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Specialists Focus Upon Aiding the Recovery of Stroke Victims
By Rosemarie Scolaro Moser, PhD & Claire Smith, RN

Recently, several high-profile cases involving stroke---including Israeli Prime Minister Ariel Sharon, Coretta Scott King and television personality Dick Clark---have focused national attention on this potentially debilitating condition. 

The common term “stroke” is actually applied to several very different conditions, 
with different causes. 


The most common form of stroke, known as ischemic stroke, occurs when the blood supply is cut off to an area within the brain, and brain cells begin to die due to oxygen deprivation. Less common, but often more deadly, are hemorrhagic strokes, which occur when a blood vessel or artery bursts, causing bleeding in the brain. 


Each year in the United States, there are more than 700,000 strokes. Stroke is the third leading cause of death in the country, causing more serious long-term disabilities than any other disease. Nearly three quarters of all strokes occur in people over the age of 65. The risk of having a stroke more than doubles each decade after 55. For African Americans, the risk of stroke is greater and more deadly---even in young and middle-aged adults. 

While strokes can be life-threatening and debilitating, new treatments are available that can greatly reduce damage to the brain. The key to minimizing stroke damage is recognizing the signs of a stroke and getting medical treatment with in the first hour of symptoms. 


Signs of a possible stoke include: 

  • Numbness or weakness of the face, arm or leg (especially on one side); 

  • Confusion, trouble speaking or understanding speech; 

  • Unexpected trouble seeing in one or both eyes; 

  • Difficulty walking, dizziness, loss of balance or coordination, and 

  • Sudden severe headache with no known cause. 


The longer blood flow is cut off to the brain, the greater the damage. Also, many of the new treatments for stroke patients are time-sensitive---meaning there’s a limited window of opportunity for treatment. Clot-busting drugs, such as tPA (tissue plasminogen activator) are effective in treating patients suffering from ischemic strokes, but must be administered within three hours from the start of symptoms. 


Despite advanced treatments for stroke, many victims are left with functional problems. The severity of damage often depends on the size and part of the brain impacted. Patients often suffer from full or partial paralysis, and difficulty thinking or speaking, as well as emotional or behavioral problems. 


Comprehensive stroke rehabilitation can improve the functional abilities of stroke survivors, often helping people resume independent living. In fact, that is the goal for stroke patients at Merwick Care Center, a unit of Princeton HealthCare System (PHCS), located in Princeton. In this facility’s 17 bed acute rehab unit, stroke patients undergo intensive therapy focused on helping them overcome their particular brain injury and its resulting deficits. 


Upon admission, patients undergo a comprehensive evaluation by a team of rehabilitation experts including a neuropsychologist, occupational therapist, physical therapist, speech pathologist, rehab nurse and physiatrist. 

Neuropsychologists use diagnostic tests to determine the specific location of the brain damage and how the patient’s thinking, behavior and emotions are affected. With a comprehensive understanding of brain function, they can translate how damage to a specific area of the brain pertains to cognitive weaknesses. 


For example, damage to the left side of the brain may be associated with language problems. In the back of the brain, or occipital lobe, damage may result in difficulty with visual processing. The front part of the brain affects planning or decision-making functions, while the temporal area (side of the head) affects memory. 


Patients undergo comprehensive testing and evaluations to help pinpoint specific and often subtle, cognitive damage caused by stroke. 


The neuropsychologist works with the rehab team to incorporate specific tasks into therapy to redevelop these functions. Neuropsychologists often help to facilitate rehabilitation, assisting rehab team members to find more effective ways to communicate and engage patients whose thought processes have been impacted by stroke.


In addition to the neuropsychological assessment, patients undergo extensive evaluations to determine the stroke’s impact on their ability to function. Occupational therapists assess patient’s ability to complete the basic activities of daily living. Physical therapists look at mobility issues, and speech pathologists perform cognitive assessments, evaluate speaking ability and/or any swallowing difficulties. 


All of this information is taken into account by team members, who then develop a highly focused, comprehensive rehabilitation plan for each patient. Every day, patients undergo intensive rehabilitation that might include re-educating muscles, re-learning how to walk, speak or swallow, strengthening upper and lower extremities, learning new ways to do regular activities or learning the use of adaptive equipment. 


Merwick Care Center’s staff of rehabilitation nurse extends the benefits of therapy to 24/7 by incorporating rehabilitation goals into the practical application of daily care. These highly skilled nurses facilitate each patient’s progress by providing an exceptional level of compassionate care, while encouraging their patients’ independence. 


On average, inpatient rehab lasts from two to five weeks, depending on the severity of stroke and residual damage. While patients with more serious deficits may continue therapy in a sub-acute environment, ideally the goal of rehab at Merwick is to achieve a community discharge---to send patients home. Additional services are available through PHCS’s continuum of care for stroke patients, including outpatient rehab or home care. 


Ultimately, the recovery process following stroke may take a year or more at various levels of care, but with new treatments and comprehensive rehabilitation, recovery from stroke---and a return to a productive and rewarding life---is possible. 


The Princeton Packet - Friday, January 20, 2006 

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