Guess how many people have a stroke…daily…in just one part of the world?

4500 in India!  That is incredible to me!

Stroke / brain attack is now the second commonest killer in the world after heart attack and the first and foremost cause of permanent disability. It is responsible for more deaths annually than those attributed to AIDS, tuberculosis and malaria combined and in India alone, 4,500 people get a stroke every day. However, stroke is eminently treatable and preventable but timely medical attention is critical.

Stroke is a catastrophe, presenting commonly as a sudden onset paralysis of one side of face, or one hand and face or one full half of the body with or without loss of sensations. Loss of ability to speak and understand spoken words is another common feature. Losing vision on one side of visual field or one eye is the other feature. Sudden vertigo or dizziness, vomiting, loss of balance in walking, double vision, difficulty in swallowing etc. are also seen when areas affected are the lower portions of brain called brainstem. Recognition of these symptoms leads to correct diagnosis of stroke in 80% of the cases.

Strokes result most often (80%) from poverty of blood flow to parts of brain which are supplied by a particular artery feeding the brain of oxygenated and glucose rich blood which help brain to derive its energy. An active normal brain consumes more energy than any other tissue in the body. So oxygen and energy deprivation kills brain cells quickly. After a cessation of blood flow to brain, within one second around 32000 nerve cells die and it has been calculated that this may translate also into loss of 9 hours of human lifespan. Hence the most important principle in the care of stroke patients is a fast response.

The need for urgency in rushing a patient with stroke to an acute facility arise from the fact that we now have a very effective treatment using a clot busting drug called tissue plasminogen activator (TPA) which given in an appropriate stroke patient within 4.5 hours from the onset of stroke dissolves the vessel blocking clot and opens up the arteries. This reestablishes blood flow to the starved brain and prevent permanent death and loss of nerve cells which can lead to immediate recovery from paralysis or a minimization of the final severity of stroke. In the meanwhile, stroke prevention strategies have to be reinforced. For primary prevention (prevention of first ever strokes), the effective steps are to a great extent the same as for heart attacks. Most important risk factors are hypertension, diabetes mellitus, high cholesterol, obesity but also includes all forms of heart diseases. Avoidance of tobacco and alcohol and abusive drugs and regular and adequate physical activity and healthy food and sleep habits help prevent stroke.

Once someone develops stroke, it is of paramount importance to prevent further strokes. Stroke rehabilitation is a specialized area and stroke units are perhaps the most effective measures in improving stroke recovery. The role of early mobilization of stroke patients and physiotherapy and occupational therapy are well-established.

Since one of the largest obstacle to emergency treatment is that many people do not know they are having a stroke, it is critical for everyone “to be stroke smart and learn the 3Rs of stroke” which are reduced risk, recognize symptoms, respond by rushing into the nearest hospital. The world stroke organization has popularized this campaign using the acronym FAST – Face, Arm, Speech and Time.

Ever wonder what people in India think of a stroke?

Article published in The Hindu

It is a common understanding in India that stroke survivors need intense and regular physiotherapy to recover lost functions of muscles and nerves. However, do you know your dear one, who is recovering from stroke, may also need speech therapy to regain language skills, much like a child who was born deaf?

With over one million stroke cases in India annually, a large number of victims grapple with the debilitating effects of post-stroke disability. Partial or total paralysis, spasticity and aphasia (impairment of language) are common side effects of stroke. While rehabilitation with physiotherapy is a common practice, not many people realise that some patients may need speech therapy too. As a result many victims whose speaking and language comprehension ability can be rehabilitated fail to get attention and are left with permanent language impairment.

A person suffering from aphasia may face difficulty in speaking, comprehending speech, expressing himself, reading or writing. This condition requires intense speech therapy to recover. However, in India, awareness is so low about this condition that most victims fail to receive required attention.

Speech and language therapy is also sometimes needed in people with neurological disorders or memory, language and attention disorders associated with brain injury. It is also needed in patients undergoing laryngectomy rehabilitation or those suffering from feeding and swallowing disorders. Language impairment occurs in more than a third of people who survive a stroke on the left side of their brain. While some recover from it, most continue to have language and speech impairment more than six months after a stroke.

Stroke can be described as a condition when blood supply to the brain is disrupted or blocked either due to narrowing of a blood vessel or due to a haemorrhage. In patients who survive a stroke, it leaves a permanent damage to the nerve cells of the brain causing loss of control over perception, movement, speech or other bodily functions.

Aphasia or speech and language difficulty post a stroke can be classified in four parts:

Expressive Aphasia: This is a condition where the patient is unable to find the required words to express his thoughts.

Receptive Aphasia: People with receptive aphasia can hear people talking but are not able to understand the sentences being spoken.

Anomic or amnesia aphasia: People suffering from amnesia aphasia are unable to take the correct names of people, objects and places amongst others.

Global aphasia: Global aphasia occurs when the language areas of the brain are damaged. Victims of global aphasia are unable to speak, understand read or write. It can be described as the most severe form of aphasia.

Such patients may not only just need physical therapy and medication but also need elaborate speech and language therapy to help them renew their understanding of verbal communication. Some therapies which are considered effective for patients include:

Melodic intonation therapy which helps stroke survivors to sing the words they are unable to speak.

Art therapy to improve expression.

Visual speech perception therapy which is focused on associating pictures with words

Group therapy which allows them to receive rehabilitation in groups of similar people

Constraint-induced language therapy where verbal communication is used. Simple, clear and slow speech should be used so that the patient is able to understand you.

Regular and intense speech therapy can help patients recover some or most of their speaking and language comprehension ability. However lack of awareness means a vast number of people suffering from aphasia do not get access to speech therapy. Some people stop therapy in a few months, without realising that sometimes recovery may take longer.