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Stroke - CVA Treatment

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Treating a TIA or stroke is a medical emergency.  You should call 911 for ambulance transport to a hospital.  The emergency room doctors will assess what type of stroke is occurring or has occurred and provide treatments to sustain life and achieve medical stability.  Treatments for stroke differ and depend on the type of stroke, the severity of a person’s condition, and any associated medical conditions.
 
It may be difficult for emergency personnel to determine if a person is having a TIA or a stroke.  However, prompt evaluation and treatment is necessary for both.  Ideally, TIAs need to be treated within 60 minutes from the start of symptoms.  Doctors can use medication or surgery to reduce the risk of stroke for people experiencing a TIA. 
 
If a clot causes a stroke, thrombolytic medication to break up clots can be provided—but this medication has strict administration criteria.  The clot dissolving medication should be given within three hours of when the stroke symptoms started.  This can save your life and help prevent disability.  Other blood thinning medications may be used for people that are not candidates for thrombolytic medication.
 
If bleeding in the brain causes a stroke, the emergency room team will carefully monitor a person’s vital signs and pressure in the brain.  They will provide medical treatments to control blood pressure, blood sugar levels, brain swelling, and seizures.  In some cases, surgery may be required to remove the excess blood in the brain, repair a brain aneurysm, and repair blood vessels. 
 
Sometimes a stroke results in a coma, a condition when a person is not alert and does not respond to stimuli.  Some people may not be able to breathe on their own and will require a respirator, a machine that breathes for them.  Other people may remain alert, but be medically fragile.  In most cases, people are transferred from the emergency room department to the Intensive Care Unit (ICU) of a hospital.  The ICU staff carefully monitor individuals for vital signs and brain swelling.  The goals of the ICU staff are to maintain life and medical stability, while preventing further medical complications. 
 
Occupational and physical therapists may work with people in the ICU to provide preventive treatments.  The therapists use passive range of motion (PROM) exercises to gently move and stretch a person’s muscles to improve circulation and to keep the muscles healthy.  This prevents the muscles from contracting, which can result in deformities.  The therapists may also provide splints or casts to help maintain body positioning.
 
Recovery from stroke is different for everyone.  It depends on many factors including the severity of the stroke, the location of the stroke, the functions of the brain area affected by the stroke, the condition of your brain and nervous system at the time of the stroke, and your other medical conditions. 
 
Treatment and rehabilitation will differ for everyone.  It takes a long time to recover from a stroke.  Generally, the fastest progress takes place within the first year, although healing continues to take place after that. Many people never fully recover from a stroke, but with assistance and adjustments, they can lead full and happy lives.
 
It is common for people to have partial or complete impairments following a stroke.  Depending on the deficit, they may need assistance, such as a cane to help them walk or another person to help them figure out their bills.  Some people may be able to return to living in their home or others may need the help of others at a care facility.  It is common for people to transfer from various facilities and levels of care during their recovery process. 
 
When a person is medically stable and able to remain alert and follow simple instructions, they are transferred from the hospital to an acute inpatient rehabilitation unit for therapy. People typically stay in an inpatient rehabilitation center for days to several weeks.  Because a stroke can affect how a person thinks, acts, moves, and feels, rehabilitation may be necessary to help a person attain abilities that were lost or impaired by a stroke. 
 
In rehabilitation, a team of healthcare professionals with expertise in stroke care help people achieve their highest level of independent functioning for Activities of Daily Living (ADLs).  ADLs include basic tasks such as walking, dressing, swallowing, and talking.  It also includes behavioral and thinking skills necessary for independent living and socialization.  The rehabilitation team works together on goals and meets regularly to monitor a person’s progress.
 
A rehabilitation team includes several healthcare professionals.  The team is usually lead by a Physiatrist, a doctor who specializes in physical rehabilitation medicine.  Physical Therapists work on improving muscle strength, flexibility, and coordination.  They focus on skills such as walking and balance.  Occupational Therapists use purposeful activities to help people obtain independent and meaningful daily living.  They focus on physical, emotional, and cognitive challenges, including feeding, dressing, thinking skills, and visual training.  Speech Language Pathologists work to improve a person’s ability to talk and comprehend what is seen or heard.  Speech Language Pathologists or Occupational Therapists work with people to improve swallowing abilities. 
 
Other rehabilitation team members include Rehabilitation Nurses, Recreational Therapists, Neuropsychologists, and Case Managers or Social Workers.  Rehabilitation Nurses work with people on goals to improve functioning and monitor their medical status. 
 
Recreational Therapists provide goal oriented leisure activities to improve social skills, muscle movement skills, and enhance self-esteem.  They regularly plan activities in the community where people may apply the skills they learn in rehabilitation.  Types of recreational therapy include pet therapy, wheelchair sports, and special social functions.
 
Neuropsychologists focus on the way the brain functions.  They assess the way the brain processes thoughts, emotions, and behavioral information.  They work with people to help them improve brain functioning and adjust to setbacks.  Their reports are important for discharge planning, return to school, and return to work.
 
Case Managers or Social Workers communicate with individuals and their families regarding treatment goals and planning.  They work with individuals and their insurance companies to assure cost-effective treatment.  Case Managers or Social Workers also facilitate discharge planning.
 
The discharge destination from rehabilitation varies and depends on an individual’s skill level, safety awareness, and the level of care that they need.  Some people may return to their homes to live independently or with supervision or a little help from their family or friends.  Other people may need more time to heal and are discharged to a subacute rehabilitation center to continue to work on therapy.  For people that need assistance or are completely dependent on the aid of healthcare professionals, discharge destinations may include skilled nursing homes, nursing homes, assisted living centers, supervised living centers, or Veterans’ homes. 
 
In addition to rehabilitation after a stroke, your doctor will manage your health to help prevent another stroke.  This may include monitoring and treating atrial fibrillation, high blood pressure, diabetes, and cholesterol.  Your doctor may also monitor and treat you for depression.  Depression is common for people that have experienced a stroke.  Depression is a real medical condition that is treatable.  Depression may cause you to feel sad, irritable, tired, and uninterested in activities that you used to find enjoyable.  You may also experience appetite changes, sleeping problems, and have trouble remember things or concentrating.  You should discuss any symptoms of depression with your doctor.  Your doctor will be able to provide you with medications or a counseling referral to help you.
 
The experience of stroke can be an emotional process for the patient and their loved ones. It is important that you receive support.  Some people find comfort in their family, friends, co-workers, and place of worship.  Stroke support groups are another good option.  They can be a good source of information and support from people who understand what you are experiencing.  Ask your doctor for stroke support group locations in your area.

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