YOGA FOR

CEREBROVASCULAR DISEASE

MÜKAM KARÔTI VACÁLAM

PANGUM LANGHAYATÄ GIRIM

YATKRIPÁ TAMAHAM VANDÄ

PARAMÁNANDA SÁGARAM

PRAYER

Name of the disease & terminologiesEtiologyPhysical examination, signs and symptoms InvestigationsModern medical treatmentAlternative therapies – Yoga managementDietBooks and journals for reference

General term for a brain dysfunction caused by an abnormality of the cerebral blood supply.

A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a "brain attack.“

Alternative names: Stroke CVA, Cerebral infarction, Cerebral hemorrhage.

CEREBROVASCULAR DISEASE

A stroke can happen when: A blood vessel carrying blood to the brain is

blocked by a blood clot. This is called an ischemic stroke.

A blood vessel breaks open, causing blood to leak into the brain. This is a hemorrhagic stroke.

If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.

CAUSES, INCIDENCE, & RISK FACTORS

This is the most common type of stroke. Usually this type of stroke results from clogged

arteries, a condition called atherosclerosis. Fatty deposits and blood platelets collect on the

wall of the arteries, forming a sticky substance called plaque.

Over time, the plaque builds up. Often, the plaque causes the blood to flow abnormally, which can cause the blood to clot. There are two types of clots:

A clot that stays in place in the brain is called a cerebral thrombus.

ISCHEMIC STROKE

A clot that breaks loose and moves through the bloodstream to the brain is called an cerebral embolism.

Another important cause of cerebral embolisms is a type of arrhythmia called atrial fibrillation.

Other causes of ischemic stroke include endocarditis and the use of a mechanical heart valve.

A clot can form on the artificial valve, break off, and travel to the brain.

For this reason, those with mechanical heart valves must take blood thinners.

A second major cause of stroke is bleeding in the brain hemorrhagic stroke.

This can occur when small blood vessels in the brain become weak and burst.

Some people have defects in the blood vessels of the brain that make this more likely.

The flow of blood after the blood vessel ruptures damages brain cells.

HEMORRHAGIC STROKE

Sites of Brain Hemorrhage

High blood pressure is the number one reason. The risk of stroke is also increased by age,

family history of stroke, smoking, diabetes, high cholesterol, and heart disease.

Certain medications increase the chances of clot formation.

Birth control pills can cause blood clots, especially in women who smoke and who are older than 35.

STROKE RISKS

Men are prone to more strokes than women. But, women have a risk of stroke during

pregnancy and the weeks immediately after pregnancy.

Cocaine use, alcohol abuse, head injury, and bleeding disorders increase the risk of bleeding into the brain.

The symptoms of stroke depend on what part of the brain is damaged.

In some cases, a person may not even be aware that he or she has had a stroke.

SYMPTOMS

Usually, a SUDDEN development of one or more of the following indicates a stroke:

Weakness or paralysis of an arm, leg, side of the face, or any part of the body

Numbness, tingling, decreased sensation Vision changes Slurred speech, inability to speak or understand

speech, difficulty reading or writing

Swallowing difficulties or drooling Loss of memory Vertigo (spinning sensation) Loss of balance or coordination Personality changes Mood changes (depression, apathy) Drowsiness, lethargy, or loss of consciousness Uncontrollable eye movements or eyelid drooping

If one or more of these symptoms is present for less than 24 hours, it may be a transient ischemic attack (TIA). A TIA is a temporary loss of brain function and a warning sign for a possible future stroke.

In diagnosing a stroke, knowing how the symptoms developed is important.

The symptoms may be severe at the beginning of the stroke, or they may progress or fluctuate for the first day or two (stroke in evolution).

Once there is no further deterioration, the stroke is considered completed.

During the exam, doctor will look for specific neurologic, motor, and sensory deficits.

These often correspond closely to the location of the injury in the brain.

SIGNS AND TESTS

An examination may show changes in vision or visual fields, abnormal reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes.

A "bruit" (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck.

There may be signs of atrial fibrillation. Tests are performed to determine the type,

location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms.

Head CT or head MRI -- used to determine if the stroke was caused by bleeding (hemorrhage) or other lesions and to define the location and extent of the stroke.

ECG (electrocardiogram) -- used to diagnose underlying heart disorders.

Echocardiogram -- used if the cause may be an embolus (blood clot) from the heart.

Carotid duplex (a type of ultrasound) -- used if the cause may be carotid artery stenosis (narrowing of the major blood vessels supplying blood to the brain).

INVESTIGATIONS

Heart monitor -- worn while in the hospital or as an outpatient to determine if a heart arrhythmia (like atrial fibrillation) may be responsible for stroke.

Cerebral (head) angiography -- may be done so that the doctor can identify the blood vessel responsible for the stroke. Mainly used if surgery is being considered.

Blood work may be done to exclude immune conditions or abnormal clotting of the blood that can lead to clot formation.

A stroke is a medical emergency. Physicians have begun to call it a "brain attack" to

stress that getting treatment immediately can save lives and reduce disability.

Treatment varies, depending on the severity and cause of the stroke.

For virtually all strokes, hospitalization is required, possibly including intensive care and life support.

The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began.

TREATMENT

Thrombolytic medicine, like tPA, breaks up blood clots and can restore blood flow to the damaged area.

Blood thinners such as heparin and Coumadin are used to treat strokes. Aspirin and other anti-platelet agents may be used as well.

Other medications may be needed to control associated symptoms. Analgesics (pain killers) may be needed to control severe headache. Anti-hypertensive medication may be needed to control high blood pressure.

IMMEDIATE TREATMENT

Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. The nutrients and fluids may be given through an intravenous tube (IV) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels.

Life support and coma treatment are performed as needed.

The goal of long-term treatment is to recover as much function as possible and prevent future strokes.

Depending on the symptoms, rehabilitation includes speech therapy, occupational therapy, and physical therapy.

The recovery time differs from person to person.

Certain therapies, such as repositioning and range-of-motion exercises, are intended to prevent complications related to stroke, like infections and bed sores.

LONG-TERM TREATMENT

People should stay active within their physical limitations.

Sometimes, urinary catheterization or bladder/bowel control programs may be necessary to control incontinence.

The person's safety must be considered. Some people with stroke appear to have no

awareness of their surroundings on the affected side.

Others show indifference or lack of judgment, which increases the need for safety precautions.

For these people, friends and family members should repeatedly reinforce important information, like name, age, date, time, and where they live, to help the person stay oriented.

Behavior modification may be helpful in controlling unacceptable or dangerous behaviors.

Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.

In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.

Family counseling may help in coping with the changes required for home care.

Carotid endarterectomy (removal of plaque from the carotid arteries) may help prevent new strokes from occurring in people with large blockage in these important blood vessels.

The long-term outcome from a stroke depends on the extent of damage to the brain, the presence of any associated medical problems, and the likelihood of recurring strokes.

Of those who survive a stroke, many have long-term disabilities, but about 10% of those who have had a stroke recover most or all function.

Fifty percent are able to be at home with medical assistance while 40% become residents of a long-term care facility like a nursing home.

EXPECTATIONS (PROGNOSIS)

Problems due to loss of mobility (joint contractures, pressure sores)

Permanent loss of movement or sensation of a part of the body

Bone fractures Muscle spasticity Permanent loss of brain functions Reduced communication or social interaction Reduced ability to function or care for self Decreased life span Side effects of medications Aspiration Malnutrition

COMPLICATIONS

To help prevent a stroke: Get screened for high blood pressure at least every

two years, especially if family history of high blood pressure.

Cholesterol check. Treat high blood pressure, diabetes, high cholesterol,

and heart disease if present. Follow a low-fat diet. Quit smoking. Exercise regularly. Lose weight if overweight. Avoid excessive alcohol use (no more than 1 to 2

drinks per day).

PREVENTION

Intravenous tPA (tissue Plasminogen Activator) Calcium channel blocker Anticoagulants Antithrombotics (anti-platelet agents and

anticoagulants) Thrombolytics Neuroprotective agents

ALLOPATHIC THERAPY

Nutrition and Diet Vitamin and Nutritional Supplements Exercise and Bodywork, including Massage,

Hydrotherapy, Tai Chi, Qigong, and Feldenkrais

Herbal Medicine Homeopathy Traditional Chinese Medicine like Chelation

Therapy Snake Venom Remedy for Stroke

ALTERNATIVE THERAPIES

Spider-Venom Remedy for Stroke Aromatherapy Bach Flower Remedies Vision therapy Mind Body Medicine including Hypnotherapy,

Biofeedback, Guided Imagery, Meditation, Stress Management, Relaxation and Social Support

Others: Light Therapy, Magnetic Field Therapy, Naturopathic Medicine, Osteopathy, Sound Therapy, Chiropracty, Reflexology and Folk Remedies

YOGA PRACTICES

YOGA IS BALANCE (SAMATVAM)

I A Y T CORRECTS IMBALANCES

AIMS :

• STRESS REDUCTION

• RELIEF OF PAIN

• MEDICATION REDUCTION

PROMOTION OF POSITIVE HEALTHBreathing practices Hands in and out breathing Ankle stretch breathing Tiger breathing Rabbit breathing Sasankasana breathing Straight leg raise breathingSithilikarana vyayama (loosening exercise) Jogging Forward and Backward bending Side bending Twisting Pavanamuktasana kriya Suryanamaskar

Yogasanas

Standing Ardhakati cakrasana Ardha cakrasana Padahastasana

Prone Bhujangasana Salabhasana Dhanurasana

Supine Sarvangasana Matsyasana Cakrasana

Sitting Pascimottanasana Vakrasana/Ardha

Matsyendrasana Sasankasana/ Yogamudra Ustrasana Deep relaxation

technique (DRT)

PranayamaKapalabhatiVibhaga pranayama (Sectional breathing)Nadi suddhiMeditation (Dhyana Dharana)NadanusandhanaOM meditationKriyasJala NetiSutra NetiVaman Dhouti

Stroke (brain hemorrhage or acute brain ischaemia)

General considerations: Proper medical treatment is necessary, yoga can be used within the framework of long-term rehabilitation.

Contraindications: No inverted asanas, the limitations of trainees should be strictly respected.

Recommendations: In the beginning relaxation, full yoga breath, Ujjayi, gentle mobilisation of the affected parts of the body.

SPECIFIC PRACTICE

Suryanamaskara Natarajasana Santulanasana Shirshasana Sarvangasana Matsyasana Dhanurasana Pachhimottanasana Shavasana Pranayama

Heat exhaustion and heat stroke