Stroke Management And Rehabilitation: Current Practices And Strategies

Empowering Older Adults with Stroke through Self-Care and Self-Management Education

Question:

Discuss about the Non Communicable Disease for Clinical Condition.

Stroke is a clinical condition in which sudden interruptions to the blood flow in the particular area of the brain results in sudden numbness, weakness, paralysis and speech difficulty in patients. The chance of a stroke increases with age and for people above 50 years old, the likelihood of stroke doubles (Jauch et al. 2017). Older adults above 50 years age with stroke can be empowered to promote their personal health by means of self care and self management education. For older adults with stroke, managing self care needs become a major problem and nurses can play a role in teaching patient about self care responsibility for living with the disease. Education mainly in the area of doing daily activities, changing behaviour, understanding the disease complications and nutritional needs empower patient to maintain their health (Aslani et al. 2016).

According to Parke et al. (2015), the five self management skills that stroke patients require include problem solving, taking adequate actions, contact with health care providers, effective resource utilization and adapting appropriate health behaviour. As older patients above 50 years old mainly tend to develop cognitive impairment, self management intervention mainly focus on training in ADL, supporting patient with adaptive equipment and providing remediation training. During self management support, patients are taught to deal with psychological responses and managing emotional stress due to the disease. Research evidence also suggests that changes in physical fitness and physical activity is also crucial to maintain health of older patients with stroke. Incorportating yoga in self management interventions provide self management  efficacy to patients (Portz et al. 2016).

There are many types of services available to support successful management of people with stroke. The first service available for people living with stroke is the rehabilitative service. This service is started after acute care in stroke units. The main purpose of post stroke rehabilitation is mainly to build the strength and capacity of people in self care skills, mobility skills, communication skills, cognitive skills and social skills. Community based rehabilitation may include various types of service such as physiotherapy or speech and language therapy (Winstein et al. 2016). Support in the area of healthy eating and maintaining healthy lifestyle minimize the chances of another stroke. Adult social services are also involved to enhance leisure and social interaction in this group of patients.

The Importance of Self-Management Skills for Stroke Patients

Services are also available for carers and their families of patient with stroke so that they get the necessary information to maintain independence and enhance coping skills in people with stroke. The advantage of this form of support for carer is that they get access to general information of the disease and other ways to provide emotional support to patients. Example of other services as part of rehabilitation program for stroke includes nutritional care, psychology, social work, support groups, audiology and recreational therapy. The advantage of recreational therapy is that it help patients to get back to their pre stroke lifestyle and activities (Post-Stroke Rehabilitation 2017). 

Australia has a national strategy for heart, stroke and vascular disease and the main goal is to maximize the opportunities for prevention of heart, stroke and vascular disease through the uptake of evidence based strategies that are disseminated specifically for the general population, those at high risk and people suffering from the disease. Due to the magnitude of death and illness due to heart, stroke and vascular disease, taking preventive steps became necessary. The population based strategies include:

• Taking coordinated step to promote physical activity and healthy eating in the population to minimize the risk of the disease
• Engage in strategies to control risk factors of disease such as tobacco consumption and smoking
• Taking support initiatives to provide good nutrition and physical activity to people living in remote areas

The national strategy for people at high risk of stroke included:

• Focussing on specific health promotion programs for Aboriginal and Torres Strait Islander people
• Taking targeted strategies for people with mental health condition and lacking social support
• Creating awareness regarding the management of atrial fibrillation and stroke
• Developing informative tools to empower health care staffs to assess risk of disease

In case of people, already having the disease, the strategy is to promote best practice in medication and lifestyle management and minimizing the chances of another stroke event. The Australian government also focused on addressing all barriers to recognition and treatment of depression in people with stroke (National Strategy for HSVH in Australia. (2017).

Different stroke survivors after releasing from the hospitals are advised to take on rehabilitation services. Rehabilitation services although planned for a certain fixed amount of time are often can never ensure that the conditions of the patient will get better within the stipulated time. Mostly the services extend beyond the stipulated time probably because they do not closely analyze the patient needs when they admit to the ward. Proper diagnosing of the patients requirements and needs after thoroughly assessing his conditions are present in very few services and therefore this is a gap which needs to be fulfilled by such services.

The services fail to identify the pace of recovery that fits with the needs and abilities of the patients. Patient usually move through different levels of care during their recover and proper distinctions between them is significant. There is often failure from the part of service providers in deciding the right setting for the rehabilitation services. Often gaps in identifying the different elements for rehabilitation in a disciplined systematic approach are not followed. Need to overcome the gap to identify the severity and unique characteristics of the physical abilities caused by stroke to a particular patient are important to provide person centred care. Often presence of other medical conditions like kidney diseases, arthritis and hart diseases are also necessary and so the multidisciplinary team should be well prepared (Kakkar et al. 2013).

Available Services for Successful Stroke Management

Moreover this services as go on for long prod between the stipulated dates, often huge financial flow takes place and therefore there is gap in developing insurance coverage which would help such patients. Incorporating family members like by properly empowering them of health literacy is important.

A stroke is a form of disorder which can attack anyone at any time. It mainly takes place when the flow of blood is cut off from reaching a particular area. When such an incidence takes place, the cells of the brain do not get oxygen as blood carries the oxygen. These cells then start to die. The activities which are controlled by that part of the brain get eventually impaired (Jauch et al. 2013). Therefore, it is seen in many cases that memory of a person after stroke is lost or the controls of the muscles also gets lost.

The degree by which a person is affected by stroke depends entirely on the location of the brain where the stroke occurs. It also depends on the intensity by which the cells of the brain are damaged. A person who has faced small strokes might face minor issues like temporary weakness of an arm or leg (Powers et al. 2015). People with larger strokes may face adverse outcomes like permanent paralysis of one side of body or loses their ability to speak.

• The risk factors that causes stroke can be lifestyle mismanagement as well as medical conditions can also cause so. The lifestyle risk factors mainly include being overweight or suffering from obesity. Others may include being physical inactive and not performing exercises. Others include heavy deinking as well as binge drinking. Moreover use of illicit drugs like cocaine and methamphetamines all increases the risk of strokes (Fleisher et al. 2014).
• Other risk factors also include high blood pressure, cigarette smoking, high cholesterol and diabetes. Moreover obstructive sleep dyspnoea and cardiovascular diseases increase the chance of the risk.
• Other factors increase personal as well as family history of stroke. Moreover being over the age of 55 or older increases the chance of stroke. Besides, there are certain races where the incidence of strokes is higher like African Americans. Moreover genders also play a role as males are more prone to strokes than females.

• Paralysis or loss of movement of muscles.
• Difficulty in swallowing as well as talking.
• Loss of memory and difficulty in thinking.
• Changes in behaviours as well as issues with self care abilities.
• Pain and emotional problems (Saxena et al. 2015).

• Cholesterol testing helps to know whether any risk persist in an individual. Id he has higher level of low density lipoprotein cholesterol called LDL, he would have a higher chance of stroke.
• Aortic aneurysm screening mainly involves the ultrasound of the largest blood vessel which is located in the abdomen. Abnormal bulging leads to ruptured if detection is not done on right time.
• Peripheral Artery Disease (PAD) helps in finding the blockage in the arteries of the legs which can lead to amputation. This is done by checking the blood pressure at the ankles and arms to identify the flow of blood patter in the legs.
• Carotid artery screening which helps in checking the ultrasound of the main artery present in the neck which eventually leads to brain (Ajwani et al. 2017).
• Atrial Fibrillation is identified by detection of abnormal heart rhythm by limited ECG. This increases the risk of stroke by several times.

• Smoking increases the risk for strokes. Therefore smoking should be reduced gradually until quitting.
• Blood pressure should be maintained with prescribed medications and other techniques mentioned by doctors. A low salt, low fat diet and regular exercises are important to control hypertension.
• Cholesterol should be maintained by taking of proper medicines and diets.
• Diabetes should be managed by proper diet, exercise plan and proper medication adherence.
• Risks for atrial fibrillation should be looked after by taking proper beta-blocker medication
• Alcohol consumption should be maintained. Little alcohol taking is not an issue but high amount of alcohol drinking increases the risks (Hankey et al. 2014).
• Obesity should be controlled by proper diet and exercises.

Every community have community support programs that provide support to stroke patients after their return form hospitalisation. Moreover rehab centres are also present. They provide multidisciplinary approach in caring for the different complications faced by patients like in movement, speech developments, swallowing issues, independency development and others. Moreover there are also care centres who allocate caregivers to homes where the patients are cared for within homes only (Emberson et al. 2014). Moreover they should be helped with brochures, pamphlets, weekend education classes which increase health literacy regarding prevention of the stroke incidences.

References:

Ajwani, S., Jayanti, S., Burkolter, N., Anderson, C., Bhole, S., Itaoui, R. and George, A., 2017. Integrated oral health care for stroke patients–a scoping review. Journal of clinical nursing, 26(7-8), pp.891-901.

Aslani, Z., Alimohammadi, N., Taleghani, F. and Khorasani, P., 2016. Nurses’ Empowerment in Self-Care Education to Stroke Patients: An Action Research Study. International journal of community based nursing and midwifery, 4(4), p.329.

Emberson, J., Lees, K.R., Lyden, P., Blackwell, L., Albers, G., Bluhmki, E., Brott, T., Cohen, G., Davis, S., Donnan, G. and Grotta, J., 2014. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. The Lancet, 384(9958), pp.1929-1935.

Fleisher, L.A., Fleischmann, K.E., Auerbach, A.D., Barnason, S.A., Beckman, J.A., Bozkurt, B., Davila-Roman, V.G., Gerhard-Herman, M.D., Holly, T.A., Kane, G.C. and Marine, J.E., 2014. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation, pp.CIR-0000000000000106.

Hankey, G.J., Norrving, B., Hacke, W. and Steiner, T., 2014. Management of acute stroke in patients taking novel oral anticoagulants. International Journal of Stroke, 9(5), pp.627-632.

Jauch, E.C., Saver, J.L., Adams, H.P., Bruno, A., Demaerschalk, B.M., Khatri, P., McMullan, P.W., Qureshi, A.I., Rosenfield, K., Scott, P.A. and Summers, D.R., 2013. Guidelines for the early management of patients with acute ischemic stroke. Stroke, 44(3), pp.870-947.

Kakkar, A.K., Mueller, I., Bassand, J.P., Fitzmaurice, D.A., Goldhaber, S.Z., Goto, S., Haas, S., Hacke, W., Lip, G.Y., Mantovani, L.G. and Turpie, A.G., 2013. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PloS one, 8(5), p.e63479.

National Strategy for HSVH in Australia. (2017). Prevention of heart, stroke and vascular disease  Retrieved 19 October 2017, from https://www.health.gov.au/internet/main/publishing.nsf/Content/11390D8C77556413CA257BF000217B4E/$File/heart3.pdf

Parke, H.L., Epiphaniou, E., Pearce, G., Taylor, S.J., Sheikh, A., Griffiths, C.J., Greenhalgh, T. and Pinnock, H., 2015. Self-management support interventions for stroke survivors: a systematic meta-review. PLoS One, 10(7), p.e0131448.

Portz, J.D., Waddington, E., Atler, K.E., Van Puymbroeck, M. and Schmid, A.A., 2016. Self-Management and Yoga for Older Adults with Chronic Stroke: A Mixed-Methods Study of Physical Fitness and Physical Activity. Clinical Gerontologist, pp.1-8.

Post-Stroke Rehabilitation. (2017). Strokeassociation.org. Retrieved 19 October 2017, from https://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/PhysicalChallenges/Post-Stroke-Rehabilitation_UCM_310447_Article.jsp#.Wegjk2iCz6Q

Powers, W.J., Derdeyn, C.P., Biller, J., Coffey, C.S., Hoh, B.L., Jauch, E.C., Johnston, K.C., Johnston, S.C., Khalessi, A.A., Kidwell, C.S. and Meschia, J.F., 2015. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke, 46(10), pp.3020-3035.

Saxena, M., Young, P., Pilcher, D., Bailey, M., Harrison, D., Bellomo, R., Finfer, S., Beasley, R., Hyam, J., Menon, D. and Rowan, K., 2015. Early temperature and mortality in critically ill patients with acute neurological diseases: trauma and stroke differ from infection. Intensive care medicine, 41(5), pp.823-832.

Winstein, C.J., Stein, J., Arena, R., Bates, B., Cherney, L.R., Cramer, S.C., Deruyter, F., Eng, J.J., Fisher, B., Harvey, R.L. and Lang, C.E., 2016. Guidelines for adult stroke rehabilitation and recovery. Stroke, 47(6), pp.e98-e169.