From: M20614@mwvm.mitre.org (Hugh Pritchard)
Subject: Re: stroke
Organization: The MITRE Corporation, McLean VA 22102
Date: Tue, 8 Sep 1992 11:42:56 GMT

In article <1992Sep7.214549.17066@ultb.isc.rit.edu>
jnynge@ritvax.isc.rit.edu (Jeanne) writes:
 
>...
>  I really know very little about stroke rehab.  It seems
> that for limbs, physical therapy can have a big impact but what
>can be done if the person is unable to speak?
 
I had a stroke (technically, a Cerebro-Vascular Accident) myself, when
I was 20.  I learned the following at that time -- 1974, so some stuff
may be outdated.
 
A stroke is the cutting-off of blood to the brain, either by buildup
of guck [non-technical term, that!] (thrombosis), or a free-floating
clump of stuff, like a loose blood clot (embolism), or a rip in the
blood vessel (hemorrhage).  This leads to death (necrosis) of the
affected part of the brain.
 
Of 100 people who have a stroke caused by an embolism or thrombosis,
approximately 36 will die, within 1 to 10 days of the stroke.  (Death
stats for strokes caused by hemorrhage are much worse.)  This stat hasn't
changed much in the past 100 years; what *has* changed is the rehab and the
rehab stats.  Of the 66 who live, 50 will continue to have some major lack
of function for the rest of their lives.  The rest are considered fully
recovered.  About half a million people have strokes every year in the U.S.
 
There is an initial six-month period of "spontaneous" recovery -- i.e.,
the patient gets better even if he doesn't care.  When I was still in
the hospital recovering, the nurses told me that all the older stroke
patients were suffering from what they called "hospitalitis":  The
patients felt entitled to 100% care-and-feeding, even if they didn't
NEED it.  (Incidentally, the Merck manual points out that "supportive
nursing care" is about the only effective help, once the patient is
stabllized.)  Beyond this initial period, the patient will have to work
at it if he wants or expects to regain any further function.
 
There are two major problems, as you noted:  Hemiplegia, and aphasia.
Hemiplegia is paralysis of one entire side of the body, usually the
side opposite to the dominant hemisphere of the brain -- i.e., right-
handers would be paralyzed on the right side, left-handers on the
left side.  This is because the stroke itself usually happens in the
dominant hemisphere.  Rehab consists of passive (physical therapist
moves patient's limbs) and active therapy (patient is expected to move
his own limbs, often against resistance).
 
Aphasia is a term covering many symptoms of "inability to communicate."
While I was recovering (and even today!), I felt capable of thinking,
yet my mental "input/output buffers" seemed to have disappeared, so
that information would evaporate as I was reading or listening to it;
and my thoughts would evaporate as I was trying to speak them.
 
One cannot do anything "physical" to aid a patient to regain speech
(this difficulty in speaking is called "dysarthria"): rubbing the
patient's throat, for example, is useless.  This is because the
problem is within the brain.  The brain that's left has to figure out
how to take up the slack left by the dead portion(s) of the brain.
 
Other aphasic symptoms might include difficulty reading (I had
*different* sorts of difficulty reading books and reading newspapers.
Strange); difficulty doing simple mental arithmetic (*that* was a blow,
since I was studying physics/math at the time!); difficulty paying
attention; difficulty understanding long, complicated sentences; even.
personallity changes.
 
As a result of all this, the patient will frequently feel VERY FRUSTRATED.
 
Often, there's also serious FATIGUE.
 
I'm sure your friend's doctors, nurses, and therapists will have given
his family information and pointers to stroke support groups.
 
**  Hugh Pritchard,  hapritch@mitre.org,  703/883-6616