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Stroke Recovery (Cerebral Vascular Accident/CVA)

A definition of Cerebral Vascular Accident (Stroke, CVA)

A stroke is the rapid disruption of brain functions due to a disturbance in the blood vessels that supply blood to the brain. As a result, limbs on the body may have the inability to move on their own or may become very weak. This inactivity leads to skin breakdown, contractures and joint stiffness. Using a dynamic splint on the affected joint provides a tension to remodel and elongate the tissues around a joint. This can prevent contractures and skin breakdown. If you have had a cerebral vascular accident, you may want to consider using a Dynasplint® System to aid in your recovery process.

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A cerebral vascular accident (CVA), more commonly referred to as a stroke, occurs when the blood supply to the brain is disrupted or interrupted, resulting in the rapid loss of brain function. An artery (a blood vessel that carries blood from the heart to the body) is blocked by a blood clot or a blood vessel (a tube through which the blood moves through the body), interrupting blood flow to an area of the brain.

Types of Stroke:

  • Ischemic stroke occurs when arteries are blocked by blood clots or by the gradual build-up of plaque and other fatty deposits. About 87 percent of all strokes are ischemic.
  • Hemorrhagic stroke occurs when a blood vessel in the brain breaks leaking blood into the brain. Hemorrhagic strokes account for 13 percent of all strokes, yet are responsible for more than 30 percent of all stroke deaths.

The particular type of stroke, or CVA, can be determined using diagnostic tests such as angiograms, CAT scans, and MRIs.

All types result in decreased blood flow to areas of the brain, resulting in tissue injury and/or death. Two million brain cells die every minute during a stroke, increasing risk of permanent brain damage, disability or death.  Recognizing symptoms and acting quickly to get medical attention can save a life and limit disabilities. Risk factors that can increase an individual’s chances of having a stroke include age, high blood pressure, previous stroke, irregular heartbeat, diabetes, smoking and high cholesterol.

The resulting damage from a stroke depends largely upon the size and extent of the blockage or bleeding, and the area of the brain that is affected. When brain cells die during a stroke, abilities controlled by that area of the brain are lost.  These abilities include speech, movement and memory.  How a stroke patient is affected depends on where the stroke occurs in the brain and how much the brain is damaged. The most common side effects of stroke are loss of function along one side or area of the body; confusion; loss or muddling of speech; and partial loss of vision. For example, someone who has a small stroke may experience only minor problems such as weakness of an arm or leg.  People who have larger strokes may be paralyzed on one side or lose their ability to speak.

Depending upon the type of stroke – ischemic or hemorrhagic – so-called clot busting medications may be used in a clinical setting to help break apart the clot, and stents – small, hollow tubes - may be inserted into the blocked artery to help improve blood flow. Individuals deemed to be at increased risk for stroke may be prescribed regular medication to help thin blood or prevent the plaque buildup that can cause vessels to become blocked.

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Stroke Rehabilitation

Rehabilitative therapy begins in the acute-care hospital after the patient's medical condition has been stabilized, often within 24 to 48 hours after the stroke. The first steps involve promoting independent movement because many patients are paralyzed or seriously weakened.  Patients are prompted to change positions frequently while lying in bed and to engage in passive or active range-of-motion exercises to strengthen their stroke-impaired limbs. ("Passive" range-of-motion exercises are those in which the therapist actively helps the patient move a limb repeatedly, whereas "active" exercises are performed by the patient with no physical assistance from the therapist.) Patients progress from sitting up and transferring between the bed and a chair to standing, bearing their own weight, and walking, with or without assistance.

Rehabilitation nurses and therapists help patients perform progressively more complex and demanding tasks such as bathing, dressing, and using a toilet. They encourage patients to begin using their stroke-impaired limbs while engaging in those tasks. Beginning to reacquire the ability to carry out these basic activities of daily living represents the first stage in a stroke survivor's return to functional independence. In general, physical therapy focuses on the reestablishment of gross motor skills, such as walking and use of hands and arms, while occupational therapy helps patients relearn skills of daily living, as well as skills they may have used during employment. Speech and language therapy can assist with learning to speak clearly, understanding speech and swallowing. Psychological counseling is often included to help the patient adjust to a newly decreased level of functionality and to help relieve feelings of stress and depression which often occur during physical and speech therapy and beyond.

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For some stroke survivors rehabilitation will be an ongoing process to maintain and refine skills and could involve working with specialists for months or years after the stroke. Some people recover completely from strokes, but more than 2/3 of survivors will have some type of disability and may continue to rely on assistive devices such as wheelchairs, walkers, canes or braces. Dynamic splinting may be used in conjunction with physical therapy to resolve or prevent contractures of the affected joints.

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