Silent Strokes: What You Should Know

If you have never had the outward symptoms of a massive stroke and think you are in the clear, think again.  Researchers are finding that more than 11 million Americans suffer from a silent stroke every year.  This is far more than the 750,000 people who have traditional, symptomatic acute strokes.  If you have high blood pressure, high cholesterol, or out of control diabetes, you are at risk for these quiet, symptom-free brain strokes.  Chances are you won’t even know you had one, and they can cause medical issues that may be attributed to other conditions.  Learning about silent strokes – and how to avoid them – is important for all stroke patients over 50, especially if you have risk factors.

Defining a Silent Stroke

A silent stroke means that you do not experience the traditional symptoms of a massive stroke, such as one-sided paralysis, difficulty speaking, or headache after a stroke.  Silent strokes can happen in the same way that regular acute strokes occur.  For instance, either a clot stroke or a bleed stroke can lead to this smaller form of stroke.  The only way you will ever know if you had a silent stroke is if you have a CT scan or an MRI of the brain.  These tests will show a small area of dead brain tissue, usually in an area that does not typically cause traditional acute stroke symptoms.  If you have a silent stroke, it makes you even more susceptible to a transient ischemic attack (TIA) or a massive stroke.

Many different risk factors can lead to a silent stroke.  The most common ones are high blood pressure that is uncontrolled by medication and high cholesterol.  Both of these can lead to clots strokes and bleed strokes in the brain that are too small to cause normal symptoms of a massive stroke.  Atrial fibrillation is another leading cause of stroke.  This is the abnormal beating of one part of your heart that can cause clots.  Diabetes mellitus is another common risk factor for silent strokes.  Metabolic syndrome, a precursor for diabetes, chronic inflammation as indicated by c-reactive protein levels, and cigarette smoking round out the risk factors from which you need to protect yourself.

Silent Stroke and Memory

You might think that having a silent stroke does not affect your life and is not something you should concern yourself with.  In fact, silent strokes can cause memory loss, and this sign is often wrongly interpreted as Alzheimer’s disease.  You can have more than one silent stroke, and the sum consequence of the many minor damages can lead to an overall decline in cognitive ability.  It happens slower than a regular acute stroke, so your doctor may not even be aware that a silent stroke is causing your memory and cognitive problems.

A study published in 2011 in the Journal of Neurology studied 658 people with an average age of 79 and no history or dementia.  They found that 174 people had silent strokes, and these stroke patients did not perform as well as non-stroke patients in cognitive and memory function tests.  If you are having mental decline, it might be worth it to ask for an MRI and also to control your risk factors.

Silent Stroke and Sleep Apnea

New research is showing that one of the more deadly side effects of sleep apnea is the tendency to cause silent strokes.  Sleep apnea is a common condition in which you stop breathing during your sleep.  It is often caused by excess tissue hanging down the back of the throat and closing off the breathing passageway.  Most people who have sleep apnea snore quite loudly or actually gasp in their sleep.  This causes less oxygen to the brain, and sleep apnea has already been implicated in causing high blood pressure and heart failure.  The treatment for sleep apnea is a mask that blows a constant stream of air into your nose and mouth to keep the passage open.  It is often an uncomfortable treatment, and many patients are unable to tolerate the mask.  However, untreated sleep apnea can cause serious medical problems.

A study presented at the American Stroke Association’s International Stroke Conference studied stroke patients who have had strokes or TIAs to see if there was any connection between sleep apnea and acute strokes.  The study found that 91 percent of those who had previous strokes stopped breathing in their sleep.  Since silent strokes and acute strokes occur from the same mechanism of action in the brain, this means that those with sleep apnea are at high risk of silent strokes, as well.  Research is still underway to determine if the lack of oxygen somehow upsets the vasculature in the brain to cause an acute stroke or silent stroke.  The message is clear, though: if you snore or have diagnosed sleep apnea, you need to seek treatment for it to avoid this costly side effect.

References

Wikipedia; Silent Stroke

http://en.wikipedia.org/wiki/Silent_stroke

ABC News; Study: Million Suffer Silent Strokes; Daniel Q. Hanley

http://abcnews.go.com/Health/story?id=117615&page=1

ABC News; Silent Strokes Linked to Memory Loss in Older Adults; Lara Salahi; December 2011

http://abcnews.go.com/Health/w_AgingNews/silent-strokes-linked-memory-loss-older-adults/story?id=15253301

Huffington Post; Sleep Apnea, Silent Strokes Linked: Study; February 2012

http://www.huffingtonpost.com/2012/02/02/sleep-apnea-silent-stroke_n_1248119.html

Improving Fine Motor Skills after a stroke

The movements produced by the body’s small muscle groups are the fine motor skills inherent in an individual. Examples of these are tasks such as drawing, using scissors, engraving, tying the shoelace, writing, and others which require fine measures of focus and skill. Fine motor skills require precision of movement and accurate control by the brain.

Aside from loss of gross motor function, fine motor skills of the stroke victim may be affected after a stroke. While recovery of gross motor functions helps patients regain mobility and function to a certain extent, recovery of fine motor skills may spell the difference between complete independence and need for assistance in performing activities of daily living.  It is, thus essential to include therapies for fine movements in the overall rehabilitation program of stroke victims.

Certain factors which causes dysfunction in Fine Motor Skills

Fine motor skills of a stroke victim may be hampered due to:

Paralysis

Paralysis causes a person lose motor skills overall, including fine movements. The stroke patient’s muscle movements are affected due to paralysis.  But apart from simple paralysis, a stroke patient may also suffer from loss of co-ordination and balance control. In such cases, carrying out any task which requires use of fine motor skills becomes tedious.

Spasticity

After an initial stage of flaccidity, the paralyzed limb often develops muscle stiffness or tightness ,termed as spasticity, which may also interfere with Fine motor movements Spasticity needs to be treated so as to prevent muscle or joint contractures.

Perceptual Disorders

A stroke may cause a patient to lose his skills in judging distances. This may make it difficult for patients to control fine motor movements and ought to be corrected by using measures to improve depth perception.

Improving fine motor skills after a stroke

Physical therapy, in general, helps a stroke patient improve his overall musculo skeletal functions.  Occupational therapy, on the other hand, emphasizes improving fine motor skills involved in the performance of specific tasks.

One technique used in rehabilitation of stroke patients is called‘Constraint-Induced movement therapy’. In this technique, the unaffected limb is restrained, forcing the use of the affected limb in executing tasks. Another technique is the use of‘Functional Tone Management (FTM)’ device to assist in enabling ‘grasp and release’ movement of the hand, by holding of the hand in its resting state. Often techniques are used in combination with one another or other sort of physical training.

Exercises to improve fine motor skills after a stroke can also be carried out at home, keeping in mind the magnitude of the deficit from the stroke.  Examples of such exercises that can be carried out at home are:

• A cardboard box is placed at the corner of a room and the patient tries to shoot in marbles
• Use of weightless resistance inducing rubber (elastic) bands to smoothly stretch muscles
• Squeezing a crazy ball or a rubber ball to stimulate strength in fingers
• Repeatedly putting in and removing pegs from a peg board
• Performing finger movements and forcing affected fingers and hands against mattress or a pillow to stretch tight muscles
• Simple routine movement of throwing and picking up coin from the floor.

Conclusion

Fine motor skill in a stroke victim is often affected with the overall paralysis and may take longer and be more difficult to recover. It is, however, very important in the overall quality of life and functional independence of the patient.  Rehabilitation of fine motor skills after a stroke could be carried out using some techniques and with the aid of professional therapists.  Nevertheless, a few simple techniques can be performed at home to help improve fine motor movements.

References

http://www.strokeassociation.org

http://www.stroke-rehab.com

The importance of self-esteem after a stroke

A stroke often robs the stroke victims of their self-esteem, confidence, and functional independence. Functional independence of a stroke victim is hampered by loss of mobility, vision or difficulty in communicating.

Various neurological and psychosocial factors resulting from stroke make it difficult upon the stroke victim to regain his freedom of movement. In order to restore his mobility, the stroke victim undergoes rehabilitation. In the process of trying to improve the stroke victim’s neurological functions, the psychosocial factors that affect the mental ability of the stroke victim after stroke may get neglected. Low self-esteem in the stroke victims may occur due to such neglect of psychosocial factors. It is very pertinent to restore the stroke victim’s self-esteem to improve his participation in and the eventual outcome of rehabilitation treatments.

Attending to the Psychosocial factors of the Stroke Victim

It is suggested that neglecting the stroke victim’s psychosocial attributes not only prolongs the period of recovery, but ultimately tends to hamper the stroke victim’s physical disability even more. Stroke victims suffering from aggravated psychosocial problems incur greater rehabilitation costs for staying in the hospital. While a lot of studies have looked at post-stroke depression, few looked at the level of self-esteem. Behavioural care in stroke patients is influenced by social support and self-esteem. Self worth is often established after reaching adulthood, but critical events or situations, like suffering a stroke, may alter or erode self-esteem. Such alteration in self esteem has to be corrected to avoid falling into a state of emotional disorder, such as depression or anxiety, of which stroke victims to begin with are already prone to experiencing from the stroke itself.

A previously employed productive provider of the family who suddenly becomes unemployed and unable to contribute to the family’s financial stability due to a stroke may have his ego threatened and see himself as a burden.  A previously active person who suddenly loses motor function and balance after a stroke may lose confidence and become anxious about doing activities independently.  The resulting loss in drive to try one’s best may indeed lead to sub-optimal recovery during the rehabilitation phase.  Community reintegration, likewise, becomes difficult.

Correlating Self esteem with Physical illness

Loss of self-esteem and physical illness appears to be a catch-22 that tends to go into a cycle that has to be stopped to prevent a downward spiral.  As a stroke victim realizes his physical limitations, his self esteem becomes affected.  Yet, the low self-esteem that develops may lead to even poorer recovery and either persistent or worsening physical condition.  It is important that family and friends understand the situation and remain patient despite seeming irrationality of the stroke victim.  Some self-help techniques that the stroke victim and/or the family and friends can are the following:

1)   Suppressing the negativity within:

After a stroke, the victim should be helped in silencing the“negative voice” within.Even while still in the hospital, family members must instill confidence in him, by way of making him do certain things which might help him regain his self esteem. Generally, stroke patients lose determination because of a feeling of being deprived.  Constant encouragement and belief in the patient’s ability would be very valuable.

2)   Realizing one’s self-worth

The stroke victim’s family and friends are very important in enabling the stroke victim to appraise his self-worth. The stroke victim needs affection and care. Making the victim realize that he remains the same person and is just as loved and wanted and important as how he was before the stroke can certainly help restore his sense of worthiness.

3)   Asking help from family members

Often, people who suffer from low self esteem find it extremely hard to digest that they cannot do certain things independently. Such feelings ought to be discarded immediately, with family members and friends showing that helping the stroke victim is not a bother at all..This avoids the stroke victim from feeling of being a burden.  However, at the same time, family and friends should avoid doing for the stroke victim things that he could do himself.  Such family members and friends may mean well, but are often themselves anxious, and may transmit that same anxiety to the stroke victim.  Occasionally, it may also become an easy way out for stroke victims to intentionally remain inactive.  It is a balance that sometimes may be difficult to achieve.

References

http://www.strokeassociation.org

http://stroke.ahajournals.org

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