Regular readers of my columns know well that when it comes to heart attacks, time means muscle. That’s why I always advise that if you have any thought that someone’s having a heart attack, call 911 right away. Don’t wait; don’t hesitate; better to overdo it than miss the chance to save heart muscle.
The same advice though, goes if someone’s having a stroke. Remember the word FAST: Facial drooping, Arm (or leg weakness), Speech difficulty means Time to call 911.
Every minute counts when it comes to treating a stroke; with stroke time means brain! The sooner you get medical attention to restore blood flow to the brain, the sooner you can begin recovery. Unfortunately, strokes can affect your physical movement, your emotional well-being and your psychological state, which means the road to recovery can be long.
During a stroke, blood flow to the brain is blocked. When blood stops flowing, cells begin to die, and the abilities controlled by that part of the brain become impaired. Depending on where in the brain a stroke occurs and how severe it is, a person may lose a range of abilities.
A person who suffers a mild stroke might only lose feeling in an arm or leg temporarily, whereas a person who suffers a severe stroke might lose the ability to walk or be unable to speak or swallow.
Depending on the severity of the stroke, some people can recover fully from the event. However, about two-thirds of stroke survivors live with some sort of stroke-related disability, even after recovery and rehabilitation. Here’s what recovery could include.
After a stroke, you have to teach your brain to do things that may have come as second nature to you before. If a stroke affects parts of the brain responsible for motor function, you may experience pain, numbness or tingling in your arms or legs and trouble walking.
But your care team will begin working with you right after your stroke to regain physical movement. Rehabilitation to help you regain this functionality will often start within 24 to 48 hours.
During a physical rehabilitation program, a therapist may focus on helping you regain motor skills, mobility and range of motion.
Physical rehabilitation often includes motor skills training to help you strengthen muscles in your hand and arm, stretching exercises to improve your range of motion, and constraint therapy, where you may wear a device that constrains your functioning arm and forces you to use the arm affected by the stroke. The key with physical rehab is repetition — you have to literally retrain your brain to use your arm, leg or other parts of your body affected by stroke.
The goal of physical therapy is to help you once again become as independent as possible.
Psychological and emotional recovery
After a stroke, it’s not uncommon to experience mood disorders such as depression, anxiety and pseudobulbar affect (PBA), also known as reflex crying.
Depression affects up to two-thirds of stroke survivors and could make you feel sad, lose interest in things you once liked doing, or have trouble sleeping.
You may feel anxious if you focus so much on worries that it impacts your daily life. Anxiety affects 20 percent of stroke survivors.
If you find yourself crying at something funny or angry for no apparent reason, you could be suffering from PBA. PBA, which affects up to half of stroke survivors, is when your feelings are mismatched with an outward expression.
Your doctor may recommend a psychological evaluation to determine if you are suffering from depression, anxiety, PBA or other cognitive issues.
Beyond feeling depressed or anxious, one of the most common feelings stroke survivors experience is frustration over issues such as not being able to speak, remember things, or move like they once did. It’s also common to feel irritable, confused and forgetful.
Your doctor may recommend cognitive behavior therapy and in some cases, medication, to treat emotional and psychological changes after a stroke.
It’s normal to go through a wide range of emotions after a stroke. After all, it affects the brain, which controls our emotions and behavior. But any stroke survivor should get help sorting out these changes through therapy.
Don’t delay if someone’s got symptoms of a heart attack and, for sure, act FAST if you suspect a stroke.
We’re fortunate that, in the area, comprehensive stroke care is available to treat strokes early and aggressively and there are excellent rehab programs to deal with later challenges.
Dr. Alfred Casale, a cardiothoracic surgeon, is Associate Chief Medical Officer for Geisinger Health and Chair of the Geisinger Cardiac Institute. Readers may write to him via [email protected]