Stroke: new evidence of early warning signs and how occupational therapy aids recovery.
Stroke: new evidence of early warning signs and how occupational therapy aids recovery.
Patients who had a stroke have steeper declines in cognition and daily functioning up to 10 years before their first-ever stroke compared with stroke-free individuals. 
The Rotterdam Study [1]
New research has found that early warning signs of stroke may show up to ten years before it strikes.
A 26-year study of over 14,700 participants showed that those who had a stroke had experienced more significant losses in cognitive skills and routine daily functioning in the preceding decade than those who hadn't had a stroke.
And those at the most significant stroke risk were carriers of the APOE gene linked to Alzheimer's disease, people with fewer academic qualifications, and women.
The researchersat Erasmus MedicalCentre, Rotterdam, ran the study from 1990 to 2016 and used several tests to assess cognitive abilities including:
- The Mini-Mental State Exam for memory.
- The Purdue Pegboard Test for manual dexterity.
- The Stroop Test for mental processing speed.
They also monitored the participants' abilities to carry out basic activities of daily living, such as washing and getting dressed, and more advanced tasks such as budgeting.
During the average monitoring period, 1662 participants had their first stroke, which happened at an average age of 80.
Significant differences were seen in their test scores up to ten years before their stroke compared to those who didn't have a stroke.
And their scores continued to fall more steeply by comparison afterwards.
The research team concluded, "Patients who had a stroke have steeper declines in cognition and daily functioning up to 10 years before their first-ever stroke compared with stroke-free individuals.
"Our findings suggest that accumulating intracerebral pathology already has a clinical impact before stroke."[1]
More stroke signs
Stroke is the second biggest cause of death globally, according to the World Health Organisation. [2]
When stroke strikes, spotting the symptoms quickly is key to preventing further damage to the brain.
The NHS suggests remembering the word 'FAST' to help recognise the signs[3]:
- Face – or mouth or eye dropping on one side or unable to smile.
- Arms – unable to lift both arms and keep them there due to numbness or weakness in one arm.
- Speech – may be garbled or slurred or unable to talk; may have problems understanding what's being said.
- Time – if the signs are there, it's time to dial 999 immediately.
Sometimes, a warning may come in the form of a mini-stroke, known as a transient ischaemic attack (TIA).
TIAs can last for a few minutes or continue for up to 24 hours.
Other signs of stroke can be[4]:
- Sudden and severe headache
- Loss of consciousness
- Complete paralysis of one side of the body
- Problems with balance and co-ordination
- Sudden loss or blurring of vision
- Difficulty swallowing
Stroke causes
In most stroke cases, the cause is ischaemic; that is, a blood clot has cut off the blood supply in the brain.
In the remainder, the stroke is haemorrhagic, meaning a weakened blood vessel has burst.
Several factors can increase the risk of stroke, including:
- High blood pressure
- High cholesterol
- Irregular heartbeats
- Diabetes
- Family history of stroke
- Unhealthy lifestyle
Stroke recovery
Because a stroke can affect different parts of the brain, treatments and therapies differ according to its impact on a survivor's physical and mental abilities.
Long term problems, however, may require rehabilitation from a range of experts, including neuro occupational therapists (OTs), who can help in the recovery of independent living skills.
Some of the areas a neuro OT can help with include:
Post-stroke fatigue
This is one of the most common results of any stroke or TIA and is described by sufferers as constant tiredness or feeling drained and out of energy.
Post-stroke fatigue affects physical and mental wellbeing in a variety of ways, including:
- Muscle weakness
- Co-ordination problems
- Recurring headaches
- 'Brain fog'
- Sensory problems
- Problems doing daily activities
- Withdrawal
- Irritability and anxiety
- Being more forgetful
In occupational therapy, the starting point to any fatigue management plan is understanding the fatigue itself.
"Fatigue can be hard to define and articulate for many brain injury survivors," says Krysalis Director Jo Throp.[5]
Education is central to helping an individual develop their insight and awareness.
Understanding a stroke survivor's fatigue first requires knowledge of any other medical conditions that may impacttheir health or sleep.
And all other areas of their life need looking at including:
- Roles
- Routines
- Goals
- Belief systems
- Behaviour patterns
- Personal and shared environments
- Emotional wellbeing
- Pain
Identifying activities that drain or energise should also form part of a fatigue management plan, with other strategies including [6]
- Recognising the early signs of fatigue
- Managing energy/time used by recording fatigue/activity patterns
- Sticking to a regular routine
- Eating healthily and exercising regularly
- Modifying the environment
- Planning ahead
- Using reminders/diaries/alarms to stay on track
- Using aids and adaptations
Daily living
A neuro OT can assess a stroke survivor's abilities in activities of daily living such as washing, dressing or making a meal in order to help them relearn or adapt old skills or develop new ones.
They can also help with a return to hobbies, work and education.
The strategies they use include:
- Assessments of physical and cognitive functioning
- Therapeutic activities to improve movement/cognition
- Aids and adaptations
- Confidence-building exercises
- Advising carers/employers/teachers
- Connecting with other experts
*World Stroke Day
The three main signs of stroke and the need for fast treatment is the focus of this year's World Stroke Day on October 29. [7]
More information about stroke and symptom management from the UK's Stroke Association here: [8]
Further reading
Waltz with us on World Stroke Day
Aphasia and occupational therapy
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References
- Heshmatollah, A. et al., "Long-term trajectories of decline in cognition and daily functioning before and after stroke," Journal of Neurology, Neurosurgery and Psychiatry, 2021.
- WHO: The top ten causes of death
- NHS: Stroke
- Krysalis: Experiences of stroke survivors
- Krysalis: Neuro occupational therapy and fatigue
- Krysalis: Fatigue and brain injury
- What's on in October 2021: occupational therapy, brain injury and neurorehabilitation events
- Stroke Association