Stroke ‘A condition that often strikes without a warning” Example; Jaleel, who is 48 years old, was brought to the satellite center by his concerned wife and son. Six months before, he had had a stroke (cerebral vascular accident) that paralyzed his right side. At first he could not walk or talk. Weeks later he began to walk with much difficulty, using a cane. But his speech did not return. He had trouble expressing his wishes. He got angry with his wife when she did not understand him - and she would get angry with him. She thought his inability to speak came from weakness of his mouth, and that if he could learn to move his lips and tongue better he would be able to talk. She was sure he understood everything she said to him, and was irritated that at times he didn't respond appropriately. Handicap International Henk Willemsen

Effects of the Stroke 1 A stroke always effects one side of the body; left or right (hemiplegic) One side of the face may be paralyzed, mouth hanging down Stiffness or paralysis of the arm and leg on one side Balance problems when sitting or standing Forgetting about the affected side

How do you get it? Caused by blood pressure, malformation blood vessels, trauma, tumour The remaining cells can help regaining the movements

How do you get it? Caused by a blood clot or bleeding in part of the brain Brain cells will die when they don't get their oxygen supply

Effects of the Stroke 2 Loss of normal controlled movements, difficulties in; activities of daily living Sitting, standing, walking swallowing; hunger and discomfort in speaking and understanding in seeing in thinking Difficulties in Swallowing due to weakness of the muscles in the face, tongue and jaw.

Effects of the Stroke 3 Psychological and emotional problems Unable to control bladder and bowel Sensory problems; difficulties in knowing where her limbs are, what position her body is

Difficulties in speaking and understanding Injury to one area of the brain's "language center" can prevent the person from understanding the spoken or written word Damage in another language area can prevent her from recalling or forming words or phrases correctly, either in spoken or written form Injury to one area of the brain's "language center" can prevent the person from understanding the spoken or written word (receptive aphasia). Damage in another language area can prevent her from recalling or forming words or phrases correctly, either in spoken or written form (expressive aphasia). Persons with severe language problems may have losses both in receiving and in expressing language (total aphasia).

What to do? 1 Use a Picture board Use gestures and signs Make a list of the things that are most important for communication in the home. This included a variety of foods and other objects.

What to do? 2 Approach the person from the front, not the side Stimulate activities of daily living Try to use both the good and the affected side in activities Use a mirror to improve movements Verbal input; tell the person what you are going to do, what you are doing Careful movements to prevent a stiff shoulder

Exercise 1 Balance when sitting / standing Changing of positions Lying ↔ Sitting Sitting ↔ Standing

Exercise 2 Standing ↔ Walking

Stimulate Activities Daily Living 1 Feeding Foam rubber or cloth can be used to adapt the handgrip When it is difficult to reach the mouth, the handle can be bent

Stimulate Activities Daily Living 2 A washmitt can be made by cutting two pieces of towel to fit the hand size and sew them together. You can guide his affected hand in holding the washmitt, while he puts the unaffected hand into the mitt, he can then wash himself

Stimulate Activities Daily Living 3 Dressing and undressing If a woman has difficulty in fastening a bra, she can fasten the bra in front, pull it around the neck, then put her arms through the straps. When putting a blouse on, the person should dress the affected side first. He should wear loose-fitting clothes that open easily in front (e.g. with press buttons)

Stimulate Activities Daily Living 4 A rail beside the toilet helps getting on and off the toilet Or a walking frame put around the toilet When using a squatting toilet, a toilet seat can be made from wood Everything the person needs should be in easy reach beside the toilet A commode can be made from a wooden chair, to place it over the toilet

Prevent contractures and pressure sores Positioning and exercises Prevent contractures of the hand using a small roll or a finger divider