Stroke is one of the leading causes of death, taking 140,000 U.S. lives each year. But it is also one of the leading causes of disability because more than 80% of people who have a stroke survive.
Survivors often face physical, emotional or cognitive challenges as a result, but UCI Health stroke neurologist Mohammad Shafie, MD, PhD, says there is life after stroke.
“The brain is a mysterious thing — it’s the last undiscovered frontier in medicine,” says Shafie, a member of the UCI Health Comprehensive Stroke and Cerebrovascular Center, one of the original Comprehensive Stroke Centers certified by The Joint Commission in Orange County and in the nation.
“Stroke affects each person in a different way,” says Shafie.
Patients may experience a range of physical limitations, including but not limited to:
- Difficulty with language and speech
- Vision problems
- Imbalance
- Difficulty swallowing
- Paralysis of one side of body
Immediate assessment
When the brain is deprived of oxygen and nutrients through a blocked or burst artery during a stroke, brain cells begin dying off within minutes, causing a range of functional and cognitive impairments.
As soon as a patient arrives to the emergency department at UCI Medical Center with symptoms of a stroke, a coordinated team of neurologists, stroke neurologists, emergency physicians and nurses start an assessment.
A neurologic evaluation is performed to examine:
- Language skills
- Strength
- Coordination
- Mobility
This assessment determines the best course of medical treatment for each patient.
Latest available individualized treatment
After treatment starts, patients are either admitted to the Neuroscience Intensive Care Unit (Neuro-ICU) or the Step-Down Unit, depending on the treatment and severity of the stroke.
There, the UCI Health stroke team, neurointensivists, neurosurgeons, specially trained nurses and therapists work together to meet the patient’s needs.
“We take a whole-person approach,” Shafie says. “From the moment stroke patients are stabilized and can tolerate it, we ask our therapists — including speech, occupational, and physical therapists — to work with the patients and help determine the level of rehab the patients will need.
“We know that some people may also benefit from psychological or financial counseling,” he says. “To this end, we ask our social workers and case managers to talk to patients and their families. We offer every resource available so that our patients can achieve the best possible recovery.”
Accepting a new reality after stroke
Shafie says the most difficult aspect of stroke is for the patient having to come to terms with a new reality that may include serious deficits. In one minute, a person’s life may be altered in a drastic way that is hard to accept.
Imagine the challenges involved in such simple daily activities as using a toilet or rolling over in bed when half of your body won’t obey commands to move.
Picture the frustration of not being able to lift a glass of water to drink, of lacking the fine-motor skills to hold a pen, or being unable to communicate your feelings and needs to others.
Post-stroke there may also be additional complex challenges, such as:
- Fatigue
- Sleep difficulties
- Bladder or bowel incontinence
- Possibly memory impairments
Rehabilitation from stroke
Rehabilitation therapy can be very successful in helping stroke sufferers recover much of their lost physical and cognitive function.
Maximum recovery from stroke occurs in the first three to six months, so treatment should be started as soon as possible — usually well before a patient leaves the hospital.
All patients are evaluated by a physiatrist, a physician trained in the specialty of physical medicine and rehabilitation (PM&R). The physiatrist and stroke team work together to determine the best therapy for each patient.
The evaluations and recommendations of the stroke team, therapists, PM&R team and case managers are used to help the patient and their family select an appropriate rehabilitation facility, such as a skilled nursing facility or an acute rehabilitation unit.
Emotional health after stroke
Emotional and physical health of stroke patients are inseparable and are therefore addressed in unison.
Nearly half of all stroke victims battle depression, which is associated with poor functional outcomes.
That’s why an assessment of a patient’s emotional and cognitive state is part of each patient’s workup, Shafie says.
While hospitalized at UCI Health, each stroke patient is evaluated by speech therapists for cognitive function and by social workers for depression and anxiety. Stroke team members also counsel patients and their families and caregivers to be on the lookout for symptoms of depression.
Care after leaving the hospital
After discharge from the hospital or rehabilitation facility, stroke patients continue to be followed by the highly trained board-certified stroke neurologists as outpatients at the stroke center.
This continuation of stroke care allows the stroke physicians to address some of the post-stroke challenges such as:
In addition to providing care to UCI Health stroke patients, the stroke center also receives referrals from physicians in surrounding areas and address a broad range of requests, including:
- Second opinion regarding the cause of stroke
- Optimization of stroke risk factors
- Management of post-stroke complications
- Assessments and referrals to appropriate therapies
Preventing another stroke
One of the most meaningful impacts of a stroke neurologist is their role in helping stroke survivors reduce the risk of a second stroke.
Certain common risk factors are modifiable, including:
There are also rare risk factors such as:
- Certain genetic diseases
- Cardiac or cerebrovascular conditions, which once identified can be modified by additional treatments such as stronger blood thinners or surgery
By addressing and managing these risk factors, as well as educating patients, their families and caregivers about the risk factors, neurologists can minimize the fear and anxiety around having a second stroke.
“Unfortunately, we can never prevent strokes completely, but by modifying risk factors, we can reduce the risk of a stroke by 50% to 60%,” Shafie says.
“A better understanding of why a stroke happened and tackling the risk factors can alleviate anxiety.”
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