research paper

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College

Research Paper

Name

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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 intrac-

erebral hemorrhage. Cerebral infarction is referred to as cell death associated with ischemia es-

tablished 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 intracra-

nial 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 lipohyali-

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nosis 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 pre-

vention 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

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Smoking is another risk factor of experiencing stroke. Remember someone who is smok-

ing 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 circu-

lation 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 circu-

lation.

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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. Ho-

wever, 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 hernia-

tion 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. Un-

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derstanding 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 con-

tinue 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 pa-

tients, with the remainder due to intracerebral bleeding.

Stroke diagnosis Missing prognosis

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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 identify-

ing 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 elec-

trocardiogram 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

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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 re-

ducing 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 carry-

ing it out the age of the patient, medical condition, size and location of the blood clot must be

established.

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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 com-

mon 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 treat-

ment 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 be-

nefit associated with an average reduction of approximately 10/5 mm Hg and with the use of diu-

retics 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 practi-

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ces must be done and any necessary improvement done. As stroke rehabilitation research beco-

mes 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 de-

signing implementation studies and when measuring implementation outcomes. Key implemen-

tation outcomes include acceptability, adoption, appropriateness, costs, feasibility, fidelity, pene-

tration, 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 profes-

sionals 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.

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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 associa-

tion between personality traits and IADL/ADL limitations. Psychology and Aging..