TREATING STROKE
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What is good stroke care?
Effective treatment of stroke has been found to prevent long-term disability and save lives according to a National Institute of Health report.. The National Stroke Strategy was published in December 2007, and provides a guide to high quality health and social care for those affected by stroke. Stroke experts have set out standards which define good stroke care, including:
a rapid response to a 999 call for suspected stroke
prompt transfer to a hospital providing specialist care
an urgent brain scan (for example, computerised tomography [CT] or magnetic resonance imaging [MRI]) undertaken as soon as possible
immediate access to a high quality stroke unit
early multidisciplinary assessment, including swallowing screening
stroke specialised rehabilitation
planned transfer of care from hospital to community and longer term support
The National Institute for Health and Clinical Excellence (NICE) has produced a quality standard for stroke that describes the level of care that the NHS is working towards.
If you are concerned about the standard of care provided, speak to your stroke specialist or a member of the stroke team.
Ischaemic strokes
Ischaemic strokes can be treated using a ‘clot-busting’ medicine called alteplase, which dissolves blood clots (thrombolysis). However, alteplase is only effective if started during the first four and a half hours after the onset of the stroke. After that time, the medicine has not been shown to have beneficial effects. Even within this narrow time frame, the quicker alteplase can be started the better the chance of recovery. However, not all patients are suitable for thrombolysis treatment.
You will also be given a regular dose of aspirin (an anti-platelet medication), as this makes the cells in your blood, known as platelets, less sticky, reducing the chances of further blood clots occurring. If you are allergic to aspirin, other anti-platelet medicines are available.
Anticoagulants
You may also be given an additional medication called an anticoagulant. Like aspirin, anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots from occurring. Heparin and warfarin are two anticoagulants that are commonly used.
Anticoagulants are often prescribed for people who have an irregular heartbeat that can cause blood clots.
Blood pressure
If your blood pressure is too high, you may be given medicines to lower it. Two medicines that are commonly used are:
thiazide diuretic: this reduces the amount of water in your body and widens the blood vessels, which decreases blood pressure
angiotensin converting enzyme (ACE) inhibitors: these widen the blood vessels and reduce blood pressure
Statins
If the level of cholesterol in your blood is too high, you will be given a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol.
Carotid stenosis
Some ischaemic strokes are caused by a narrowing in the carotid artery, which is an artery in the neck, which takes blood to the brain. The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques.
If the carotid stenosis is particularly bad, surgery may be used to unblock the artery. This is done using a surgical technique called a carotid endarterectomy. It involves the surgeon making an incision in your neck in order to open up the carotid artery and remove the fatty deposits.
Follow up rehabilitation
Rehabilitation following even partial recovery of stroke can bring back a positive approach to life. The Tutor system has shown amazing success in stroke rehabilitation.
The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy. The Tutors have been shown to be effective not only for stroke patients but also for those suffering from Pakinson’s disease, Brain Injuries, Spinal Cord Injuries, CP, MS, Radial and Ulnar nerve injuries, Brachial Plexus Injuries and a variety of upper and lower limb surgeries. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.
Want to know more?
The Stroke Association:go to making sense of medication
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