kind of car I had and what month it was. They gave me pictures and asked if I could say what it was.”

Patients also receive leisure therapy, so they can return to their leisure activities, Bhole said. Memorial has a variety of “situations” in place in the rehab department, so that patients can practice everyday life.

Benches, recliners and a car help patients to become accustomed to different types of seating, as well as getting up and down from those seats.

There is also a grocery store set up so that patients can practice bending over to get groceries, checking out, memory and managing their finances when they pay.

“We have the different feels of loose floors, curbs, plush carpets and flat flooring, because all surfaces make a difference in how you hold your balance when you’re walking,” Bhole said.

In addition to the health care provided to stroke survivors, Memorial also has a Stroke Support Group and a Peer Support Group, through which stroke survivors will come to the hospital and speak with the stroke patients in acute rehab. Green is one such survivor who reaches out to fellow survivors through the peer group.

After a stroke, the lives of both the survivor and the caregivers are changed drastically, but through the complete care of Memorial’s Stroke Center, patients are given another chance to resume as much of their lives before stroke as possible.

“We are very connected to what our patients do when they leave rehab,” Bhole said.

“We truly want to get patients back to their life roles.”

———————-

3-hour window
Those believed to be having a stroke should receive medical attention so that medication such as tPA or other treatment can begin.

tPA and other similar drugs must be given within three hours after symptoms start to be effective and reduce the amount of damage to the body caused by a stroke or heart attack. tPA is administered to a patient through an IV line by hospital personnel.

tPA stands for tissue plasminogen activator. It is a thrombolytic agent, which means it breaks up blood clots. tPA has been shown to be effective in treating ischemic stroke, which is caused by blood clots that block blood flow to the brain, and is the only drug approved by the U.S. Food and Drug Administration for the acute treatment of ischemic stroke.

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