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Stroke Recovery And Rehabilitation



A stroke is a brain attack. It is a sudden interruption of continuous blood flow to the brain and a medical emergency. A stroke occurs when a blood vessel in the brain becomes blocked or narrowed, or when a blood vessel bursts and spills blood into the brain. Just like a heart attack, a stroke requires immediate medical attention.




Stroke Recovery and Rehabilitation



Strokes can be prevented and treated. Making lifestyle changes and getting regular medical and prenatal care can help prevent stroke and significantly reduce the risk for other disorders such as dementia, heart disease, and diabetes.


People who have a stroke may not realize what is happening to them or mistakenly choose to ignore the signs, thinking the problem will pass. Even when people know there's a problem, they may not be able to call for emergency help on their own. The people around them might not know what is happening either, but they may recognize that something is wrong.


The brain is nourished by one of the body's richest networks of blood vessels. A blockage or rupture in one of these blood vessels may occur in any area of the brain. Since each area is responsible for different functions, the effects of stroke may range from mild to severe disabilities depending on the type, severity, and location of the stroke. The symptoms may be temporary or permanent.


There are two main types of stroke. Ischemic stroke, the most common type in the U.S., accounts for approximately 80 percent of all strokes. The other kind, called a hemorrhagic stroke, accounts for the remaining 20 percent.


Acute ischemic damage can also provoke inflammation, swelling (edema), and other processes that can continue to cause damage for hours to days after the initial insult. In large ischemic strokes, the swelling can cause the pressure inside the skull to rise to dangerous levels.


When an artery in the brain bursts, blood gushes into or around the brain, damaging the surrounding tissue. This is called a hemorrhagic stroke. The blood that enters the brain increases the pressure inside the skull (intracranial pressure) that can cause significant tissue damage. The mass of blood compresses the adjacent brain tissue, and the toxic substances in the blood mass further injure the brain tissue.


Conditions such as chronic high blood pressure (hypertension) and cerebral amyloid angiopathy (a buildup of the protein amyloid on the inside wall of blood vessels) can cause blood vessels to burst. Irregularities in the brain's vascular system (the network of arteries, veins, and smaller blood vessels) can also cause hemorrhagic stroke.


Arteriovenous malformations (AVMs) also increase the risk of hemorrhagic stroke. An AVM is an abnormal, snarled tangle of defective blood vessels within the brain that cause multiple irregular connections between the arteries and veins. The irregular connections allow arterial blood to travel directly to veins instead of first passing through a fine web of tiny capillaries. The blood flow through AVMs is exceedingly high and can cause the vessels to rupture.


Each year nearly 800,000 Americans have a stroke, and about 600,000 are first strokes. Once a person suffers a first stroke, the risk of another stroke increases. The risk of a recurrent stroke is greatest right after a stroke and decreases with time. In fact, about 25 percent of people who recover from their first stroke will have another stroke within five years, and approximately three percent of individuals with stroke will have another stroke within 30 days of their first stroke. Overall, one-third of recurrent strokes take place within two years of the first stroke.


Some risk factors for stroke apply only to females. These include pregnancy, childbirth, and menopause. These factors are tied to hormonal changes that affect females at different stages of life. In females of childbearing age, stroke risk is relatively low (with an annual incidence of one in 10,000). However, studies have shown that pregnancy increases that risk three times.


Infants and children who have a stroke will experience symptoms that are similar to those in adults such as headache, hemiplegia (paralysis on one side of the body), and hemiparesis (weakness on one side of the body). However, children are more likely than adults to have other symptoms, including seizures, breathing problems, or loss of consciousness.


Risk factors for childhood stroke include congenital (present at birth) heart problems, head trauma, and blood-clotting disorders. An important risk factor for Black children is sickle cell anemia (a genetic blood disorder characterized by red blood cells that take on a sickle or crescent shape and block arteries). In addition to anemia, the disorder can cause joint pain, swollen spleen, frequent and severe infections, and narrowing of brain arteries.


The outcome of stroke in children is difficult to predict. A stroke during fetal development may lead to cerebral palsy. A stroke that occurs during infancy or childhood can also cause permanent disability. Generally, outcomes are worse in children under age one and in those who experience decreased consciousness or seizures.


Children who have a stroke generally recover better than adults after treatment and rehabilitation. This is due in part to the brain's plasticity, or its ability to reorganize, change, and adapt to deficits and injury, and to rewire itself to carry on necessary functions.


Some people are at a higher risk for stroke than others. Understanding the risk factors and working on them may help prevent a stroke. Generally, stroke risk factors fall into two categories: unmodifiable or modifiable.


Modifiable risk factors are those that can be changed or controlled to prevent or reduce the risk of stroke. The most important modifiable risk factors for stroke are high blood pressure, heart disease, diabetes, and smoking. Others include heavy alcohol use and high cholesterol. Stroke is preventable and treatable. A better understanding of the causes of stroke has helped people make lifestyle changes that have cut the stroke death rate nearly in half in the last two decades.


Making lifestyle changes can reduce a person's risk of stroke. It is important for individuals to not stop taking their medications without first speaking with and getting approval from their healthcare provider. Stroke can be caused by people stopping their medications without medical guidance. The following are considered modifiable risk factors in preventing stroke:


Doctors use several tools to help diagnose stroke quickly and accurately. The first step is a neurological examination, which is an observational ev