Warning Signs of Stroke

By Tamela Thomas, Wellness Manager

I can remember staring at my hands as a child and marveling at how the instant I thought to move my fingers they would "perform" just as I wanted. As an adult I hadn't given it much thought until I prepared to introduce this article.

After many years of taking the mind-body connection for granted it, must be very difficult to comprehend how, in an instant, that connection could be gone or greatly limited. Imagine looking down at your healthy looking arm and willing it to move with no result. If that starts to rock your boat, then imagine a stroke affecting the sight or speech centers of your brain—Is fear the overriding emotion you begin to feel?

That's why this article is so important. The first tool against fear is to arm yourself with information. Learn the early warning signs for stroke; understand its basic physiology; and discover the latest research areas to help unlock and improve its outcomes.

Real 'Survivors'—Knowing the Warning Signs of Stroke

By Nancy Alarcon, MS, CCC-SLP

Bill was nauseated and had quite a headache when he awoke, so he decided to stay home that day. Since he was resting quietly, his wife left for work. When she checked on him later in the morning, no one answered the phone. Fortunately she decided to run home to check on him. She found Bill sprawled on the bathroom floor, unable to tell her what had happened. She immediately called 911. Bill, 45 years old, had reportedly felt as healthy as ever—by the end of the day they learned he had suffered a stroke.

Mary knew something was wrong as she pushed the grocery cart down the aisle. She suddenly felt confused and dizzy. What was happening? With her granddaughter in tow, Mary managed to get through the checkout stand and found a pay phone outside. Thank heaven her husband answered the phone at work. She tried to explain that something was wrong but, as her husband reported later, he knew it was Mary's voice but she wasn't making much sense. Mary had experienced a Transient Ischemic Attack (TIA).

In an instant, everything can change. We recognize how precarious life can be, but assume "it" always happens to other people. For stroke survivors, they know too well how lives are turned upside down in an instant.

A stroke, or "brain attack," is a disruption in blood flow (ischemia) and a disruption in the delivery of oxygen (hypoxia) to an area of the brain. TIAs, like the one Mary experienced, are temporary stroke symptoms with a disruption in blood flow for less than 24 hours with no evidence of permanent neurologic impairment.

A stroke may occur as the result of a cerebral vascular accident, trauma to the head or other neurologic conditions. The extent of impact is, in part, dependent upon the location of the stroke. An estimated 500,000 to 750,000 strokes occur each year in America. It is a significant cause of disability in young people and the leading cause of disability in adults. Approximately 4 million stroke survivors live in the U.S. today. As you1ll note, we use the term "survivors," not victims. The complications of stroke may include sensory and motor impairments, swallowing impairment, vision changes, the disruption of speech and language, weakness or partial paralysis on one side of the body (hemiparesis), and increased tone and possible muscle spasms (muscle spasticity). In addition, the stroke survivor may face limitations doing familiar activities, experiencing significant difficulty in daily activities such as walking, talking, listening, driving and working. Unfortunately, the impact of stroke doesn't end there.

The stroke may physically affect the individual, but it also markedly impacts family and friends. A stroke survivor faces the challenge of reestablishing himself or herself as a meaningful member of society. The success of participating in society is typically wrought with obstacles in part due to lack of public awareness of stroke and its impact on daily living. Given the incredible challenges stroke patients face, they are survivors.

Unlocking the mysteries

We live in exciting times as we endeavor to unlock the mysteries of the brain. Research is focusing on identifying high-risk profiles for earlier identification of individuals who may be prone to stroke. In addition, the National Stroke Association and the American Heart Association are strong proponents of stroke awareness with national efforts focused on raising the consciousness of Americans to lead healthy lives and seek immediate medical attention when faced with warning symptoms. The National Aphasia Association offers education and resources to assist families and patients coping with the disruption of communication.

When a stroke happens, changes occur at the cellular level in neurons and surrounding tissue. These destructive changes are brought about by two mechanisms: programmed cell death, and a shift in ion concentrations and the release of neurotransmitters. The body has a natural neuroprotective response to stroke. Research is trying to understand the complexities of this acute response, and optimize neuroprotective intervention.

Scientists are finding that in order for agents or medications to be able to cross what is referred to as the blood-brain barrier without adverse effects, they must be given within a specific time frame and must not have negative side effects. As a result of a 1995 National Institute of Neurological Disorders and Stroke study, the drug TPA has been the focus of extensive reports for its potential to significantly reduce devastating effects of stroke for certain individuals when administered within the first three hours. Neuroprotective intervention is aimed at administering agents that are most effective following the ischemic event within a critical time period. Though our knowledge in this area is in its infancy, the outcome looks incredibly promising.

Therapies

The course of recovery for a stroke survivor and their family is arduous and often an emotional roller coaster. However, research in rehabilitative medicine, as well as complementary and alternative therapies, continues to address patient and family hopes.

Constraint-induced movement therapy findings, first publicized in the spring of 2000 as a result of a study at the University of Alabama, is now undergoing further investigation through a six- center National Institutes of Health (NIH) study. The thrust of treatment is rewiring the brain and recruiting nerve cells to replace the working ability of cells destroyed by the stroke. Family-based therapy for individuals with chronic or long-term language disruption (aphasia) is being investigated by this author and her colleagues, Dr. Margaret Rogers and Dr. Lesley Olswang, at the University of Washington. As part of their clinical work in the area of neurologic communication disorders, we are exploring the impact on the quality of life of individuals with severe aphasia and their communication partners when treatment is focused on the communication partner.

Acupuncture is one of 200-plus alternative and complementary therapies that are outside of the traditional rehabilitation model in medicine. A 1997 NIH sponsored conference suggested that acupuncture might be helpful as an adjunct therapy in a number of medical conditions such as stroke rehabilitation. Further research was recommended and is ongoing. Additionally, therapies such as the use of hyperbaric oxygen therapy to increase the amount of dissolved oxygen in the blood, and the use of ginkgo biloba in post-stroke patients to improve attention and short-term memory are being investigated.

Often, a person's body is not suitably aligned for a particular activity or activity level. One example would be excessive foot pronation (flat feet) which may be fine for daily activities but not for long distance running. If a pronation problem exists an orthotic or arch support may be recommended.

Some of the most exciting yet daunting and controversial scientific research happening today is the exploration of nerve cell regeneration; the identification, development and use of nerve growth factor; and nerve tissue transplanting. Government and private support for research in these areas will hopefully bring us closer to lessening or eliminating the devastating impact of stroke. However, these areas of exploration will also challenge our ethical conscience.

Response is critical

For the time being, what should we do? Neurologist Dr. Jose Suarez recently remarked in a review of acute ischemic stroke that "time is brain." It is key for each of us to lead healthy lives. However, it is critical for us to recognize and respond immediately to the warning signs of stroke:

• Sudden numbness or weakness of face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

If faced with any of these symptoms, you should immediately seek medical attention. Time is of the essence!