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Tuesday, December 01, 2020

Dealing with long-term disability due to delayed treatment of ischemic stroke

Ischemic stroke is mainly caused by the blockage of an artery, which reduces the flow of blood and oxygen to the brain

By: Lifestyle Desk | New Delhi | November 1, 2020 7:10:28 pm
strokeThree levels of disabilities could impact an individual affected by the stroke. (Photo: Getty)

While there are three main types of strokes, it is the ischemic stroke — caused by the blockage of an artery, which reduces the flow of blood and oxygen to the brain — which leads to damage or death of brain cells.

Dr Rajesh Benny, Consultant-Neurology at Fortis Hospital, Mulund says when it comes to the acute treatment of ischemic stroke, timing is everything. “For every minute of delay in seeking treatment for stroke, 1.9 million neurons die! In cases with completed reperfusion in acute ischemic stroke, 1.2 billion neurons die. One-third of those who survive a stroke are left with severe and lasting disabilities,” says Dr Benny.

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He further explains that there are three levels of disabilities that could impact an individual.

Physical impairment

Those who suffer from ischemic stroke tend to have significant disabilities. “In those with dominant brain strokes (left side in most individuals), along with the weakness on the right side, they have residual language issues (difficulty in comprehending or expression) and often swallowing issues,” the doctor says. He adds that there can be additional issues related to the bladder and bowel control.

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Cognitive impairment

“Cognition and memory abnormality is seen commonly after a major stroke or those involving strategic areas of the brain. Up to 30 per cent of survivors can have lasting cognitive impairment leading to dementia in the years to come, the doctor explains.

Emotional and behavioural impairment

Those who are disabled by stroke often feel guilty for taking help, thus ending up being frustrated and anxious. As a result, it often leads to emotional outbursts which can be distressing for both the patient and their caregiver. “Early stroke rehabilitation is important after an acute stroke. Depending on the dominant disability (weakness, loss of coordination, swallowing problems, bladder bower control, or emotional/ cognition deficits), exercise regimes are planned accordingly.”

Dr Benny points out that successful stroke rehabilitation is also dependent on the patient’s mood and motivation, along with support from loved ones. He suggests that “stroke rehabilitation should start in the hospital’s inpatient rehabilitation unit, on discharge in the outpatient unit and eventually, home-based programs should be planned”.

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What is involved in stroke rehabilitation?

When working on the rehabilitation process, two aspects are focused on — improvement of physical function, along with cognition and psychological treatment. This is done by incorporating motor skill exercises. “These are aimed to improve limb muscle strength, coordination, and also swallowing exercises. The physiotherapist can take the help of technology to improve motor function in selected muscles: use of a computer or video games to simulate real-life situations like cooking, picking up objects from the floor, or crossing the road, to train the brain in a better manner,” explains the doctor.

Alongside, a trained psychologist also works in helping the patient get adjusted to their disability, and also keep them motivated for rehabilitation. “Patients need to be reassessed periodically for stiffness in the limbs or use of anti-depressants to improve outcomes from the rehabilitation program,” Dr Benny concludes.

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