Stroke was first recognised more than 2,400 years ago. Back then it was known as “apoplexy” a word that translated into “struck down by violence”. Since then, the diagnosis and management of stroke has evolved considerably, however, the condition still stands true to its original name – stroke victims are still considered “struck down” in physical, psychological and social aspects. However, with modern-day interventions and neuro-rehabilitation therapies, it is only a matter of time before this perception changes. Here, we explore the evolving landscape of stroke diagnosis, management, and rehabilitation, highlighting the importance of early intervention in improving outcomes.
The spectrum of affected individuals:
Stroke can affect individuals across the entire age spectrum, from neonates to the elderly, albeit with varying mechanisms, pathophysiology, etiologies, recovery, and prognosis. Notably, there has been a significant increase in stroke incidences among the young population, particularly in the 18-50 years age bracket. Hospitalization rates for younger stroke patients have surpassed those of the elderly, emphasizing the need for focused medical and social awareness to address this growing health issue.
Identifying, evaluating, and assessing stroke:
Effective evaluation of stroke follows a comprehensive “head to heart” approach, encompassing screening of the skull’s vertex to neck vasculature and thorough cardiac evaluations. Arterial dissections remain a leading cause of stroke in young individuals. Imaging techniques such as CT scans serve as the gold standard for screening, while MRI aids in differential diagnosis and identification of mimics.
Mnemonics such as FAST (face, arm, speech, time) and BE FAST (balance eyes, face, arm, speech, time) are strengthening the awareness strategies. Symptoms such as headaches, blur or double vision, slurred speech, facial deviation, cognitive impairments, loss of balance, sensory or motor loss that’s limited to one side of the body are widely known. Social media too has played a crucial role in raising awareness about stroke symptoms among the young populace, leading to early detection, prompt treatment, and an overall reduction in the burden of the disease.
The root cause and after effects
Several factors contribute to the escalating risk of stroke, including high blood pressure, diabetes, smoking, illicit drug use, excessive alcohol consumption, motor vehicle accidents, impact sports, and activities involving vigorous head and neck movements. A recent survey report indicated that post COVID-19 infection, an increase in stroke cases among the young population has been observed. The pathogenesis pointed towards hyperinflammatory, hypercoagulatory, cardiac, endothelial injuries and CNS invasion as sequelae. The disabling nature of stroke magnifies its impact, especially among younger individuals who are in their prime productive years, affecting not only the patient but also their families and society as a whole. Unexpectedly succumbing to a highly disabling condition results in eternal torments and ubiquitous implications and is magnified in case of younger individuals.
The recovery journey
The past decade has witnessed significant advancements in stroke care, leading to the establishment of a “Golden period of recovery.” Early intervention within hours of the stroke’s occurrence can maximize preservation of function and improve the quality of life for patients. While the most significant benefits of physical rehabilitation are seen within the initial six months post-stroke, the recovery journey continues, often characterized by intermittent plateau phases that can cause discouragement and depression in young stroke survivors. Embracing a holistic approach is paramount for achieving safe, effective, and swift patient integration into society. Physical, cognitive, and psychotherapy work together to build endurance, enhance mental strategies, boost confidence, and alleviate depression. Modern-day neurological rehabilitation centers that deploy innovative techniques, including robotics, artificial intelligence and virtual reality, provide a safe ground for patients with stroke-related disabilities. Here patients can practice routine tasks in a simulated environment and neuro-rehabilitation experts can deploy unprecedented management tools to accelerate the patient’s recovery process.
Keeping it in Check
The adage “Prevention is better than cure” holds immense significance in the context of stroke. Preventive measures gain precedence, considering the high risk of recurrence among young stroke survivors. Embracing a healthy lifestyle, regular physical activity, weight control, a nutritious diet, avoiding excessive alcohol and tobacco consumption, refraining from smoking and illicit drug use, and cautious use of oral contraceptive pills all play pivotal roles in prevention. Regular monitoring and control of blood pressure, diabetes, and cholesterol levels through health check-ups are essential. Most of these risk factors are modifiable, emphasizing the individual’s responsibility to prioritize their own fitness and well-being.
Stroke rehabilitation has come a long way since its early recognition. With the right interventions, early detection, and comprehensive neuro-rehabilitation therapies, stroke survivors have significantly higher chances to regain their independence, rebuild their lives, and contribute to society. By focusing on prevention, risk factor management, and embracing innovative techniques, we can collectively work towards reducing the impact of stroke and ensuring a healthier and more resilient future for all.
The author is Manager and Center Head, Atharv Ability – Neuro Rehabilitation Centre. Views expressed in the above piece are personal and solely that of the author. They do not necessarily reflect Firstpost’s views.
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