1.What is a stroke?
A: Stroke is a syndrome of acute onset of neurological deficits due to local cerebral blood circulation disorders, with symptoms lasting at least 24 hours, but symptoms of only a few minutes or hours should also be taken seriously.
2.What are the names of strokes?
A: Stroke has many names, such as “stroke”, “cerebrovascular accident” and “cerebrovascular disease”. Patients are confused, what exactly am I suffering from? In fact, they all diagnose the same disease. Since this disease is fast-onset, sinister and changeable, just like the wind in nature, “good and changeable”, Chinese medicine calls this type of disease “cerebral stroke”. Since this disease occurs when the cerebral blood vessels unexpectedly go out of order, the onset is sudden and unpredictable, therefore, it is also called “cerebrovascular accident”. Western medicine then calls it “cerebrovascular disease”.
3.What are the categories of stroke?
A: Stroke is usually divided into two categories: ischemic stroke and hemorrhagic stroke.
3.1 Ischemic strokes mainly include
(1) Transient ischemic attack (TIA, also called cerebellar stroke or transient ischemic attack), which is a functional impairment caused by transient, ischemic, focal damage to brain tissue.
(2) Cerebral infarction, including cerebral thrombosis and cerebral infarction. (1) Cerebral thrombosis: mostly has the onset of atherosclerosis, various arteritis, trauma and other physical factors, blood-induced blockage of blood clots formed by local lesions of cerebral vessels. ② Cerebral embolism: it can be induced by the emboli generated by various diseases entering the blood and blocking the blood vessels in the brain. Clinically, heart disease is the most common cause; followed by fat into the blood after fracture or trauma; worm eggs or bacterial infection; air into the blood such as pneumothorax, emboli formed by phlebitis and other factors, which embolize the cerebral vessels.
3.2 Hemorrhagic stroke mainly includes: ①: due to cerebral hemorrhage: refers to the rupture of blood vessels in the brain parenchyma bleeding, excluding traumatic cerebral hemorrhage. Mostly caused by hypertension, atherosclerosis, tumors, etc. ② Subarachnoid hemorrhage is caused by rupture and bleeding of blood vessels on the surface and base of the brain, and blood flows directly into the subarachnoid space. Common causes include ruptured aneurysm, vascular malformation, hypertension, atherosclerosis, blood disorders, etc.
4. Is stroke preventable and treatable?
Stroke can be prevented. We need to correct misconceptions and unhealthy lifestyles, and consciously avoid risk factors for stroke; in addition, we should pay attention to pathological changes that have already formed in the body, such as stenosis caused by carotid plaque, and conduct regular stroke screening to detect disease problems early, achieve early diagnosis and early treatment, and then we can effectively prevent stroke from occurring.
After a stroke occurs, more than a certain time (about 3 hours) brain tissue necrosis occurs and usually cannot be treated in an effective time. Studies show that less than 1% of patients (probably less than 1 in 10,000 in China) can be treated in time. Therefore, with timely treatment after a stroke, some patients can be completely relieved or even return to normal without any sequelae.
5.When does stroke prevention start?
A: Stroke prevention should start at an early age. The pathological changes of atherosclerosis often start in childhood and get worse with age, mainly related to high fat content in food and high sugar diet leading to obesity in early childhood.
Hyperlipidemia and obesity are the main causes of atherosclerosis. Starting from early childhood, proper control of high cholesterol and high sugar food intake, more fruits and vegetables; develop the habit of not being partial and not over-eating; actively participate in various sports and develop good living habits, which are extremely beneficial to people’s life.
6.Why do stroke patients need rehabilitation treatment?
A: Patients with stroke often have various sequelae and dysfunctions, including unfavorable limb movement, sensory numbness, slurred speech, swallowing difficulties, incontinence, etc., resulting in patients being unable to take care of themselves and even bedridden for a long time. Clinical emergency treatment mainly focuses on saving patients’ lives and reducing complications, while the management of these sequelae requires timely rehabilitation treatment. Rehabilitation is the comprehensive application of various means to correct or improve the various sequelae of stroke as much as possible, to improve the patient’s ability to take care of themselves, including independent dressing, eating, washing, walking, etc., and to improve the patient’s quality of life, so that the patient can return to society. In addition, rehabilitation treatment also helps to reduce weight, improve sugar and lipid metabolism and control blood pressure, and correct bad behavior patterns, thus reducing the risk of stroke reoccurrence.
7.What are the methods of stroke rehabilitation treatment?
A: Stroke rehabilitation treatment methods include rehabilitation medical treatment, physical therapy, occupational therapy, speech therapy, psychotherapy, orthopedic treatment, traditional Chinese treatment and rehabilitation therapy. Among them, rehabilitation medical treatment mainly deals with various clinical problems of stroke patients. Physiotherapy emphasizes improving the patient’s mobility through repetitive motor training so that the patient can turn over, sit up, stand and walk independently. Physical therapy includes electrotherapy, phototherapy, magnetic therapy, and hydrotherapy. Occupational therapy focuses on training patients to perform daily activities such as dressing, eating and washing independently to improve patients’ ability to take care of themselves. Speech therapy can improve patients’ verbal and non-verbal expression. Psychotherapy is a psychological and pharmacological treatment for patients with depression or anxiety secondary to stroke. Patients with foot drop and pronation can be treated with additional ankle-foot orthoses. The rehabilitation group consists of rehabilitation physicians, rehabilitation therapists and rehabilitation nurses, who analyze and evaluate the problems of stroke patients in all aspects, develop individualized rehabilitation treatment plans and carry out integrated, comprehensive and systematic rehabilitation treatment.
8.When should stroke patients undergo rehabilitation treatment?
A: Prolonged bed rest for stroke patients can lead to muscle atrophy, joint contracture and deformation, osteoporosis and skin breakdown. Therefore, stroke rehabilitation must be carried out as early as possible. Patients can undergo rehabilitation as soon as their condition is stable. Early rehabilitation treatment is based on postural placement, passive limb activities and light active activities, which help patients recover their neurological functions and avoid the adverse effects of prolonged bed rest. The best time for post-stroke rehabilitation is within 3 months after the onset of stroke. If rehabilitation treatment is carried out more than 1 year later, the efficiency of various functional recovery will be reduced.
9.How to deal with the problem of limb spasm after stroke?
A: Limb spasm refers to high muscle tension, involuntary strong contraction, which can lead to joint contracture and deformation in severe cases. This can cause patients who were able to resume walking to be unable to walk due to obvious joint deformation or restricted movement, which seriously affects the patient’s daily life. There are various rehabilitation treatments for limb spasticity, the most commonly used being distraction therapy, and spasticity can also be inhibited by electrical stimulation of the muscle group opposite to the spastic muscle operation. For joint contractures and deformities caused by spasticity, orthoses can be added to fix the spastic limb in a normal position to correct the deformity. For severe myospasm that cannot be corrected by manual stretching, nerve block therapy can be used.
10.What if a stroke patient has swallowing disorder?
A: Stroke patients often have swallowing disorders, mainly due to difficulty in eating, repeated choking and coughing, and aspiration, which can be secondary to aspiration pneumonia and malnutrition. For patients with swallowing disorders, the first thing to do is to adjust the food form to a thick, liquid form. Drinking water is most likely to cause choking and coughing. It is advisable to adopt a semi-recumbent position with the neck bent forward when eating, so that gravity can be used to make the food easy to swallow and to reduce accidental aspiration. Each mouthful of food should start with a small amount and gradually increase to find the right “bite size”. If food remains in the mouth or pharynx and cannot be swallowed completely, stop feeding and let the patient repeat the swallowing action several times or give some liquid to promote swallowing of the remaining food. Patients with severe swallowing disorders should be promptly seen by the Department of Rehabilitation Medicine for swallowing training.
11.What kind of position should stroke patients take when they are in bed?
A: Patients with stroke spend a lot of time in bed in the early stages, so the posture of bed position is particularly important. Commonly used postures include the affected side, the healthy side and the supine position:
11.1 When lying on the affected side, pay attention to the upper limb of the affected side and place it on a soft pillow, with the fingers fully extended; the lower limb of the affected side and the healthy side are flexed and placed on a soft pillow.
11.2 When lying on the healthy side, pay attention to the upper extremity of the affected side in forward flexion, fingers extended to hold the soft pillow in front of the chest; the lower extremity of the affected side is placed on the soft pillow in flexion.
11.3 In the supine position, place a soft pillow under each of the upper and lower limbs on the affected side, keeping the upper limb fully extended forward with the palm of the hand facing upward; the lower limb is abducted and slightly flexed. Many patients are accustomed to supine position, in fact, postural abnormalities and pressure sores are easy to occur in supine position, so the time of supine position should be reduced appropriately.
12.What should stroke patients do if they have depression and anxiety?
A: Stroke patients are prone to emotional disorders due to brain damage and its secondary dysfunction, the most common of which include depression and anxiety. First of all, we should provide comprehensive rehabilitation treatment for the various sequelae of stroke to improve the patient’s mobility, achieve self-care as much as possible, enhance the patient’s self-confidence and ensure the quality of life in the period. Secondly, the patient’s family and friends should pay full attention to the patient’s psychological state and give psychological guidance at the right time, encourage the patient to actively carry out rehabilitation training by depression or anxiety scale and other tools for psychological assessment, according to the assessment results, serious patients need to add antidepressant/anxiety drugs.
13.How to communicate with aphasic patients in a simple way?
A: When a patient has aphasia, communication with family members becomes the primary problem. Mastering simple communication methods can help to understand the patient’s needs and detect changes in the patient’s condition in a timely manner, and the specific methods are as follows.
13.1 Gesture method: Agree with the patient on a hand gesture schematic, into the upper thumb indicates stool, the lower thumb indicates urine; open mouth is eating, palm up and down turning is turning over. The hand over the forehead indicates headache, and the hand moving on the abdomen indicates abdominal discomfort. Except for those with hemiplegia or bilateral limb paralysis and those with comprehension disorders, all other aphasia can be applied. 13.2 Physical picture method: Use some physical pictures for simple thought exchange to meet physiological needs and solve practical difficulties. Use common objects such as: teacup, commode, human head, hospital bed, etc., repeatedly teach patients to use. For example, a teacup means to drink water, a human head means a headache, and a hospital bed means to turn over. This method is most suitable for communication of hearing impairment.
13.3 Text writing method: It is suitable for patients with high cultural quality and no mechanical writing disorder or visual-spatial writing disorder.
14.How to prevent constipation from occurring in bedridden stroke patients?
A: Constipation is one of the common complications in bedridden stroke patients. It can be prevented by the following methods.
14.1 Pay attention to diet adjustment. Once a stroke patient has eaten by mouth, it is best to choose foods that are high in fiber and increase the volume of stool. Increase water intake to prevent dry stools and keep stools as soft as possible.
14.2 Develop good habits: 1) Develop the habit of regular defecation, preferably in the morning after waking up, or 20 minutes after breakfast, even if you do not have the urge to defecate at this time, it is better to relieve (defecate) once to promote the formation of the normal defecation reflex; 2) It is better to concentrate on defecation in a quiet environment without disturbance; 3) Do not force defecation; 4) Use the gastrocolonic reflex to choose defecation after meals; 5) In case of stool ⑤ If stool impaction occurs, the patient can be assisted to defecate by hand.
14.3 The above measures can be supplemented by the application of drugs or enemas for constipation.
15. How should a stroke patient with constipation be treated?
A: Excessive forceful defecation due to constipation increases the abdominal pressure, strengthens the heart contraction, and increases blood pressure, which can easily trigger a stroke. Therefore, constipation must be treated promptly.
15.1 Advise the patient not to strain excessively to defecate.
15.2 Massage the abdomen in a clockwise direction (from the right lower abdomen upward, then leftward, then downward to the left lower abdomen) to promote intestinal peristalsis.
15.3 Drink 2000-2500 ml of plain water daily.
15.4 Instruct the patient to eat foods containing more fiber, such as celery, leek, spinach, coarse grains, beans, cereals, fresh vegetables and fruits, etc., which can promote intestinal peristalsis and prevent dry stools.
15.5 Take oral laxative medication or use open-loop as prescribed by the doctor.
15.6 For dry and hard stools, wear gloves and pull out the stool with fingers or a small spoon.
15.7 Scrub the perianal skin with warm water to promote contraction.
16.What family first aid measures should be taken in case of sudden stroke?
A: If a patient with high blood pressure, heart disease or diabetes suddenly has dizziness, headache or fainting, followed by symptoms such as slanting of the mouth and eyes, drooling, slurred speech or vomiting, or hemiplegia of one limb, it is likely to be a stroke and the following measures should be taken immediately.
16.1 If multiple stroke symptoms occur alone or at the same time, call the emergency telephone number “120” or “999” immediately.
16.2 The patient should be placed on his back with the head and shoulders padded in a head-high, foot-low position to reduce the pressure on the blood vessels in the head; tilt the head to the side to prevent choking from sputum or vomit, or suffocation from aspiration back into the trachea. If there is vomit obstruction in the patient’s mouth and nose, try to pick it out to keep the airway open. If the patient is not awake, do not blindly feed water or drinks to the patient.
16.3 Unbutton the patient’s collar, tie, trouser pocket, bra, and remove dentures, if any.
16.4 If the patient is awake, pay attention to comforting the patient and relieving his or her tension. It is advisable to remain calm, do not panic, and do not cry or shout at the patient to avoid causing psychological stress to the patient.
16.5 Do not seek help from far away. Early management of stroke patients is a moment of gold and must be done every second. Do not delay resuscitation by going to a prestigious hospital.
16.6 Never give the patient drugs, such as haemostatic agents, Anguilla pills, etc., but also the usual antihypertensive drugs, to prevent aggravation of the disease until there is a clear diagnosis by the doctor.