In this post we are going to talk about the What, the How, the Where, the Who and the Next of strokes. By the end of this post, you will have a greater understanding of what a stoke is, how it occurs and the different types of stroke, where a stroke can happen and how that can determine the types of symptoms that will present, who has a higher risk of stroke and the lifestyle factors associated and the next steps – what rehab can look like for someone who has experienced a stroke.
Let’s dive in!
What?
In the broadest sense, a stroke is a brain injury.
The heart and stroke foundation defines a stroke as ‘A stroke happens when blood stops flowing to any part of your brain, damaging brain cells. The effects of a stroke depend on the part of the brain that was damaged and the amount of damage done.’ (https://www.heartandstroke.ca/stroke)
When blood stops flowing then oxygen is cut off. Brain cells begin to die within minutes of oxygen being cut off.
And so, a stroke is a brain injury that can cause lasting brain damage, disability and even death. The brain controls everything from voluntary movements of our body and limbs, breathing and digestion to language and emotions. Depending on where the stroke happens in the brain, the lasting effects can range from mild physical challenges and/or cognitive challenges to severe paralysis.
How?
In the last section we learned that stroke happens when blood stops flowing to parts of the brain. There are 2 ways this can happen and so there are 2 main types of stroke. The resulting impairments are the same in both types.
1.Ischemic stroke
An ischemic stroke is when a blood clot has formed or some kind of blockage has occurred in a blood vessel in the brain. The blockage or clot may develop in the brain or it can develop somewhere else in the body and travel to the brain.
There is another type of stroke that would fall under an ischemic stroke. It is called a Transient Ischemic Attack or TIA. Sometimes this is referred to as a ‘mini-stroke’. A TIA happens when a blood vessel is blocked by a small clot for only a short period of time and flow is restored. TIA symptoms disappear completely within 24 hours. If they have not disappeared in 24 hours then it would be considered a stroke. It is important to pay attention to any TIAs experienced as they can be a warning sign of a future stroke. A TIA is still an emergency and 911 should be called immediately. At the onset of TIA symptoms, you won’t know if it truly is a TIA or a stroke.
2.Hemorrhagic stroke
A hemorrhagic stroke happens when a blood vessel in the brain ruptures. This break in the blood vessel interrupts the blood flow, damaging cells and injuring the brain. Aneurysms are balloon-like bulges and are weak points in blood vessels. With continued stress on these weak points, they can burst – causing a hemorrhagic stroke. High blood pressure makes vessels work harder than they need to resulting in these aneurysms or weak points.
Symptoms of both types of strokes are the same and so knowing the signs of a stroke will get the person the help they need quicker and therefore can mitigate the extent of injury. Do you know the F.A.S.T. acronym? Maybe you have seen this graphic on the back of an ambulance – I know I have.
If you or someone near you is experiencing any of these signs of a stroke, call 911.
Some less common signs are: blurred or double vision, sudden severe headache, numbness (usually on one side of the body), balance issues.
Who?
Risk factors:
90% of Canadians have at least one risk factor for heart conditions, stroke or vascular impairments (Heart and Stoke Foundation of Canada)
The following risk factors can lead to a stroke by either increasing the strain on the vessels in the brain or blocking the vessels in the brain from blood and oxygen
High blood pressure is the leading cause of stroke. As mentioned above, high blood pressure puts more strain on the blood vessels in the brain and can cause aneurysms. You may not feel any symptoms of high blood pressure so it is important to have your pressure checked regularly.
High cholesterol. Cholesterol is a fat like substance that is made by the liver or ingested in your food. Your liver makes enough cholesterol for the body and so if we take in more cholesterol than the body uses, then this fatty substance can build up in the arteries. This can lead to a build up in the vessels in the brain, blocking proper flow of blood and oxygen which may lead to a stroke. A blood test can tell you if you have high cholesterol.
Heart disease is when plaque builds up in the arteries. When plaque builds up in the arteries of the brain, it can cut off the flow of blood and oxygen to the tissue of the brain, leading to an ischemic type stroke or TIA.
Diabetes can cause a build up of sugars in the bloodstream and in turn reduce the amount of available oxygen for the brain cells. A lack of oxygen can damage the brain cells and thus a stroke. High blood pressure is common in people with diabetes.
Sleep apnea. Interrupted sleep can decrease the amount of oxygen getting to the brain and can also cause high blood pressure. Leading to lack of oxygen and/or increased pressure on the blood vessels of the brain.
Other risk factors related to lifestyle:
-unhealthy diet
- inactivity
- smoking
- Excessive alcohol consumption
- birth control or hormone replacement therapy – medications containing estrogen increase risk of stroke, TIA and heart attack
- recreational drug use
- prolonged, unmanaged stress
Prevention
You know what they say “an ounce of prevention is worth a pound of cure”. Prevention is not as sexy as cure can be. We don’t see immediately the effects of any prevention we do in the present but we might see the effects of the treatment of the illness. Most preventative measures can be helpful across many areas of our life, health and wellness.
Based on the risk factors listed above, you can mitigate your risk of stroke by; not smoking, limit alcohol consumption, manage stress, active lifestyle, limit unhealthy foods.
Let’s dive deeper into the active lifestyle portion of our prevention pie!
We can think of this in 2 buckets – 1. Exercise 2. Physical activity. I know what you are thinking – isn’t that the same thing? And the answer is yes and no!
Think of physical activity as the movements you do in just your day to day; like walking from your car into the store, cleaning, working on the computer, playing with your dog and so on.
In the other bucket we have exercise. This is the part that is more purposeful; like going to the gym, an exercise session with your kinesiologist, going out for a walk, playing volleyball.
Both of these buckets are important and useful in our overall healthy lifestyle. From the Canadian activity guidelines, our goal is 150min a week of moderate to vigorous activity- this time includes both purposeful exercise and physical activity. We also want to limit the amount of time being sedentary.
Many of the risk factors are interrelated. Stressful work or life can lead to behaviours such as smoking, unhealthy eating, drug use which can lead to risk factors such as high blood pressure, diabetes, high cholesterol. Being regularly physically activity can lower your blood pressure, help manage diabetes, and help manage weight. Regular physical activity can help manage mental health as well; which in turn can help with behaviours that were started to manage stress.
Exercise can release those feel good hormones like endorphins and enkephalins (regulates pain sensation) that can make problems feel more manageable. Exercise can also promote the creation of new neurons in the part of the brain that is involved with memory, emotional regulation and learning – the hippocampus. The Ontario Kinesiology Association position paper on Exercise and Mental Health has cited that exercise can be an effective treatment of anxiety. “Normal and elevated levels anxiety can be significantly reduced following exercise. Anxiety is reduced by a statistically significant degree within 5 to 15 minutes of the end of exercise and remains decreased for 2 to 4 hours afterward”
Where?
The effects of a stroke can be anywhere on the continuum of mild where you may not even know that they had a stroke to severe where they are unable to speak or walk.
The location in the brain and severity of the stroke will determine what deficits occur. Each person who has had a stroke with have different results. Each area of the brain is responsible for different functions so when there is an injury to the brain it has the potential to affect a variety of things in the body and the brain. Which means that the resulting effects may be physical or cognitive or both.
Some of those effects are:
- Paralysis (inability to move parts of the body), weakness, or both on one side of the body.
- Trouble with thinking, awareness, attention, learning, judgment, and memory.
- Problems understanding or forming speech.
- Trouble controlling or expressing emotions.
- Numbness or strange sensations.
- Pain in the hands and feet that worsens with movement and temperature changes.
- Trouble with chewing and swallowing.
- Problems with bladder and bowel control.
Next steps:
After having a stroke and the medical emergency is over, the hard work begins. It is important to get moving as soon as possible. The stroke patient may receive some type of physical therapy in the hospital. It will be important that purposeful exercise and/or rehab continues after discharge. The old adage of ‘if you don’t use it, you lose it’ very much applies to stroke recovery.
In my experience as a Kinesiologist, in the early stages of recovery, stroke patients will receive assessment and/or treatment from physiotherapy, occupational therapy, and speech and language pathology. This might begin as inpatient care and eventually to outpatient care. Focus of early care would be things necessary for everyday life. For example; getting up from bed or chair, transferring from surface to surface, eating, dressing, moving around in bed, speech, locomoting – walking or wheeling, using the washroom and so on.
At some point, patients will be discharged from the care of professionals listed above. Continuing with purposeful exercise and rehab is important for continued progression or at minimum maintenance of the gains made. This may look like an independent home exercise program that the physiotherapist and/or occupational therapist provides to the patient. Or this can look like having another rehab or exercise professional come regularly. This is a great time for a kinesiologist to come in.
Most often, my clients are referred to me by physiotherapists who are about to discharge their patient and the patient wants more one on one exercise rehab and/or the physiotherapist is recommending this. After a referral from a physiotherapist, I will have a conversation with the physiotherapist about what they have been working on and any other important information. Then, I will perform an assessment with the patient. Here, we will look at how they are moving, assess strength, balance, endurance and discuss goals.
From here I will develop an individualized plan to help achieve the goals we have discussed. The plan may include things like strengthening, mobility, stretching, balance, walking, functional tasks etc. My practice is 100% mobile, meaning I come to my client’s home for sessions. The advantage to this is that we can practice any movement that is difficult right in the place where they do it. For example, if a client is having a difficult time getting up the 2 steps onto the back deck, we are able to trouble shoot and practice on those steps. If we were in a clinic environment, we would have to imagine and try to match the situation as best we could and hope that it will translate to the steps at home.
With regular visits from your kinesiologist, exercises can be progressed when needed which will encourage more and more improvement. Someone who has had a stroke may see benefits like improved fitness, walking speed, balance, increased independence, decreased disability from a specialized exercise plan.
I hope you learned a little about strokes and how we can prevent and manage them!
If you are interested in learning from a first-person perspective, a good book to read is “A Stroke of Insight” by Jill Bolte Taylor, PhD. A brain scientist has a stroke and takes us along on the road to recovery. She talks about what she remembers from the moment the stroke occurred to when she was retraining to speak and walk. It is a great insight to the experience of recovering from a stroke.
Interested in learning more about kinesiology session with Carrie? Reach out on the Contact us page to set up a complimentary Discovery Call.
Sources:
National Center for Chronic Disease Prevention and Health Promotion , Division for Heart Disease and Stroke Prevention
Carrie Doll Kinesiology provides in-home Kinesiology services to Kitchener- Waterloo, St. Jacobs, Elmira and area