research paper

STROKE

STROKE

College

Research Paper

Name

Introduction

Stroke is one leading cause of death worldwide. It is characterized as a neurological deficit due to an acute focal injury of the central nervous system by cerebral infarction or intracerebral hemorrhage. Cerebral infarction is referred to as cell death associated with ischemia established on pathological, imaging, other objective evidence and clinical evidence. On the other hand intracerebral hemorrhage is defined as focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma (Belagaje 2017). Need a purpose statement

This research paper focuses on ischemic stroke which is the most common type of stroke. Ischemic stroke can be categorized in the following according to the trial of org in acute stroke treatment criteria (TOAST); large artery atherosclerosis, stroke of other determined cause, cardio embolism, small vessel occlusion and stroke of undetermined causes (Stephan, Fundenberger, Sutin, & Terracciano 2021). Large arteries affected by atherosclerosis include both and intracranial vessels. Cardio embolism accounts for about on fifths of ischemic strokes. The most frequent reason for cardio embolic stroke is atrial fibrillation. Other sources of cardio embolism include a patent foramen ovule, bio prosthetic or mechanical heart valves, ventricular thrombus due to myocardial infarction, endocarditis, and dilated cardiomyopathy, among others.

Small vessel disease affects small penetrating intracerebral arteries arising from the distal vertebral artery, the basilar artery, and the proximal branches or the middle, anterior, or posterior arteries. Occlusion of the penetrating vessels is usually attributed to proliferation and lipohyalinosis of their intima media secondary to hypertension. Small vessel disease causes the so-called lacunar infarcts. Stroke of other determined cause involves no atherosclerotic vasculopathies such as arterial dis-section and vacuities. The last TOAST subtype, i.e., stroke of undetermined etiology, includes strokes of which the cause cannot be determined and stroke with two or more identified causes. The TOAST criteria are helpful for classification of stroke subtypes in clinical trials and epidemiological studies as well as for everyday running with respect to secondary prevention approaches

Stroke risk factors Has to be in paragraph format. No lists.

There are several factors which may lead to stroke. It is important to note that some of the risk factors may increase the risk of getting one type of stroke either ischemic or hemorrhage. The risk factors include,

Age

People aged forty years are at risk of experiencing stroke. This may be associated with the developmental changes occurring in their bodies and cell responding to various activities within the body

Heart diseases

A person with an existing condition of heart disease is also at risk of experiencing stroke. This majorly based on the fact that they experience poor blood circulation within the body and the brain as well

Smoking

Smoking is another risk factor of experiencing stroke. Remember someone who is smoking as high chances of infecting the lungs something which may lead to poor oxygen circulation within the blood hence poor blood circulation within the brain and the whole body in general.

Previous history of attack

When an individual had a past experience of having stroke, chances are that they might experience the same in the future.

Inactive lifestyle

Lack of physical exercise may also cause stroke. This is due to the increased levels of fat within the body which should be shed during exercise. Also individuals have weak muscles which may respond poorly in case of an attack.

Obesity

In the United States of America obesity has been ranked as one risk factor of stroke. This is merely because anybody with proper understanding of obesity knows that with it one has high fat content within their bodies. This may lead to vessel blockage hence poor blood flow or circulation within the brain and other parts of the body (Stinear, Lang, Zeiler & Byblow 2020).

Current or past history of blood clots

When one is experiencing blood clots or has either experienced it, the chances of one getting stroke. One will agree when the argument is that blood clots limit or prevent blood circulation.

High blood pressure

High blood pressure may also be a cause of stroke. Blood pressure may reduce the rate of blood flow to the brain or increase the rate as well. Having blood pressure may always be a risk factor of stroke.

Stroke pathology

Stroke initiates a pathophysiological cascade that leads to the formation of brain edema this edema represents an additional volume within the fixed internal volume of the skull (Stinear, Lang, Zeiler & Byblow 2020). The edematous increase of brain volume occurs at the expense of other compartments. Usually, the space occupied by cerebrospinal fluid is the first displaced structure that is squeezed out into the spinal canal. This compensatory mechanism allows for an increase of the brain volume without or with only little changes of the intracranial pressure. However, after internal carotid or proximal middle cerebral artery occlusion, the large volume of infarction results in larger edema and thus the intracranial volume reserve is rapidly exhausted. The resulting increase in intracranial pressure and the tissue shifts with subsequent brain herniation and brain stem compression are associated with high mortality rates (Stinear, Lang, Zeiler & Byblow 2020).

The signs and symptoms of stroke are diverse. In some individuals they develop suddenly and may temporarily improve or get worse depending on the type of stroke. It is very important for individuals to note any similar symptoms and seek medical attention before the situation worsens. In many scenarios stroke become worse due to assumption of the basic symptoms. Understanding the symptoms and signs of stroke is very important and in many states it has proofed to be lifesaving. The following are the most common signs and symptoms of stroke;

Face again no lists. Make it pararaph form. The only bold should be subheadings.

In some scenarios a patient may experience sudden weakness or droopiness of the face. Additionally a patient may experience blurred vision.

Arm

Stroke may also be manifested through weakness or numbness of either one arm or both arms

Speech

Patients may manifest difficulties during speech or slurred speech together with garbled speech. When such symptoms are experienced individuals are advised to seek medical attention. It is very important to note that time is very crucial during stroke treatment and if the above signs manifest individuals should seek medical attention immediately. On the other hands the signs and symptoms of stroke might be similar to other ailments, it is therefore important to seek advice from trained medical professionals before starting any form of medication. Increasing study continue to show that some form of inflammatory are key risk factors of stroke. Ischemic stroke is caused by poor blood and oxygen supply to the brain; hemorrhagic stroke is caused by bleeding or leaky blood vessels. Ischemic occlusions contribute to around 85% of casualties in stroke patients, with the remainder due to intracerebral bleeding.

Stroke diagnosis Missing prognosis

Anyone experiencing the signs and symptoms of stroke must seek medical attention in a recognized medical institution. It is very clear that many medical officers cannot establish whether one has stroke or not therefore the following is done to effectively diagnose the patient;

Brain and blood vessel imaging No lists

After physical examination the doctor or nurse may advise the patient to take both CT scan or MRI scan and imaging test of the blood vessels that supply blood to the neck and head. This allows the medical officer to see the part which is affected by the stroke as well as identifying the type of the stroke which the patient has (McDonald, Black, Copland, Corbett, Dijkhuizen, Farr & O’Sullivan 2019).

Heart testing

Most patients with stroke tend to have underlying heart problems. Carrying out an electrocardiogram test helps the clinicians to treat any heart disease quickly and safe the patient life

Medical Management and Physical Therapy Treatment implications

Treatment of stroke depends on which type of stroke it is. However patients with signs and symptoms of stroke must undergo medical treatment and therapy to manage it. In medical management should include medications. Thrombolytics?

Medical treatment

Patients with stroke in most cases are managed in intensive care unit during and after stroke. The initial management of any patient with stroke revolves around; determining the cause, managing blood pressure, stopping any kind of medication which may result to bleeding or increase the blood pressure and measuring and managing the pressure within the brain.

Surgical treatment may also be conducted to prevent or stop bleeding together with reducing blood pressure inside the brain. This should be conducted within 48 to 72 hours after the stroke or even delayed up to fourteen days to allow the patient’s condition to improve.

Another form of treatment is aneurysm treatment. This refers to a blood vessel which has a weak area which moves outwards and if the area ruptures it might result to stroke. A clamp can be placed at the weak area. This is achieved through a surgical procedure.

Arteriovenous malformation treatment 

This form of treatment may result to further bleeding. To carry out this treatment it is very important for the medical team to consider the age of the patient, abnormalities of the veins which drain the malformation and whether it has a history of bleeding together with the location and size of the malformation.

Decompressive craniotomy

This is encouraged when the situation is life threatening to the patient. And before carrying it out the age of the patient, medical condition, size and location of the blood clot must be established.

Stroke complications

During and after medication patients suffer different conditions. Research has shown that most of deaths associated with stroke are out of complications after medication. The most common complications vary from; heart failure, blood clots, bed sores, urinary tract infections, bleeding in the digestive system

Evidence Based Practice Interventions in Stroke This is Medical Management. You need to discuss 2-3 physical therapy based interventions (treatments) in detail. Then you need 1-2 more paragraphs discussing modifications and progression of Physical Therapy treatment with patients post stroke.

There is no global recommendation as to the absolute target blood pressure or the optimal

Drug regimen. Targeted blood pressure values as well as the choice of antihypertensive agents should be adapted to individual patient. However, randomized controlled trials indicated a benefit associated with an average reduction of approximately 10/5 mm Hg and with the use of diuretics alone or in combination with an ACE inhibitor. Accordingly, current guidelines of the American Heart Association (AHA) and American Stroke Association (ASA) for the primary prevention of stroke recommend “regular blood pressure screening and appropriate treatment, including both lifestyle modification and pharmacological therapy (McDonald, Black, Copland, Corbett, Dijkhuizen, Farr & O’Sullivan 2019). It is very clear that the effectiveness is based on availability and usability of the evidence based practice. Individuals must ensure that they keep learning and improving on what they know. Additionally, a clear analysis of the existing practices must be done and any necessary improvement done. As stroke rehabilitation research becomes more stout, it is encouraged that researchers investigate implementation strategies to better facilitate translation into clinical practice. Work in partnership with implementation scientists may help guide scholars toward an understanding of how to structure methodologies when designing implementation studies and when measuring implementation outcomes. Key implementation outcomes include acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability (Goodman &Fuller 2016).  

Role of the PTA, Interactions of the Health Care Team

The physical therapist assistant plays a critical role in patient management. It is very true that in many occasions their duties are stressful and more engaging than their medical professionals team members (Goodman &Fuller 2016). Some of the PTA roles in stroke management include; reading the patient’s chart, transferring the patient, assisting the patient in exercise, gait training, ambulation, applying physical agents such as heat, cold, and electrical stimulation to specific muscles, instructing the patient and caregiver in functional activities, and observing and reporting changes in the patient’s condition to the physical therapist. Add interactions with team members? Which ones?

Need conclusion

Your weakest part of the paper is your Physical Therapy section.

References

*Sciences. American Stroke Association. / https://www.stroke.org/

*Goodman &Fuller (2016). Pathology for the Physical Therapy Assistant-E-Book Elsevier Health

*Belagaje (2017). Stroke rehabilitation. CONTINUUM: Lifelong Learning in Neurology, 23(1), 238-253.

*McDonald, Black, Copland, Corbett, Dijkhuizen, Farr & O’Sullivan (2019). Cognition in stroke rehabilitation and recovery research: Consensus-based core recommendations from the second Stroke Recovery and Rehabilitation Roundtable. International Journal of Stroke, 14(8), 774-782.

*Stinear, Lang, Zeiler & Byblow (2020). Advances and challenges in stroke rehabilitation. The Lancet Neurology, 19(4), 348-360

*Stephan, Fundenberger, Sutin, & Terracciano (2021). Cross-sectional and prospective association between personality traits and IADL/ADL limitations. Psychology and Aging..