Stoke

Stroke is the second single largest killer in New Zealand with more than 2000 people every year, (NZ Heart and Stroke Foundation, 2007).

Etiology:

According to the Heart and Stroke Foundation a stroke is defined as a sudden loss of brain function; a stroke occurs when brain cells die from oxygen deprivation, oxygen deprivation occurs if blood flow to the brain is blocked by a clot or vessels are damaged, without oxygen brain cells cannot function.

There are two types of Stroke:

Hemorrhagic: A Hemorrhagic stroke occurs when the blood vessels in the brain burst due to high blood pressure, artherosclerosis and congenital malformation. A burst vessel causes bleeding into the brain and increased blood flow into the damaged vessel, blood build up increases pressure in the brain damaging nerve cells and collapsing smaller blood cells.
Ischemic: Occurs when blood flow through the crucial blood vessels is blocked by a blood clot or plaque.


Pathogenesis (Signs and Symptoms):
The human brain is divided into regions. Each region controls different movements, senses, or intellectual functions (Fritz, 2004). Therefore, the effects of a stroke depend on which region of the brain is damaged. Fatigue will be an effect of any stroke, and different types of stroke can also cause similar damage.

The effects of a stroke depending on where the damage has occurred to the brain can vary for each patient.

Physical effects include: Weakness, paralysis, movement limitations, pain, fatigue and interruptions to sleeping patterns.
Strokes can also severely effect patients emotionally: Anxiety and depression are a common repercussion of a stroke.
Thinking, speech and memory difficulties can effect the patient mentally.

The American Stroke Association has identified several stroke warning signs. Someone having a stroke may not experience all of the warning signs and warning signs can come and go. Symptoms of stroke depend on the type and which area of the brain is effected. Signs of ischemic stroke usually occur suddenly, and signs of hemorrhagic stroke usually develop gradually (Chandrasoma & Taylor, 1997, p.929).

Symptoms of a stroke include:

• Immediate numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Immediate confusion, difficulty speaking or understanding.
• Difficulty seeing in one or both eyes suddenly.
• Sudden difficulty walking, dizziness, loss of balance or coordination.
• Sudden severe headache with no known cause.
• Paralysis on one side of the body.
• Speech problems may occur as a result of ischemic stroke.
  

Complications that may develop gradually as a result of immobility caused by stroke include the following:

• Blood clots.
• Bedsores.
• Fibrosis of connective tissue resulting in decreased mobility.
• Malnutrition.
• Pneumonia.
• Urinary tract infections.

Treatment :

Treatment for strokes usually involves Rehabilitation which includes physical therapy, speech therapy, and occupational therapy. Physical therapy involves using exercise and other physical means (e.g., massage, heat) to help patients regain the use of their arms and legs and prevent muscle stiffness in patients with permanent paralysis.
Your aim as a massage therapist should be to: help relax, ease pain, and comfort the person who has had a stroke with Massage. Massage therapy can also help to increase circulation to areas that are in need of more nutrients and blood flow and massage can also promote the release of endorphins that can help in pain control.

Treatment indications and contradictions for massage.

Aim:

• Prevent joint stiffness.
• Promote relaxation.
• Reduce pain.
• Decrease muscle spasticity.
  

Massage Guidelines:

• Massage strokes should be slow, soothing, and superficial.
• Joint mobilisations and passive stretching should be done within clients’ tolerance and not forced.
• The first few treatments should be brief (30mins max), a couple of times a week so you don’t tire the patient.
• Make sure the client is well supported and comfortable through out the session.
• Deep pressure massage is not recommended, due to pain relief they may not have an adequate pain tolerance.
• Check-in with their physician about their treatment.
• Refer to appropriate health care practitioners for diet and lifestyle modifications and treatment of underlying conditions .i.e. blood pressure, quit smoking, nutrition.
• May be on blood thinner medications.

Cause and prevention are often closely linked. A combination of factors that have been present or developing for a long period of time can contribute to a stroke. If someone has two or more of the risk factors below, stroke risk can be dramatically increased.

Controllable stroke risk factors:

• Check blood pressure
• Stop smoking
• Exercise regularly
• Limit alcohol intake
• Eat a healthy diet and reduce salt intake
• Lower cholesterol
• Control weight

Anyone who is high risk you should encourage to see their doctor, who will usually assess each risk factor for stroke (and heart disease) before deciding on necessary treatments.

Prevalence: Approximately 70% of ischemic stroke patients are able to regain their independence and 10% recover almost completely. Approximately 25% of patients die as a result of the stroke. The location of a hemorrhagic stroke is an important factor in the outcome, and this type generally has a worse prognosis than ischemic stroke.
More than 30% of stroke patients require assistance with daily living and approximately 15% require care in an assisted-living facility (e.g. nursing home, rehabilitation centre). Approximately 20% of stroke patients require help walking (e.g., cane, walker) and as many as 33% suffer from depression.

Incidence: Stroke affects all ages. In New Zealand each year, 40 stroke victims will be children and nearly 2,000 (a quarter of all strokes) will be under retirement age.

References:

Carlson, S. (2006). Massage for Stroke Patients. Retrieved August, 2nd 2009, from http://massagetherapy.suite101.com/article.cfm/massage_for_stroke_patients

Dr. Premkumar, K. (1959). Pathology A to Z: A handbook for massage therapists (2nd Ed.). Canada: VanPub Books.

Frtiz, S. (2004). Mosby’s Fundamentals of Therapeutic massage (3rd Ed.). Missouri: Mosby.

New Zealand Stroke Foundation Inc, (2007). Retrieved August, 7th 2009, from www.stroke.org.nz

Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists (2nd Ed.). Elsevier Health Science.

Chandrasome, P, Taylor, C R (1997). Concise Pathology. Michigan: Appleton & Lange.