It’s Just a Stroke…Right? Highlighting the Importance of Education Around the Impact of Strokes to Survivors,

Caregivers, and Professionals

4/11/2013

Sara Lassig, LICSW, PhDStroke Team Coordinator

& Social Work Case ManagerVA Medical Center

George Bill

75 year old stroke patient in acute rehab

32 year old TBI patient in acute rehab

George Bill

George Bill

Traumatic Brain Injury (TBI): Injury to the brain caused by an external force. Common causes: MVA’s, falls, striking the head, gunshot wounds

Acquired Brain Injury (ABI): Includes Cerebral Vascular Accidents (strokes) and loss of oxygen to the brain (Hypoxic Brain Injury

Lack of uniformity around the inclusion of TBI as a part of the more “umbrella” term “ABI.” TBI One type of ABI

Stroke is the 3rd leading cause of death in the United States.

Stroke is the leading cause of serious, long-term disability in the United States.

Each year, approximately 795,000 people suffer a stroke.

Nearly three-quarters of all strokes occur in people over the age of 65.

(American Stroke Assoc)

Left Brain Stroke: - Damage to the left side of the brain can weaken or paralyze the right side of the body, and may cause problems with speech and with the understanding of spoken and written language.

Right Brain Stroke: - Damage to the right side of the brain can weaken or paralyze the left side of the body and may cause lack of awareness and neglect of the left side of the body.

Cerebellar Stroke: -Damage to the cerebellum can cause lack of balance or coordination on the same side of the body. It can also cause slurring of speech.

Brain Stem Stroke: -Damage to this part of the brain can cause serious impairment in this life- sustaining functions. Symptoms of dizziness, slurred speech and double vision are also common. It may also cause paralysis on both sides of the body. 

Beyond hemiparesis, aphasia, neglect, and apraxia…◦Emotional reactions◦Confusion◦Changes in eating, sleeping, and thinking

◦Depression◦Fatigue

Severity of impairment

Extent of emotional reactions and changes

Family Reactions

Research

Pseudobulbar Affect Emotional lability, reflect crying

Rapid mood changes Crying or laughing that doesn’t match mood Depression ** Anxiety Frustration Fatigue

*Based as well on area of the brain affected*

Ambiguous Loss Physical absence with psychological presence. ◦(Example: severe hemiparesis)

Psychological absence with physical presence.◦(Example: severe fluent aphasia)

Ambiguous Losses are most difficult of all losses. ◦“Where is he/she?”

Family/caregiver/support system that is available to stroke survivor

Level of impairment Role in the family prior to the stroke Available resources “Status” of the stroke survivor

◦Research on care provision

Physical age Body image, “how old I feel” Perception of stroke survivor vs. perception

of others Era / Generation – Experience with adversity Emotional responses linked to age and

stage variations

George Bill

Loss of control Loss of self-image Loss of Independence Fear of stigma Fear of abandonment Fear of expressing

anger Fear of isolation

Loss of control Loss of self-image Loss of Independence Fear of stigma Fear of abandonment Fear of expressing

anger Fear of isolation

Do we change our care based on age alone? Do we change our expectations of

patient/stroke survivor behavior based on diagnosis?

Do we expect more? Less? Are we more patient? Are we providing the same quality of

education for the patient and family as we might for other brain injuries?

Are we as care providers educated?

Individuals who have experienced a stroke have a brain injury.

Professionals providing care to stroke patients have the responsibility to be educated on the resulting effects of strokes, in order to:◦ Provide improved patient and family care◦ Educate and support stroke survivors and their

families

Bob – 87 Joe - 65