What You Need to Know About Stroke
Or t h o - Ne uro Se r v ice s | m ou nta in state s he a lth a llia n ce | www.msha .com
Medication Log
Name __________________________________________________________________________________
Physician’s Name ________________________________________________________________________
Medications
When I Take It
Dose
Date Started
Specific Instructions From Your Doctor
Other Instructions
Contents
Health Resource Center & Our Stroke Team
3
Stroke Warning Signs4
Purpose of Material 5
TIA6
Ischemic Stroke7
Hemorrhagic Stroke8
Tests and Assessments9
Medication 11
Rehabilitation12
Changes Caused by Stroke14
Left-Side Brain Injury15
Right-Side Brain Injury16
Cognitive-Communication Disorder 17
Aphasia18
Dysarthria19
Dysphagia20
Nutrition21
High Blood Pressure22
Caregiver Role25
Every year many patients and families are impacted by the diagnosis of stroke.
Stroke is one of the leading causes of disability and mortality in the United
States. Early identification and intervention can improve outcomes and quality
of life.
Through community education, alignment with Emergency Services and
availability of tertiary level services, the Stroke Team is making strides in the
management of this disease.
You will be provided with education regarding the diagnosis of stroke and most
importantly, the plan for risk reduction. Your active participation in all aspects
of education will be instrumental in recovery and future outcomes.
As an outreach service of Mountain States Health Alliance, our Health
Resources Centers are open to everyone. Come browse through books
and literature to find current health information or chat with our health
professionals to get answers to your questions. If we don’t know the answer,
we’ll help you find the resource you need. We also offer the following services
and programs, and most of them are FREE!
• Daily blood pressure checks
• Health screenings
• Assistance with becoming smoke-free
• Personal nutritional counseling with
a registered dietitian
• Diabetes self-management classes
• Support groups
• Health seminars
• Physician lectures
• Healthy cooking classes
• Health library – books and brochures
• Referral information
Contact the Health Resources Centers
HRC at The Mall at Johnson City, 423-915-5200
HRC at the Kingsport Town Center, 423-857-7981
Our Stroke Team
General Physicians
Intensivists
Neurologists
Neuro Surgeons
Neuro Radiologists
Director of Ortho/Neuro/Trauma
Clinical Leaders
Stroke Trained Nurses
Pharmacists
Physical Therapists
Occupational Therapists
Speech Language Pathologists
Dietitians
CT Technicians
MRI Technicians
Cardiovascular Technicians
Social Worker/Case Managers
www.msha.com | orthopedic and neurological services | page 3
Stroke Warning Signs
• Sudden numbness or weakness of the face, arm or leg,
especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or
coordination
• Sudden, severe headache with no known cause
If you or someone with you has one or more of these signs,
don’t delay! Immediately call 911 or the emergency medical
services (EMS) number so an ambulance can be sent for you.
It is very important to get to the hospital quickly! If given
within three hours of the start of symptoms, a clot-busting
drug can reduce long-term disability for the most common
type of stroke.
Time lost is brain tissue lost!!
If a stroke warning sign occurs, what are the most important
things to remember?
• Do not ignore the warning signs, even if the symptoms go
away! Some people may only have one or two signs. Others
may have more.
• Check the time. When did the first warning sign start? You
will be asked this important question later.
• Act quickly and call 911. Stroke is a medical emergency.
• Every second counts.
Write down the emergency medical services number and your
physician’s number and put them by your phone.
Remember, not every person has all the signs of stroke. When
you see any of them, act quickly!
page 4 | orthopedic and neurological services | www.msha.com
Purpose of Material
The purpose of the following material is to provide stroke education to patients and their families. Special attention
will be made to discuss the following with you by your stroke care team:
• Stroke risk factors that you have and modifications needed to change them
• Stroke warning signs
• Early activation of EMS
• Follow-up after discharge with your primary care physician
• Medications prescribed
Stroke Risk Factors
A risk factor is a characteristic or behavior that increases your risk for stroke.
Stroke risk factors fall into 2 categories:
1. Those you can modify, treat or control with your doctor’s help.
2. Those you cannot control.
Risk factors you cannot change:
• Increasing age
• Sex (gender)
• Heredity and race
• Prior stroke
Risk factors you and your healthcare provider can change, treat or control:
o High blood pressure
o Tobacco use
Smoking Cessation
o Diabetes mellitus
Smoking doubles the risk for stroke. Addiction to
o Carotid or other artery disease
cigarettes is both physical and psychological. If you stop
o Atrial fibrillation
smoking today, your risk of stroke will immediately begin
o Other heart disease
to decrease. Use a support network of family, friends,
o High blood cholesterol
Internet and medicines from your doctor.
o Poor diet
o Physical inactivity and obesity
o Alcohol
o Drug abuse
o Sickle cell disease
www.msha.com | orthopedic and neurological services | page 5
TIA (Transient Ischemic Attack)
A TIA is also referred to as a “mini stroke.” A TIA occurs when a blood clot blocks blood flow and part of the brain
does not get the oxygen it needs. TIAs are brief episodes of stroke-like symptoms that last from a few minutes to
24 hours and then the blood flow is restored. TIAs do not cause permanent disability. However, they can be serious
warning signs of an impending stroke. Approximately one-third of people who have a TIA are expected to have a
stroke. Most of these will occur in the first few days to weeks after the TIA. It is very important to recognize the
warning signs/symptoms of a TIA or stroke. TIAs, strokes and recurrent strokes can be prevented through lifestyle
changes, surgery, medication or a mixture of all three.
The symptoms of TIA are the same as for
stroke. The symptoms vary depending on
which part of the brain is affected:
• Sudden weakness or numbness of the face,
arm or leg usually on one side of the body
• Sudden confusion, trouble speaking or
understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, or
problems with balance or coordination
If you experience any of these symptoms or notice them
in someone else, seek medical attention immediately.
You cannot tell if you are having a stroke or a TIA. If
you are having a TIA, a doctor can evaluate and treat the
causes and set up a plan of action to prevent a stroke.
The goal of TIA management is to prevent a future
stroke. The treatment depends on the cause of the TIA.
In addition to lifestyle changes such as diet and exercise,
your doctor may recommend drugs to treat high blood
pressure, high cholesterol or heart disease. These drugs
may reduce your risk of further TIA or stroke.
There are many medicines that help prevent blood clots from forming,
reducing the risk of full-blown stroke.
Aspirin – the least expensive and most common of these medicines
Aggrenox® – a combination of aspirin and extended-release dipyridamole
Clopidogrel (Plavix®)
Warfarin (CoumadinTM) – commonly prescribed to prevent clots from forming in patients with atrial fibrillation
Statins used for treatment of high cholesterol and blood pressure control may also reduce stroke risk.
page 6 | orthopedic and neurological services | www.msha.com
Ischemic Stroke
Ischemic (is-KEM-ik) stroke is a stroke that is caused by a lack of blood reaching part of the brain. The blood vessels
that supply the brain become narrowed or clogged, restricting blood flow to that part of the brain, causing injury to
the brain cells. Ischemic strokes are the most common type of stroke. They may be preceded by warning signs that
may include loss of strength or sensation on one side of the body, problems with speech, and changes in vision or
balance. Symptoms can develop over a few minutes or worsen over many hours.
There are three types of ischemic stroke:
Thrombotic
strokes are caused by a blood clot
in an artery going to the brain.
Blood clots usually form in arteries
damaged by arteriosclerosis.
Embolic
strokes are caused by a clot that
is formed elsewhere in the body
and carried by the blood flow to a
blood vessel leading to the brain.
Systemic hypoperfusion
occurs because of circulatory
failure of the heart. The heart’s
pumping action fails and too little
blood reaches the brain. This
may occur as a result of a heart
attack.
Acute hospital care is needed for patients with ischemic strokes. Tissue plasminogen activator (tPA), a clot-busting
drug, may be used if it has been less than three hours since the stroke symptoms started. Medication may also
be used to treat brain swelling that sometimes occurs after a stroke. Cranial Mechanical Thrombectomy- Cranial
Mechanical Thrombectomy may be performed for ischemic stroke patients who are not t-PA candidates. This
procedure may be performed if patient criteria are met.
High blood pressure is the most important risk factor for ischemic stroke that you can change.
www.msha.com | orthopedic and neurological services | page 7
Hemorrhagic Stroke
A hemorrhagic stroke occurs when a blood vessel ruptures, sending blood flow to part of the brain and causing damage to that area of the brain or around the brain in the subarachnoid space or into the fluid-filled ventricles. This
kind of stroke is often associated with a very severe headache, nausea and vomiting. The symptoms appear suddenly.
There are two types of hemorrhagic strokes:
Subarachnoid (sub-ah-RAK-noid) hemorrhage occurs when
a blood vessel on the surface of the brain ruptures and bleeds
into the space between the brain and the skull. A ruptured
aneurysm, often caused by high blood pressure, is the most
common cause. An aneurysm is a blood-filled pouch that
balloons out from an artery wall.
Intracerebral hemorrhage occurs when a blood vessel bleeds into
the tissue deep within the brain. Chronic high blood pressure
or aging blood vessels are the most common cause of this type
of stroke.
Increasing the risk of
hemorrhagic strokes are:
• Cigarette smoking
• Use of anticoagulants. Anticoagulants,
often called blood thinners, are
medications that slow the clotting of
blood. They do not actually thin the
blood but increase the time it takes
a blood clot to form. Anticoagulants
help prevent existing blood clots from
becoming larger.
• Excessive alcohol intake
• Use of illegal drugs (e.g. cocaine,
amphetamines)
Because hemorrhages may be life-threatening, hospital care is required in an intensive care unit. Medication
can be used to control further bleeding, high blood pressure and brain swelling that occurs with a stroke.
Surgery may be needed depending on the cause of the hemorrhage. Surgery could be done to repair an
aneurysm or remove a blood clot.
page 8 | orthopedic and neurological services | www.msha.com
Tests and Assessments for Stroke Patients
NIH Stroke Scale
The National Institute of Health Stroke Scale is a
systematic assessment tool designed to measure the
neurologic deficits most often seen with acute stroke
patients.
It can be used in all areas of the hospital as a
standardized measure of neurological function and
stroke severity.
The scale includes measures of level of consciousness,
sensory and motor weakness and visual problems.
The information obtained will be used by other
members of the healthcare team to direct treatment and
measure improvement.
The exam is usually performed by a Registered Nurse
and will take about 10 minutes to complete.
CT Scan of the Brain
(Computed Tomography)
A CT Scan or CAT Scan is a key imaging test of the brain. It uses radiation to create a picture of the brain. It is
usually one of the first tests given to a patient with stroke symptoms. CT test results give valuable information about
the cause of stroke and the location and extent of brain injury.
MRI of the Brain
(Magnetic Resonance Imaging)
An MRI is a detailed magnetic scan to produce an image of the brain. Like the CT, it shows the location and extent
of brain injury. The image produced by MRI is sharper and more detailed than a CT Scan, so it is used to diagnose
small, deep injuries.
www.msha.com | orthopedic and neurological services | page 9
Carotid Duplex Ultrasonography
Carotid duplex ultrasound is an imaging procedure that uses
high-frequency sound waves to view the carotid arteries and to
determine the presence of narrowing.
Dysphagia Screen
During the bedside swallow evaluation, the Speech Language
Pathologist (SLP) will test your swallowing ability with a variety
of foods and liquids to determine the presence of a swallowing
disorder. You will be observed closely for signs and symptoms
of difficulty. If problems are noted, the SLP may recommend
further testing via swallow X-ray (Modified Barium Swallow
Study).
Modified Barium Swallow
The Modified Barium Swallow (MBS) is a diagnostic test done
in the X-ray department, conducted by the Speech Language
Pathologist (SLP) and the Radiologist. During the MBS, you
will be given different textures of food and thicknesses of liquid
combined with contrast. A real-time image of your swallow will
be evaluated to determine the presence of a swallowing disorder.
The SLP will recommend the safest type of diet based on this
test.
CT Angiography
Angiography is a medical procedure, otherwise called
arteriography. In this test, special substances are injected into
blood vessels and an X-ray is taken.
Angiography gives a picture of blood flow through the
vessels. This allows the size and location of the blockage to
be evaluated. This test is especially valuable in diagnosing
aneurysms and malformed blood vessels and is valuable
information before surgery.
MRA
A magnetic resonance angiogram (MRA) uses a magnetic field
and pulses of radio wave energy to provide pictures of blood
vessels inside the body. MRA can find problems with the blood
vessels that may be causing reduced blood flow. With MRA,
both the blood flow and the condition of the blood vessel walls
can be seen.
page 10 | orthopedic and neurological services | www.msha.com
Medication
Anticoagulant
Antiplatelet Agents
Anticoagulants (blood thinners) are medicines that delay
the clotting of blood. They make it harder for clots to
form or keep existing clots from enlarging in your heart,
veins or arteries. Treatment should be supervised, and
last only as long as necessary. Two examples are heparin
and Warfarin (brand name Coumadin).
Antiplatelet medicines keep blood clots from
forming by preventing blood platelets from
sticking together. They are used as part of a
treatment for patients with atherosclerosis or with
increased clotting tendencies.
Atherosclerosis is the process by which deposits of
cholesterol form along inner walls of blood vessels,
creating conditions for blood clots to form.
Antiplatelets are generally prescribed preventively,
when atherosclerosis is evident but there is not yet
a large obstruction in the artery.
Antiplatelet drugs include aspirin, ticlopidine
(Ticlid ®), Clopidogrel (Plavix ®) and aspirin/
dipyrimadole (Aggrenox ®).
Anticoagulants and antiplatelet agents are used to
help patients prevent strokes caused by a blood clot
by improving blood flow. Both anticoagulant and
antiplatelet agents are medicines that interfere with the
blood’s ability to clot in an artery, vein or the heart.
Aspirin is an important therapeutic agent for
stroke prevention. It’s a medicine that can save
your life if you have heart problems, or if you have
had a stroke or TIA. You must use aspirin just as
your doctor tells you.
www.msha.com | orthopedic and neurological services | page 11
Rehabilitation After Stroke
Stroke rehabilitation starts as soon as your physician has assessed that your condition is stable.
Stroke rehabilitation differs for individuals depending on the severity, level of involvement
and loss of function. The patient, along with input from his or her physician, occupational
therapist, physical therapist, speech therapist and case manager, will choose the level of
care that is most appropriate to maximize return of function. Admission to a specific area
of rehabilitation is dependent on the condition of the patient and insurance coverage. The
different levels of care include:
Inpatient Rehabilitation:
Skilled Nursing Facility:
A facility dedicated to the recovery of function
in patients who have suffered a stroke. The
patient stays in the facility and is scheduled
daily for intensive therapy that is specific to
each patient.
A facility dedicated to the recovery of function
in patients who have suffered a stroke. This
facility is most appropriate for patients who
will need to stay in the hospital for an extended
period of time. Patients receive therapy at a
less intensive level to better match the patient’s
ability to participate.
Outpatient Rehabilitation:
Home Health Services:
This type of care takes place in an outpatient
facility dedicated to the recovery of function
in patients who have had a stroke. The patient
is scheduled for treatment and participates at a
level that is appropriate for each individual.
This service takes place in the patient’s home.
Patients receive this level of care when being
hospitalized is not necessary, but the need to
receive therapy still exists to maximize function
recovery.
The Role of Occupational Therapy (OT) in Treatment of Stroke -“Skills for the Job of Living”
The OT looks at the whole person, not just arm
toileting, bathing, and dressing independently. weakness, and uses activities (or “occupations”)
The OT will also help the family and/or friends
that are meaningful to the patient, to help regain
learn ways to help increase strength, regain use
independence. Patients may begin to transition to
of the affected arm, regain sensation while the
edge of bed sitting to address trunk control and/or
patient is recovering. In rehab, they will continue
weight bearing techniques to strengthen the weak
to improve those skills and will teach the use of
side. The patient will begin to perform simple
adaptive equipment to make daily tasks easier, and
tasks such as washing the face, brushing teeth,
make protective splints, if needed.
page 12 | orthopedic and neurological services | www.msha.com
The Role of Speech-Language Pathology in
Treatment of Stroke
The Role of Physical Therapy in
Treatment of Stroke
The Speech-Language Pathologist (SLP) focuses
The Physical Therapist (PT) focuses on overall mobility
on communication and swallowing skills. First and
(movement) and strength of the patient to help
foremost, the SLP will be responsible for checking
recover his or her independence. In the ICU, the
the swallowing skills of the stroke survivor. Many
major focus is early movement and positioning of the
people will experience difficulty swallowing and
patient. The PT will start with helping the patient to
are at risk for aspiration of food or liquid into the
edge of the bed, then to the chair, and on to more
lungs. The SLP will recommend the safest diet
challenging skills like walking and balanced activities.
level, make recommendations for safe swallowing
The PT will educate the patient and significant others
and teach the patient and family about swallowing
on ways to help the patient regain independence.
safety. Rehabilitation of swallowing disorders
involves strengthening the muscles and improving
coordination. This can be done through exercise and
stimulation techniques.
The SLP will also evaluate the stroke survivor’s
communication and thinking skills and help the
patient express themselves and understand what is
being said to them. Rehabilitation of communication
problems after stroke is very individualized depending
on the problems that are noted.
www.msha.com | orthopedic and neurological services | page 13
Changes Caused by Stroke
Most common effects of stroke:
How you move, feel, think and behave are controlled by
the brain. Brain injury from a stroke may affect any of these
abilities. You may experience some of these effects of stroke:
• Hemiparesis – weakness on one side of the body
• Hemiplegia – paralysis on one side of the body
• One-sided neglect – a result of hemiparesis or hemiplegia,
motor impairment and loss of sensation on one side of the
body often causes stroke survivors to ignore or forget the
affected side
• Aphasia – difficulty with speech and language
• Dysphagia – trouble swallowing
• Decreased field of vision and trouble with visual
perception
• Loss of emotional control and changes in mood
• Cognitive changes – problems with memory, judgment,
problem solving or a combination of these
• Behavior changes – personality changes, improper
language or actions
Common emotional effects of stroke:
• Depression
• Apathy and lack of motivation
• Tiredness
• Frustration, anger and sadness
• Reflex crying (emotions may change
rapidly and not match the mood)
• Denial of the changes caused by the brain
injury
Remember the following:
• You must follow your doctor’s instructions
• Have regular blood tests to determine how the medicine is
working
• Never take aspirin with anticoagulants unless ordered by
your doctor
• Tell other healthcare providers that you are taking
anticoagulants
• Always check with your doctor before taking other
medications or food supplements, such as aspirin,
vitamins, cold medicine, sleeping pills or antibiotics. These
can alter the effectiveness and safety of anticoagulants by
strengthening or weakening them
• Discuss your diet with a healthcare professional
• Tell your family how you take anticoagulant medicine and
carry your emergency medical ID card with you
Tell your doctor if:
• Your urine turns pink or red
• Your stools turn red, dark brown or black
• You bleed more than usual when you have
your period
• Your gums bleed
• You have a very bad headache or stomach
pain that doesn’t go away
• You get sick or weak, faint or dizzy
• You think you are pregnant
• You often find bruises or blood blisters
• You have an accident of any kind
In most cases the patient does get better. The effects of a stroke are greatest immediately after
the stroke occurs. From then on, the patient may start to get better. How fast and how much
improvement is made depends on the extent of the brain injury and the success of rehabilitation.
page 14 | orthopedic and neurological services | www.msha.com
Left-Side Brain Injury
Common problems include difficulty communicating and/or
understanding speech; difficulty recognizing or using common
objects like a washcloth, spoon, etc.; saying either yes or no to every
question; and recognizing his or her own arm or leg. The right side
of the body may be weak, numb or have decreased feeling.
How to Help:
SAFETY
• Never allow anyone to pull on the right arm when
moving the person
• Allow the person to take as much time as needed to
complete a task; don’t rush
• Don’t ask a lot of questions, because he or she may
become anxious or frustrated when unable to answer
• Give the person plenty of time to answer the questions
you do ask
What May Happen:
SAFETY
• May be anxious
• May become upset when she or he can’t do
things right
COMMUNICATION
• May answer “yes” or “yeah” to every question,
or “no” to every question
• May not be able to understand what is said or
what is written
• If more than one language is spoken, she or
he may only understand the first language
learned
• May not be able to recognize numbers, but
able to tell time
• May have dysarthria (slurred speech)
COMMUNICATION
• Family, friends and healthcare personnel should all use
the same, simple directions and use pantomime (like
the game of charades) to tell the person what you want
him or her to do, or what you are going to do
• Speak slowly, clearly and face the person as you speak
• Reduce noise and other distractions; turn off the TV or
music, only one person talk at a time
• Allow plenty of time for the brain to process a question
or direction
MOVEMENT AND FEELING
• Family and friends can assist by helping with the
exercise program given by the occupational therapist,
physical therapist and speech therapist several times
during the day. Be sure to support the joints: don’t
hold the wrist to move the arm—hold at the elbow
and wrist. Don’t hold the ankle, but hold the knee and
ankle. The therapists will show you how.
• Feeling can come back if it is absent, or settle down if
it is tingling. Rub the arm or leg with lotion, with a
warm cloth, a cool cloth, a cotton ball or piece of gauze
for a few minutes several times a day. Stop if it seems to
bother him or her.
www.msha.com | orthopedic and neurological services | page 15
Right-Side Brain Injury
Common problems may include understanding only very simple
conversation; vision and thinking skills may also be affected. The left side
of the body may be weaker and the sense of touch may be less. The patient
may ignore the left side or seem not to be aware of deficits. To encourage
recovery, stand on the left side of the bed or chair to talk to your loved one
as much as possible. Remind him or her to look left.
How to Help:
SAFETY
• Never allow anyone to pull on the left arm while
helping move the person
• Form a routine; make a schedule, keep checklists
for the day’s activities
• Remind your loved one of the time, place, situation
• Break tasks into steps, waiting until the first step is
finished before starting the second step
COMMUNICATION
• Get rid of distractions; turn off the TV, close the
door
• Talk TO the person, not ABOUT the person
• Use gestures to remind the person to look at you
while you are talking
VISION
• Make a boundary on the left side of anything to
read (can use a ruler or a bright colored paper),
encourage looking left to right, use an index card to
read only one line at a time
• Make a boundary and remind the person to look to
the left of the plate to make sure they don’t forget
food on the left
THINKING SKILLS, MEMORY
• The person can self cue by talking aloud through
the steps of an activity
• Take extra time to learn new information
• Describe ideas when unable to think of a certain
word
• Keep up a daily routine
• Use written reminders
• The caregiver can talk the person through the steps
of an activity
What May Happen:
SAFETY
• May not be aware of anything on the left side (may
not notice if the left arm is dangling over the side of
the bed or chair), may not notice the left arm under
his or her body while lying in bed
• May have trouble paying attention
• May have trouble remembering new things
• May act without thinking first, may have poor
judgment
• Probably will not be aware of any problems, and may
deny that there is anything wrong
• May forget steps in everyday activities
• Difficulty keeping track of time
COMMUNICATION
• Talks a lot but may not stay on track; or may not try
to talk, even if talkative before
• Imagines he or she has just gotten back from some
place (store, work) when really in bed
• Takes things literally; may not understand things
unless very specific directions are given
• Interrupts
• Changes topics without warning
• Misses social cues
• Loses eye contact
• Flat tone of voice
• May have dysarthria (slurred speech)
page 16 | orthopedic and neurological services | www.msha.com
What is Cognitive-Communication Disorder?
Cognitive-Communication Disorder is dysfunction in one or more of the areas of cognition or the process of
thought. It can occur in people who have suffered a stroke, especially if the right hemisphere of the brain has been
affected. No two people with cognitive-communication disorder have the same degree of impairment or have impairments in the same areas of cognition.
Difficulties that may occur can include problems with:
• Paying attention
• Remembering names, appointments or daily
events
• Understanding and processing things that are
told to them
• Performing daily tasks in an organized manner
• Reasoning or logical thinking skills
• Poor judgment and safety awareness
• Recognizing familiar people
• Inappropriate behavior or personality changes
• Staying on a specific topic during conversation
• Seeing things in their left visual field (objects,
words, pictures, the food on their plate)
• Making eye contact while talking
• Understanding humor or sarcasm (may be very
literal in their thinking)
• May be unaware that they are experiencing any
problems
What can family and friends do to help?
There are several things that can be done to improve the functioning of the person with cognitive deficits
and decrease the frustration for the individual and his or her family. First, the individual should never be
treated like a child or “babied.” Consistency and repetition are the basic rules to follow.
The following is a list of general recommendations:
• Use a calendar to help keep the person oriented
to the date, remind them of appointments and
important dates
• Use a clock or watch to orient them to the time
of day and their daily schedule
• Review other personal information such as
their name, address, family members’/friends’
names, their location, telephone numbers and
information about their situation
• Limit distractions while talking. Keep noise to a
minimum
• Encourage the person to make eye contact when
talking
• Keep instructions basic and to the point
• Write things down to help with memory and
understanding. Keep a journal of things that
are happening (visitors, accomplishments in
therapy)
• Do not change the topic of conversation quickly
or often
• Always explain things carefully with less
complex language to decrease the potential for
misunderstandings
• Supervise situations that may be unsafe,
specifically those recommended by the therapy
team
• Practice using the call light when assistance is
needed
• Reinforce safety precautions to reduce the
chance of fall or other injury
• Try to avoid emotionally stressful discussions
• Be patient – provide encouragement
Your therapy team may also suggest specific recommendations.
www.msha.com | orthopedic and neurological services | page 17
What is Aphasia?
Aphasia occurs when the language center of the brain is affected by stroke. The individual with aphasia may have
difficulties expressing thoughts and ideas and understanding what is said by others. Aphasia can also affect the
person’s ability to read and write but does not affect their intelligence.
What are some of the common
language problems?
No two people with aphasia have the same degree
of impairment or impairments in the same area
of language. Problems that may occur include
difficulties with:
• Following conversations
• Following directions
• Difficulty “finding” words
• Expressing thoughts, needs, ideas
• Reading
• Writing
• Using numbers (counting, performing math tasks)
• Answering questions
• Interpreting other people’s facial expressions
• Understanding humor
• Crying or laughing excessively
• Using gestures
Sometimes speech is produced with effort and
misarticulations (speech sounds are produced
incorrectly). Naming errors are very common. A
“fork” may be called a “knife” or a “tork.” The person
usually will know the correct name of the object,
but is unable to correctly say it. The message route
from the brain to the mouth has been damaged
by the stroke. In some cases, it may sound like the
individual is speaking in a “made-up” language.
Other people may not be able to get words out at all.
How can family members help?
• Keep distractions in the room to a minimum
(limit phone, radio, TV)
• Try to limit the number of people talking at once
• Give the person plenty of time to respond to
questions or commands
• Phrase questions to allow “yes/no” response
• Do not try to answer questions for the person or
talk for them
• Do not pretend that you have understood them
when you have not
• Encourage them to use other means of
communication to help communicate their ideas
(pointing to pictures, gestures, drawing)
• Provide emotional support and encouragement
• Practice language exercises provided by the
Speech-Language Pathologist
• Don’t shout when trying to communicate. The
person with aphasia will have no new hearing
impairment.
page 18 | orthopedic and neurological services | www.msha.com
What is Dysarthria?
Dysarthria is difficulty with speaking resulting from poor muscle
control due to weakness, slowness and word coordination. A
variety of speech components may be affected: breathing, using
the voice, pronunciation, airflow through the mouth/nose,
inflection and intonation of speech.
What are the symptoms of Dysarthria?
• Fast or slow rate of speech
• Unusually quiet or loud speaking voice
• Drooling and possibly associated swallowing problems
• Words may sound slurred or speech may sound sluggish
• Lips and tongue may be slow in moving
• Lips and cheeks may droop or sag
• Lips, cheek and tongue may be weak or paralyzed
• Lips and tongue may be difficult to move
• Speech may not be clear enough to be understood
• Speech may be harder to understand when tired
What can be done to improve communication?
• Speak one word at a time
• Exaggerate speech production
• Limit distractions in the room
• Remember to take time to swallow saliva before talking
• Keep a towel available in case drooling occurs
• Do the oral motor exercises prescribed by the SLP (SpeechLanguage Pathologist)
• Family can provide feedback to encourage clear speech and
assist the patient with their exercises (more frequent practice
will lead to more rapid improvement)
www.msha.com | orthopedic and neurological services | page 19
What is Dysphagia?
Dysphagia is defined as difficulty swallowing. It may exist in one or all three phases of the swallow (oral, pharyngeal
and esophageal). During a normal swallow, food is introduced into the mouth and chewed. Food is then moved
to the back of the mouth by the upward/backward movement of the tongue. The swallow response is triggered. As
the food is swallowed, it passes through the throat. The airway closes to protect the lungs and the food is propelled
through the esophagus and into the stomach.
What are the signs of Dysphagia?
• Difficulty initiating a swallow (holding food in the
mouth)
• Coughing or choking during or after eating/
drinking
• Needing to swallow 2-3 times to clear the food/
liquid from the mouth
• Food remaining in the mouth after the swallow
• Food or liquid draining from the mouth
• Wet/gurgly-sounding voice
• Excessive drooling, a large amount of extra
secretions
• Increased body temperature
• Increased chest congestion or pneumonia due to
food or liquid going into the lungs
What swallowing guidelines
should be followed?
• Always sit upright, well-supported in the bed or
chair
• Eat/drink slowly and carefully
• Do not talk while swallowing
• Check your mouth for pocketed food
• Make sure you are fully alert while eating
• Do not attempt to eat if you are very short of
breath
• Limit distractions during the meal so you can
concentrate
• Follow all suggestions/recommendations made by
the SLP (Speech-Language Pathologist)
• Make sure your mouth is kept very clean
• Be sure to notify your nurse or SLP if you have any
problems or concerns about your swallowing
How is Dysphagia treated?
The SLP will provide you with individualized swallowing guidelines that should be followed
whenever you eat, drink or take medications. In addition, swallowing exercises and
stimulation techniques will be used to strengthen the muscles. Also, the SLP may recommend
that the texture of your foods and liquids be changed or altered with severe dysphagia, you
may be “NPO.” This means you will not receive food or drink by mouth. Tube feedings may
be required.
page 20 | orthopedic and neurological services | www.msha.com
Nutrition and Stroke
Recovery Period
Post-Stroke Lifestyle Changes
Having the right nutrition is important to
your recovery.
Healthy eating habits are an important part
of reducing your risk of another stroke.
• A registered dietitian (RD) can assist you with
your nutritional needs based on your current
condition and your medical history.
• Your diet may be modified in texture and
consistency to ensure safe swallowing after a
stroke.
• If eating by mouth is not safe, your doctor may
recommend tube feeding.
• If long-term tube feeding is needed, an RD
can teach you and your family how to manage
tube feeding at home.
• Eat right
• Control portions to maintain a healthy weight
• Eat fewer calories (limit fried foods and desserts)
• Add more nutritious foods (whole grains and
fibers)
• Aim for five servings of fruit and vegetables
• Select more low-fat protein foods (beans, fish
and poultry)
• Limit red meat, even if it is lean
• Shop Smart - Read nutrition labels carefully
• Avoid convenient foods (which are high in salt)
• Limit your salt intake to 2000-2300mg (about
one teaspoon) per day
• Limit cholesterol intake to 300mg per day
• Check with your doctor before drinking alcohol
Eat Right and Shop Smart to Prevent Another Stroke
A registered dietitian is available for individualized diet instructions.
www.msha.com | orthopedic and neurological services | page 21
High Blood Pressure
What is high blood pressure (hypertension)?
Blood is carried from the heart to the rest of your body in vessels called
arteries. Blood pressure is the force of blood against artery walls. Two
numbers are measured when checking the blood pressure. The first
(systolic pressure) measures the pressure in arteries when the heart is
contracting. The second (diastolic pressure) measures the pressure while
your heart rests between beats.
High blood pressure does not mean that you are tense, nervous or
hyperactive. You can be a calm and relaxed person and still have high
blood pressure. You usually cannot tell if you have it! The only way to
know if you have high blood pressure is to have it checked regularly.
In an adult the normal blood pressure is less than 120/80 mm Hg
(millimeters of mercury). You have prehypertension if the top number
(systolic) is 120-139 OR your bottom number (diastolic) is 80-89. High
blood pressure (hypertension) means that the top number is 140 or higher
OR the bottom number is 90 or higher. If you have hypertension your
blood pressure should be lowered to less than 130/80.
In 90 to 95 percent of high blood pressure cases, the cause is unknown.
In fact, you can have high blood pressure for years without knowing it.
That is why it is the silent stalker – it creeps up on you. In a few cases
high blood pressure is caused by an underlying problem such as a kidney
abnormality, tumor of the adrenal gland (a gland near your kidney) or a
congenital heart defect (a structural abnormality of the heart existing since
birth).
page 22 | orthopedic and neurological services | www.msha.com
High blood pressure adds to your heart’s workload and
A high blood pressure test is quick and painless. You can
damages your arteries and organs over time. By the time
have it done in a doctor’s office, hospital clinic, school,
you know you have it, the damage may have already
nurse’s office, company clinic or at a health fair. Many
started. Compared to people whose blood pressure is
devices are available for monitoring your blood pressure
normal, people with high blood pressure may be more
at home. It is important to keep a record of your blood
likely to have a stroke, more likely to develop congestive
pressure to show to your doctor.
heart failure, and more likely to develop coronary heart
disease (which leads to a heart attack). High blood
It is important to have your blood pressure checked
pressure can also cause kidney disease and blindness.
and treated if it is too high. Stroke is a leading cause
of disability and the third leading cause of death in the
There is only one way to find out if your blood pressure
United States. It is a devastating disease. That is why it’s
is high: Get it checked! If your blood pressure is
so important to minimize your risk.
normal, get it checked at least every two years. If you
have prehypertension (your top number is 120 – 139
OR your bottom number is 80 – 90) you should get it
rechecked within one year. If you have a family history
of high blood pressure, you are at a higher risk. Your
doctor will tell you how often to have it checked.
What causes high blood pressure?
In most cases, it is impossible to pinpoint an exact cause of high blood pressure.
Some groups, however, are at higher risk.
Your risk of high blood pressure is higher if:
• Someone in your family has high blood pressure
• You are a man over the age of 45
• You are a woman over the age of 55
• You are African-American
• Your blood pressure reading is in the pre-hypertension range (120 – 139/80 – 90)
• You take birth control pills
• You are pregnant
• You smoke
Other things that can increase high blood pressure include:
• Being overweight
• Eating too much salt
• Not eating enough potassium
• Not exercising
• Having diabetes
• Drinking too much alcohol
www.msha.com | orthopedic and neurological services | page 23
How does high blood pressure increase stroke risk?
Uncontrolled high blood pressure increases a person’s stroke risk by 4 to 6 times. It may:
• Thicken the artery walls, causing cholesterol or other fat-like substances called plaque to build up. The plaque
buildup can then break off of the artery walls, causing a clot and blocking blood flow to the brain. This may cause
a type of stroke called an ischemic stroke.
• Weaken the artery walls, leading blood vessels to break and bleed into the brain, causing what is called a
hemorrhagic stroke.
How can high blood pressure be treated?
In most people, high blood pressure can be controlled through healthy habits or taking medicines – or a
combination of both. You need to know what your blood pressure should be and keep it at that level.
Talk to your doctor about healthier choices that can
reduce your blood pressure:
• Enjoy a low-salt diet
• Eat enough fruit and vegetables, and fat-free or lowfat dairy products
• Lose weight if you are overweight
• Enjoy regular physical activity
• Limit alcohol to no more than two drinks a day
if you’re a man and one drink a day if you’re a
woman. Check with your doctor regarding alcohol
consumption
For some people, these lifestyle changes won’t be
enough to lower the blood pressure to a normal range.
These people will need to take medications to control
the blood pressure.
• Partner with your doctor to determine which of the
many blood pressure drugs are best for you
• Try not to get discouraged if you have to try several
drugs before you find the right one; this is common
• Stay on your medications – even if you feel fine
Various hypertensive drugs work differently. Some decrease the volume of plasma in the blood or slow the rate of
blood flow through the body, while others relax the heart by affecting the passage of certain elements in the blood.
High blood pressure is a lifelong disease. It can be controlled but not cured.
If you have already had a stroke, lowering your blood pressure can reduce your risk of having another stroke – even
if you do not already have high blood pressure.
page 24 | orthopedic and neurological services | www.msha.com
High Cholesterol
Know your cholesterol number. Lowering your cholesterol (a fat-like substance in your blood) may reduce your risk
for stroke. High cholesterol puts you at greater risk for heart disease, which can lead to an increase risk for stroke. • Combined HDL and LDL cholesterol should fall below 200
• High cholesterol can often be controlled with diet and exercise, however some people may need medicine known
as statins(see below statement regarding statins)
• Recent studies have shown that even some individuals with normal cholesterol may lower their risk for stroke by
taking cholesterol-lowering medicines
Statin benefit in stroke patients.
Statins like atorvastatin (Lipitor(r)), simvastatin (Zocor(r)), pravastatin (Pravachol(r)) are a group of medications
used to lower cholesterol. If you have too much cholesterol in your blood, it can stick to the walls of your arteries,
forming plaques. These plaques can decrease or block blood flow to the brain. Statins are safe for most people and
can be very helpful to people who have previously had a stroke or transient ischemic attack (TIA). The American
Heart Association (AHA) and the American Stroke Association (ASA) support the use of statins for a person who
has previously had a stroke or a transient ischemic attack (TIA). Multiple studies have shown that taking a statin can
decrease your risk of having a second stroke by as much as 25%.
The Caregiver Role after Stroke
Caring for one who has had a stroke can be very difficult both physically and emotionally. Remembering a
few things and sharing what you have learned with others will help.
A stroke is not just a patient affair, it is a family affair. A stroke is often as hard on the family and the ones
who love the individual as it is on the one who is suffering the stroke.
One of the best ways to overcome some of the stress of this time is to communicate with one another and to
communicate clearly with the patient. Here are some pointers that will help:
1. Always include the patient. Often the person who has had a stroke cannot communicate as easily, but that
does not mean that he or she does not understand. The patient needs to maintain all the independence
that is possible.
2. Always ask the patient if he or she needs help, do not assume or just do for the individual. The more the
individual does for himself or herself the more self-reliant he or she will become.
3. Take care of yourself. This is one of the more difficult things to remember. During this time, due to stress
and loss of sleep, many individuals find themselves exhausted. Once this occurs it is very hard to stay
physically and mentally sharp. To truly help the one you love you have to take care of your needs as well.
Allow others to help you if able.
4. Ask questions. Education about one’s care is the best tool you have. Use the resources around you. You
will be exposed to many different healthcare professionals who can answer your questions and give you
helpful insight.
www.msha.com | orthopedic and neurological services | page 25
Johnston Memorial Hospital - 276-258-1000
Norton Community Hospital - 276-439-1000
Smyth County Community Hospital - 276-378-1000
www.msha.com
13-00100 Rev. 01/15
Indian Path Medical Center - 423-857-7000
Johnson City Medical Center - 423-431-6111
Sycamore Shoals Hospital - 423-542-1300