RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling

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RCS 6080Medical and Psychosocial Aspects of
Rehabilitation Counseling

• Stroke and Hemiplegia

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Stroke and Hemiplegia

• Stroke is the third leading cause of death in the
  US and the leading cause of disability
• approx. 700,000 strokes 160,000 deaths
• Modifiable risk factors include TIA, diabetes,
  hypertension, atrial fibrillation, substance
  abuse, and smoking
• Nonmodifiable risk factors include age, gender,
  race, and family history

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Stroke and Hemiplegia

• Of those who survive the initial onset, the most
  frequent presenting problem is hemiplegia
  (75-88)
• During the acute period, there is high incidence
  of associated neurological deficits
• One important medical concern is the incidence of
  comorbidities that may affect management and rehab

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Types

• Ischemic (83)
• Can be silent ischemia (no sx)
• Caused by atherosclerosis
• Cerebral thrombosis (most common)
• blood clot forms in arteries leading from heart
  to brain (carotid)
• blocks blood flow
• Often preceded by TIA
• Cerebral embolism
• less frequent
• blood clot forms elsewhere (embolus), travels
  through bloodstream, lodges in cerebral artery

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Types

• Hemorrhagic stroke
• less common than ischemic strokes
• more deadly
• if person survives, better recovery of function
• Why?
• Ischemic Blood supply to brain stopped tissues
  die, do not regenerate
• Hemorrhagic pressure from blood compresses
  brain, affects function, pressure relieved,
  function returns

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Hemorrhage

• subarachnoid hemorrhage
• blood vessel on surface of brain leaks
• bleeding into space between brain skull
• cerebral hemorrhage (10)
• Defective artery in brain bursts
• Causes
• aneurysm (blood-filled pouches that balloon out
  from weak spot in artery)
• advancing age, congenital malformation
• aggravated by hypertension
• head injury

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Stroke and Hemiplegia

• Right-Hemisphere Stroke
• The right hemisphere controls the movement of the
  left side of the body as well as analytical and
  perceptual tasks
• Left-Hemisphere Stroke
• The left hemisphere controls the movement of the
  right side of the body as well as speech and
  language abilities

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Stroke and Hemiplegia

• Cerebellar Stroke
• The cerebellum controls many of our reflexes and
  much of our balance and coordination
• Brain Stem Stroke
• The brain stem is the area of the brain that
  controls all of our involuntary, life-support
  functions as well as abilities such as eye
  movements, hearing, speech, and swallowing

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Symptoms

• sudden numbness, weakness face, arm, leg (one
  side of body)
• sudden severe headache
• difficulty seeing in one or both eyes
• confusion, trouble speaking or understanding
• dizziness, loss of balance/coordination

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Treatment of a stroke

• Getting medical help quickly essential!
• Ischemic stroke
• "Clot-busters"
• tissue plasminogen activator (tPA)
• Must give within 3 hours
• Hemorrhagic stroke correct cause of hemorrhage

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Function after Stroke
Function
Time
I
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Some residual effects of strokes

• Emotional lability (mood swings, depression)
• Perceptual effects Difficulty recognizing,
  understanding familiar objects
• Difficulty planning, carrying out simple tasks
• Loss of awareness (One-side neglect )
• Dysphagia (difficulty swallowing)
• Aphasia difficulty putting thoughts into words
  or understanding speech

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Risk Reduction

• lifestyle changes
• aspirin
• blood thinning medications
• carotid endarterectomy (remove plaque)
• Experimental neurogenesis (regenerating affected
  neurons)

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Reactions Rehabilitation

• social isolation
• grieving process
• physical, occupational, speech therapy
• 20 require long-term care
• Recovery affected by extent of brain damage,
  patients attitude, support system, rehab. team
  skill

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Voc Rehab and Stroke

• Estimated that 30 of strokes occur in people
  under 65
• One study found a 49 RTW rate for people 21-65
  year old
• Physical factors and aphasia play significant
  roles and complications in vocational planning

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Voc Rehab and Stroke

• Some strategies for aphasia
• Reduction of working hours or territory covered
• Selective interaction with customers or suppliers
  with whom the person had dealt with prior to
  stroke
• Reliance on overlearned behavior and language in
  the performance of new tasks
• Initial help from a relative or close friend
• Job carving

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Additional Resources and Information from the Web

• National Stroke Association (www.stroke.org)
• American Stroke Association (www.strokeassociation
  .org)
• National Aphasia Association (www.aphasia.org)
• Journal of Stroke and Cerebrovascular Diseases
  (www.strokejournal.org)
• The Brain Attack Coalition
• (www.stroke-site.org)