Stroke Helpline 0303 3033 300 stroke.org.uk Care Home Training A workshop on Stroke

Stroke Helpline 0303 3033 300stroke.org.uk

Care Home TrainingA workshop on Stroke


To be clear about what a stroke & TIA are, what causes them and the range of effects

Learning Objectives •To be clear what a stroke and TIA are•To know about the physical effects of stroke•To know how stroke affects swallowing and the importance of oral care •To have an understanding of the effects on communication and vision following a stroke•To have an awareness of the cognitive and psychological impact

Learning Objectives •To be clear what a stroke and TIA are•To know about the physical effects of stroke•To know how stroke affects swallowing and the importance of oral care •To have an understanding of the effects on communication and vision following a stroke•To have an awareness of the cognitive and psychological impact


A guide to stroke


What is a stroke?

• Damage to part of the brain

• Caused by a problem with its blood supply

• Blood is supplied through arteries

• There is a ‘blockage’ or ‘burst’

• Usually happens quickly and strikes suddenly- brain attack


How does this happen?

Ischaemic (69% - 80%)• Death of tissue

(infarction) because of blockage by:

• Thrombosis – a solid clot of blood in artery supplying brain or

• Embolism – a clot or other substance (fat, cholesterol, blood platelets) carried from elsewhere in circulation


How does this happen?

Haemorrhage (15% - 20%)• Bleeding in the brain• Burst blood vessel e.g.

artery• High blood pressure can

weaken artery• Bursts and damages tissue• Brain damage is the result


Transient Ischaemic Attack

• Occurs when the brain’s blood supply is briefly interrupted

• Classification: effects last no longer than 24hours from onset or the symptoms start to resolve within 1–20 minutes

• Very rarely, symptoms of a TIA are due to bleeding (haemorrhage) in the brain

• The FAST test helps people to quickly recognise the key symptoms of a TIA or stroke


.Facial weaknessC

Arm weaknessCan the person raise

Speech problemsCan the person speak say

Time to call 999Stroke is a medical emergency. If you see any one of these signs, seek immediate medical attention

.Facial weaknessC

Arm weaknessCan the person raise

Speech problemsCan the person speak say

Time to call 999Stroke is a medical emergency. If you see any one of these signs, seek immediate medical attention

Act FAST

Other symptoms include:•Sudden weakness or numbness on one side of the body•Sudden confusion•Sudden dizziness or unsteadiness •Sudden visual problem•Severe headache

Other symptoms include:•Sudden weakness or numbness on one side of the body•Sudden confusion•Sudden dizziness or unsteadiness •Sudden visual problem•Severe headache


Obesity

Family History or Ethnicity

Diabetes

Previous Stroke & TIA Age

Binge Drinking & Substance Misuse

Inactivity

Heart Disease

HypertensionHormonal Contraception & HRT

Smoking


Stroke Facts

• Every year, approximately 152,000 people have a stroke in the United Kingdom

• That is more than one every five minutes

• In 2008, stroke was the fourth largest cause of death in the UK after heart disease, cancer and respiratory disease

• Stroke is the largest cause of complex disability in adults


Body talk


Temporal Lobe•Memory functions•Word based memory (dominant)•Visual Memory (non-domination)

Frontal Lobe•Planning actions •Learning New tasks•Motivation•Behaviour regulation

Brain Stem•Breathing•Blood Pressure•Digestion•Heart Rate•Other Autonomic Functions

Cerebellum•Coordination•Balance•Equilibrium •Muscle tone

Occipital Lobe•Visual Perception •Colour recognition

Parietal Lobe •Taste, temperature, pain•Understanding language

• Auditory & visual memory• Calculations• Reading & writing• Spatial awareness

The brain


LEFT BRAIN controls:

•Right side of body •Movement•Vision •Hearing•Memory•Reading•Writing•Speaking•Understanding•Mathematics

RIGHT BRAIN controls:

•Left side of body •Movement•Vision•Hearing•Memory•Art•Music•Spatial awareness

What happens in the brain?

! !


Exercise:


Neuroplasticity

Neuroplasticity: The brain's ability to reorganise itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment


Normal muscle tone?

The amount of contraction in a group of muscles which enables smooth voluntary movement to take place


How stroke affects tone

• Low tone – muscles tend to be loose and weak, hanging limply.

• Flaccidity

• High tone – tightening of muscles, tendons and ligaments that prevents normal movement.

• Spasticity


What can help

• Good positioning• Support and stabilise limbs• Symmetrical

• Medication • Baclofen• Botox

• Encourage use• Move in normal patterns


Down the wrong way


The swallow process

There are four stages to a swallow:• Preparation/anticipation• Mouth• Throat• Throat to stomach

Stroke can affect any stage - Dysphagia


Aspiration

• Epiglottis fails to close off windpipe

• Fluid/food goes into the lungs

• Chest infection/pneumonia

• Life and death matter


Warning signs of Dysphagia

• Recurrent chest infections

• Weight loss

• Inability to maintain posture

• Poor dentition

• Aphonic / weak voice

• Weak, ineffective cough reflex

• Coughing / choking pre/post swallow

• Wet, gargly voice quality

• Change in respiratory status

• Change in colour


Speech and Language Therapists

may advise:• Thickening drinks and soups

• Food supplements

• Soft diet

• Pureed diet

• Enteral feeding (NG / PEG)


Tips for safe swallowing





Ensure carers and family members understand the stroke survivors swallowing problems


Daily Mouth Care


Making sense of the world


What did you have for breakfast?



How do we communicate?

34

When we talk...

• 55% is communicated via body language

• 38% is communicated via tone of voice

• 7% is communicated by actual words


Types of aphasia

Receptive aphasia

• Unable to understand words

Expressive aphasia

• Unable to find words or sentences


Stroke and communication

DYSARTHRIA

• Weak muscular activity• Difficulty articulating speech• Slurred, unclear speech

DYSPRAXIA

• Difficulties sequencing speech • Co-ordinating movements• “jumbled-up” unintelligible

speech, can be repetitive

She shells sea shells on the she shore

I was a rangahoo



Visual problems after stroke

• High proportion of people who have had a stroke have some form of visual dysfunction as a result - 62% - 71%

• Visual Field loss

• Visual Inattention & Neglect

• Eye movement problems

• Perception problems

• Focussing and reading problems



http://www.undergrad.ahs.uwaterloo.ca/~aktse/drawing.gif


Cognitive effects

• Memory

• Language

• Attention

• Concentration

• Vision and perception

• Reasoning and problem solving


How are you feeling?


Psychological effects

• Anxiety/fear

• Frustration

• Anger

• Apathy

• Depression

• Emotional lability

Documents

Stroke Helpline 0303 3033 300 stroke.org.uk Care Home Training A workshop on Stroke