Strokes are one of the leading causes for disability and mobility problems. According to the CDC, someone in the United States dies from a stroke every 4 minutes.
I have spent many years during my time as an occupational therapist working with people who have had strokes. In fact, while working at one particular rehabilitation hospital, I was part of the hospital’s stroke team, which means nearly 95 percent of the patients on my caseload were victims of stroke.
Having helped countless patients and families through recovery, I can tell you with confidence that the most important aspect of prevention is recognizing the signs and symptoms, as well as knowing how to act quickly. With strokes, time is of the essence. I am here to help you learn how to quickly notice the signs so that you can help your loved one in their time of need.
Pro Tip: To learn more about how to care for your loved ones at home, check out our guide: What Is a Caregiver?
What Happens During a Stroke?
During a stroke, the blood supply to your brain is stopped or slowed, which causes rapid dying of brain tissue due to lack of oxygen and nutrients carried through your blood. This is why time is so important in recognizing the signs of stroke; the longer your brain goes without oxygen, the worse the damage will be, and the chances of survival are greatly reduced.
There are three main types: ischemic strokes, hemorrhagic strokes, and transient ischemic attacks.
Ischemic stroke: The most common type of stroke, an ischemic stroke occurs when a blood vessel is obstructed. The main cause for ischemic stroke is narrowing of the blood vessels due to fatty deposits, which reduces flow of blood to the brain (atherosclerosis). A part of a fatty deposit breaks free and travels through the blood vessel until it can no longer pass due to its size. The same is true if blood clots in other parts of the circulatory system form and travel to the blood vessels of the brain and become stuck, cutting off blood flow in the same fashion.
Hemorrhagic stroke: Less common than ischemic strokes, hemorrhagic strokes occur when a weakened blood vessel ruptures, causing blood to flow into the brain. The blood then creates pressure on brain tissue, which causes damage. There are two types of hemorrhagic strokes: aneurysms, which are weakened sections of vessels that expand and eventually burst, and arteriovenous malformation, which is a cluster of malformed vessels, any of which can hemorrhage at any time.
Transient ischemic attack (TIA): A TIA can be thought of as a mini stroke and should be viewed as a warning for a more serious stroke in the future. A TIA is a temporary blockage in a blood vessel caused by a clot or fatty deposit that dislodges or dissolves on its own in a short amount of time. TIAs should NOT be ignored.
Risk Factors for Stroke
Technically speaking, any person (of any age) could have a stroke at any time; however, there are some factors that increase your risk. These include:
High blood pressure
History of TIAs
There are also factors that you have no control over that can lead to a higher chance of having a stroke. These are things like heredity, age, gender, and race. For example, age correlates with a greater likelihood of strokes. Additionally, men are more likely to have strokes than women.
Warning Signs of a Stroke: FAST
Thankfully, there are immediate signs that a person is having a stroke. Recognizing these signs and acting quickly can literally be the difference between life and death, or at least decreasing the damage that will be done. The acronym FAST is the first place to start when looking for signs a person is having a stroke.
F (Facial drooping): Look for one side of the person’s face to be drooping, or reports of numbness on one side. If asked to smile or blow air into their cheeks and hold it, is one side lopsided, or are they unable to comply?
A (Arm weakness): Your loved one is describing weakness or numbness of one arm, or you notice one arm is moving strangely. If asked to raise both arms out in front of their body, is one arm lower or unable to move?
S (Speech issues): You notice slurred or jumbled speech, confusion, or an inability to speak in the usual manner. Ask them to say, “You can’t teach an old dog new tricks.” Is their speech slurred, or do they mix up the words?
T (Time to call 911): If you are seeing these signs, immediately call 911. This is a medical emergency.
Some other symptoms of stroke are sudden changes involving:
Ability to walk
Numbness in one arm or leg
If you suspect your loved one may be having a stroke but are not sure, it is always best to call 911. Do not hesitate!
8 Ds of Stroke Care
When it comes to strokes, rapid response is critical to a person’s survival, and it will dictate the amount of damage sustained. In order to implement a more streamlined approach to how we all respond when a loved one is having a stroke, the American Heart Association created what are known as the 8 Ds of Stroke Care. These procedures, known as the Stroke Chain of Survival, are the major steps in diagnosis and treatment of stroke taken by family members, emergency and hospital staff.
The eight Ds of stroke care are detection, dispatch, delivery, door, data, decision, drug/device, and disposition.
Immediately pinpointing the signs of stroke will greatly increase a person’s chance of survival, as well as reduce permanent long-term damage. Look out for difficulty walking, sudden problems with sight, and severe headache, and always remember FAST: facial drooping, arm weakness or numbness, speech impairment, and don’t delay calling 911.
You may be tempted to take your loved one to the hospital yourself. When it comes to a stroke, this is not the best plan. Always call EMS as soon as you suspect your loved one is having a stroke so that they can immediately employ actionable steps, such as checking vital signs, performing a stroke assessment, and informing the hospital to activate the stroke team en route.
During transport, the EMS staff can be contacting the stroke center, ordering CT scans or MRIs, and preparing the facility for your loved one’s arrival to reduce lag time between onset and delivery to medical staff. This fast response can cut valuable minutes off the time between arrival and treatment.
This step refers to the arrival at the door of the facility. Here, staff rapidly respond to review patient history, document onset of symptoms, and perform neurological assessments. If the previous steps were taken within appropriate time, the staff will be ready at time of arrival.
Appropriate testing, such as a CT scan or MRI, will be conducted to determine the type of stroke so that the proper measures can be taken. This is important because the response and treatment for each type of stroke will be different. The faster the tests can be performed and results obtained, the faster your loved one will be treated.
At this step, the severity of the stroke and its damage will be evaluated. Family members will be notified. The team will decide on the next steps regarding treatment and therapy options, and discuss the risks and benefits with family members.
Fibrinolytic/thrombolytic therapy, intra-arterial strategies, and other treatments will be utilized based on time frame and decisions made by family and team. If a person suffers an ischemic stroke and is within three hours of the onset of symptoms, the use of thrombolytic therapy is possible. A drug called tPA (tissue plasminogen activator, which helps restore blood flow to the brain) can be used, though there are other similar medications that are also known to dissolve clots and restore blood flow. A thrombectomy, which is the surgical removal of the clot or blockage, may also be considered. Each treatment will be conditional upon the response time from onset, as well as any other underlying issues.
For a person who has suffered a stroke, admission to an ICU or stroke unit within three hours of arrival at the emergency department is ideal. They will continue to be monitored and tested for neurological changes until discharge to a rehab facility or home, depending on the severity of the stroke and recommendations of the stroke team.
Stroke rehabilitation will begin while in the acute setting, with occupational therapists (OTs), speech therapists (STs), and physical therapists (PTs) working in tandem with the medical team. At this time, the severity of the stroke as well as any physical and mental deficits will be evaluated, and a plan of care will be created to best suit the patient and their needs.
The effects of a stroke can vary greatly. Some people experience minimal memory loss and little to no physical impairment. Others, however, lose the ability to speak and experience loss of the use of half of their body (hemiparesis), resulting in lack of independent mobility and total dependence on others. Treatments will range from minimal to all-encompassing.
The average hospital stay for a person who’s had a stroke is roughly one week, in my experience. After that, the patient will be discharged to an inpatient skilled nursing home, rehab hospital, or home (usually with outpatient services planned), based on the severity of the stroke and the therapy needed. Early rehabilitation efforts are key. The first three months are the most vital in regaining mental and physical abilities, with progress slowing down around the six-month mark. Though progress can still be made, it will be slower at this point.
The focus on rehabilitation will begin with ADLs (activities of daily living), such as oral hygiene, grooming, dressing, and toileting, as well as the use of the affected arm during these tasks, often with the occupational therapist using hand-over-hand techniques to move the limb through its normal range of motion. Speech therapy will focus on any issues with swallowing/eating, memory strategies and cognitive therapy, and oral communication. Physical therapy’s main concern will be biomechanically directed, with balance work, leg brace fittings (if needed), and ambulation as their targets. Through the hard and intensive work of the interdisciplinary team, the achievements can be quite extraordinary.
In one of my cases, a 73-year-old woman who was fully independent had a massive ischemic stroke that was not caught early. At the start of our time together, she was completely immobile and noncommunicative, basically catatonic. My sessions were conducted at her bedside, with me providing all of the movement to her left arm during ADLs and therapeutic exercise. By the time of her discharge six weeks later, she was able to nod and shake her head in response to questions, sit up at the bedside unassisted, and get dressed with minimal assistance. She was discharged to her home with home healthcare, and she eventually recovered some speech and even more physical ability in the following months. Swift and ardent rehabilitation efforts are imperative for recovery.
Caring for a Loved One After a Stroke
Once your loved one has returned home, care after a stroke can be challenging, depending on the outcome. The best piece of advice I can give is to speak to your OT, PT, and ST before discharge to get helpful tips for caring for your loved one at home. Here are a few I can offer:
If you are assisting them with self-care, it is important to allow them to try before jumping in to help. They will most likely have learned what are called hemi-techniques in therapy if they struggle with use of one arm. It will be important to continue these strategies at home to facilitate independence in their daily routine.
Always stay vigilant for signs of another stroke. Remember, a person is much more likely to have a stroke if they have already had one.
Encourage safe exercise and therapeutic activities to promote progress. Though progress may have slowed, it will be imperative to help your loved one stay active to keep pushing toward goals.
Be patient and encouraging, but know how to read the room. Depression is common among stroke survivors, especially if they have lost a great amount of physical and/or cognitive function. Sometimes a person doesn’t need a cheerleader every day, so be aware that silent support can go a long way on those days.
Reach out to your team even after discharge with any questions or concerns you may have. Therapists, the medical team, and social services will try to help out in any way they can, so do not hesitate to make that call.
This year, 795,000 people in the United States will have a stroke. Understanding the risk factors can help you — or the person you’re caring for — lower the chance of stroke. Quitting smoking and keeping your blood pressure and cholesterol under control can also greatly reduce your odds.
Being able to recognize the signs of a stroke and act quickly can literally save a person’s life, and decrease the lasting effects afterwards. Remember FAST and the 8 Ds of a stroke, and make that call to 911 sooner than later! If you are caring for your loved one after they have suffered a stroke, do your best to assist them in their recovery by supporting their emotional needs and encouraging them to continue with their therapy exercises and activities.
To learn more caregiving tips, be sure to check out our helpful guides:
Yes. A silent stroke is a stroke that happens without a person realizing it. The damage is very minimal and undetectable unless seen on a CT scan. Oftentimes, there will be temporary and brief symptoms, such as a sudden balance deficit, memory loss, and issues with muscle control.
Recovery from a stroke will vary depending on the severity of the stroke. Recovery from a TIA or less serious stroke can take as little as a few days, while more severe strokes will require months of intense rehabilitation, with outcomes just as varied. Some people will make a full recovery, and others may be dependent on others for the rest of their lives.
Sometimes the damage done to the brain is too severe for recovery to occur. The most prevalent signs of impending death after a stroke are an increase in labored breathing; escalation of pain; increased respiratory secretions, often referred to as the “death rattle”; and advanced confusion.
A former member of the Navy, Jenny Atwell has spent six years as an occupational therapy assistant, working in rehab hospitals, skilled nursing facilities, and, most recently, as a home health care specialist. Her primary focus is on geriatric care in a variety of settings.