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Brian Michael Mutandwa-Correspondent
A stroke or cerebral vascular accident (CVA) occurs when there is sudden disruption to the blood supply to the brain resulting in localised loss of function to the involved parts of the brain.
This disturbance is usually sudden and occurs without a warning, and is accompanied with a painful episode of headache, loss of balance, hemiparesis, numbness and loss of bladder control.
Basically the doctors and nurses stabilise the patient`s vitals namely, pulse, breathing rate, blood pressure, temperature and manage the underline conditions. Restoration of lost function falls under the domain of the rehabilitation team with the Occupational Therapist playing the centre part.
It is very important for the patient not to overlook and not go through the rehabilitation process to ensure a quick and sound road to recovery. However, personally, I have noted that the challenge we have in Zimbabwe is that some medical practitioners do not emphasis this need and misguide the patient into overlooking the need of the rehabilitation process.
The other challenge is patients themselves and their caregivers fail to appreciate the importance of the rehab process. That results in a stroke bringing a lifelong disability and patient may never gain function at all. Those patients that turn up for rehabilitation after years of the stroke do so with a variety of complications namely shoulder subluxation, adhesive capsulitis, contractures, and so forth.
The road to recovery after a stroke is never easy to map, but it basically depends on the assessment findings, patient motivation, cooperation, comorbidities, age and level of arousal.
Assessment is mainly subdivided into sensory function, motor function, perception and cognition and psychological.
A person who has had a cerebral vascular accident, usually shows hemi paralysis — loss of function in one side of the body and the muscle weakness can be partial or total. It is the role of the Occupational Therapist to stimulate the affected muscle groups using various methods techniques namely, heat therapy, cryotherapy, electrical stimulation.
As soon as the muscle shows a little voluntary movement, the therapist then starts prescribing exercises that strengthen specific muscle groups.
Stroke is a horrible experience to the family and the patient. Over the years I have worked with stroke patients, I have come to realise that the majority of the patients experiences serious psychological and emotional challenges. Having a stroke is often a traumatic and devastating experience for the stroke patient and their family.
It is perhaps not surprising that a range of emotional problems often present, either immediately after the stroke, or at some later point, either during rehabilitation or after it has ended.
It should, however, be acknowledged that while emotional difficulties are common, they are by no means universal, and not everyone who has had a stroke will suffer.
In my experience, above 90 percent of the stroke patients I have worked with had one question that bothered them, their worry is that will they lose their life.
Stress related to those issues and other issues around the loss of function, feeling helpless, loss of employment, hospital bills and pre existing bills often increase the risk of mood disorders.
Depression is the most common mood-related problem after a stroke, with estimates suggesting that between 20 to 50 per cent of patients might be clinically depressed at any one time.
Some people may feel depressed in the early phase after the stroke, whereas for others this might not occur until much later on. Feelings of depression can sometimes emerge towards the end of rehabilitation, often as people start to realize that they may not have made as many gains as they had hoped.
Feelings of distress are, however, common, and are understood to be a part of the natural process of emotional and behavioural adjustment. Emotions experienced often include shock, disbelief, anger, and frustration.
Patients often ask: ‘Why has this happened to me?’, ‘What have I done to deserve this?’ These feelings of distress have been likened to the process of grieving following a bereavement, as a stroke too is associated with loss, usually loss of a former life.
Anxiety is another common issue in a stroke. Panic is a specific type of anxiety sometimes experienced by stroke patients, and tends to be characterised by very rapid or deep breathing.
The effect of this is that the amount of oxygen in the lungs will be reduced, and this can then in turn lead to a range of unpleasant body sensations, such as faintness, dizziness, tingling, headaches, racing heart, flushes, nausea, chest pain, and shakiness.
These sensations can be extremely worrying for the patient, and are often misinterpreted as something medically wrong, such as having another stroke.
Fears and concerns then intensify, which results in further over breathing, and hence a vicious circle of panic can develop.
Routine assessment of cognitive functioning is usually undertaken with a screening instrument, and followed up with in-depth specialist assessments if problems are detected. Screening instruments vary in their complexity and the range of functions that they assess.
The Mini Mental State Examination is conducted by the Occupational Therapist and it assess orientation, short-term memory, attention and concentration, praxis, hemi-negligence, concrete thinking, consciousness, agnosia, and many more.
These tests are important in order for the Occupational Therapist to make recommendations for the patient`s safety in the environment.
For instance, if a patient with left side hemi-neglect is allowed to drive a vehicle, chances are that they will go on bumping into objects on the left side of the vehicle.
In conclusion I would like to encourage stroke patients and their caregivers to visit utilise the Occupational Therapy departments in their local hospitals and clinics to have some of their problems addressed.
◆ Brian Michael Mutandwa is an occupational therapist by profession with particular interest in neurology rehabilitation. He writes in his personal capacity. Comments and views: [email protected]. 0783739691.The views given here in are solely for information purposes they are guide lines and suggestions and are not guaranteed to work in any particular way.
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