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STROKENET Newsletter
July 1,
2001 Issue #8
Linda Wisman , Editor,
mailto:LWisman@strokenetwork.org
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By subscription only! Welcome to your next
issue of
"STROKENET".
You are
receiving this newsletter because you
requested
a subscription or are on the Stroke
Newsletter
list. Unsubscribe instructions
are at
the end of this newsletter.
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IN THIS ISSUE
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=> Sponsorship Notice
=> Positions Open
=> Organization Highlights
=> Editor's Message
=> Stroke In A New Zealand Winter
=> Peace of Mind
=> Communicating With Our Caregivers
=> Rehabilitation “Plateaus”
=> Website Review: www.healthlinkusa.com
=> Subscribe/Unsubscribe information
If you
would like to be a sponsor of this newsletter, please
contact
me: mailto:LWisman@strokenetwork.org
------------------------------------------------------------
POSITIONS OPEN
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The positions of Nurse and Occupational Therapist
are currently
open on our web page www.strokenetwork.org. If you are a
Professional who would be willing to help our
readers please
contact Pat Provost at Pprovost@strokenetwork.org. We
would
also appreciate your passing this request on.
Thanks.
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ORGANIZATION
HIGHLIGHTS, By Steve Mallory
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The Stroke Network is getting closer and closer to
becoming non-profit.
I estimate that we are probably as close as $50-75.
That is really
pretty good, better than I expected for this time of
the month.
Several other members have already pledged their
donation so I’m
expecting that the next newsletter will have
fantastic news about
our status.
We have other excellent news to announce. Steve
Page, PhD, a Research
Scientist and Stacy Fritz, a Physical Therapist,
have joined our panel
of Experts, which you can send an e-mail to and get
answers to your
questions. Please go to http://www.strokenetwork.org/professionals/
if you would like to use this service.
I have been contacted by a Writer and Pastor, who is
attempting to
find out how to prominent a medical policy for
stroke survivors.
He found a stroke survivor who had been declared as
“brain dead”
a little too fast. The hospital actually wanted to
call the
survivor brain dead in order to harvest organs. If
you have
had a similar experience or know of someone who had
that actually
happen, please contact me immediately at SMallory@strokenetwork.org
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Editor’s Message, by Lin Wisman
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We are
pleased to welcome the newest contributor to the
Newletter,
Steve Page, PhD. Dr Page brings to us an extensive
background
in rehabilitation medicine. His article
“Rehabilitation
‘Plateaus’” comes as a
relief to those of us
who
know we have made improvements following the one year
plateau!
Also in
this issue is an article by David Ray continuing the
saga of
Stroke in New Zealand. Rhonda Petersen writes an article entitles “Peace of Mine.”
In it she discusses some of the basic elements of stroke. Paulina Perez gives
us important data on
managing
caregivers. It’s not an easy job and difficult for
all concerned. Barbara Layne provides a review on the website www.healthlinkusa.com
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Stroke In A New Zealand Winter by David G Ray
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Last month I mentioned the
weather here and the fact that we
experienced a very mild
autumn
(Fall.) Continuing on with
the weather theme we are now
experiencing winter. As I
type this it is the last week of
June and we have yet to
have our usual cold frosty mornings,
strong northerly winds and
heavy rain. Our garden cannot make
up its mind what to do.
Some of our spring flowers have
already burst into colour
in a state of seasonal confusion.
However as I type this
letter it is cold and wet outside.
Our Stroke Club is nearing
the end of its fiscal year and
its programme for the
first six months. Next month we will
have our annual meeting
when, among other things, we will
elect the committee for
the next 12 months. Unfortunately we
have had two deaths within
the committee since Christmas and
we will need to elect at
least two new committee members. Last
week my wife and I
attended the annual meeting of our local
Horticultural Society and
no members allowed their names to be
put forward for election
to the committee. The result was that
the society would be wound
up. Everyone wants the society but
no one is willing to do
the necessary work.
Our Stroke Club consists
mainly of older people who are
unwilling to anything but
turn up at the fortnightly
gatherings and pay their
fees. Already a couple of Stroke
Clubs in the Wellington
area have closed down because, I
suspect, no one is willing
to do the work. Our club will
survive for at least
another year because existing committee
members have agreed to be
re-nominated.
It is my belief that older
stroke people need to keep their
brains working and get
involved in as many activities as
their disability will
allow. Too often the answer I get to
requests to get more
involved is "I can't do that." My reply
is to repeat the words of
Thomas Edison before he invented
the incandescent light
bulb; "I can't do it, yet." It is my
view that whatever
disability a person may have, there is
always something, however
small, that one can do.
During the last month our
stroke club has had talks from a
lawyer on matters that
affect disabled and older people such
as Family Trusts, wills
etc, and a member of the Hearing
Association. Both sessions
were of particular interest to our
members especially the
latter as decreasing hearing ability
is having an affect on
most of us. Last week we had our
mid-year lunch at a
Chinese Restaurant. This occasion was
most useful, not because
of the excellent food, which everyone
enjoyed, but because it
allowed everyone to communicate
with each other in a more
convivial setting.
I conclude by sending a
mid-winter greeting to all readers.
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Peace of Mind
by Rhonda Petersen
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A mind
is a terrible thing to waste.
Mind
your own business!
Mind
your P’s and Q’s!
Exercise
your mind.
I gave
him/her a piece of my mind!
Don’t
have a Stroke over it!
Everyone
has heard these sayings at one time in their life.
But
have we ever stopped to consider the grand importance of
your
mind? If you hooked all the computers together in New
York
City, Los Angeles, Boston, and Chicago, you would only
partially
reach the capacity of one human brain. Our brain
makes
us who we are! Our brain controls all involuntary
movements
such as heart rate, breathing, and reflexes. Our
brain
also controls all voluntary movements such as
swallowing,
movement, coordination, emotions, and every
thought
we think.
As our
heart pumps, our brain demands oxygenated blood to keep
working
properly. The blood goes to billions of cells (little
computers)
throughout the brain. These cells must have fresh
blood and
oxygen in order to perform their tasks. When brain
cells
are deprived of blood, because of a piece of cholesterol
or
blood clot, an Occlusive Stroke occurs. When a blood vessel
ruptures
and areas of the brain cannot be fed fresh nutrients
causing
bleeding inside the head, this is called a Hemorrhagic
Stroke.
Within a matter of minutes after being deprived fresh
blood,
brain cells will start to die. Using everything we
presently
know in medical science, there is no way to revive
or
regenerate dead brain cells. Once they’re dead they will no
longer
perform the function they once did. The only thing we
can
hope for is that, through therapy and time, other brain
cells
will perform double duty and take over some of the
function
of these dead cells.
A
stroke is a Brain Attack and as important as a heart attack.
But the
symptoms of stroke are sneaky, sudden, non-painful,
and
usually come and go, as part of our brain circuitry begins
to show
signs of lack of oxygenated blood.
I did
not realize, at 43 years old, I was experiencing classic
stroke
symptoms even though I was a nurse! Doctors and nurses
are no
more immune from disease than anyone else. I naively
thought
that Strokes do not occur in young people. Since then,
I’ve
learned that even children and infants can and do have
Strokes.
Although,
medical technology has made strides against stroke,
there
is much more to be done. Although, it is with regret
that I
look back, I provide speaking presentations to prevent
Stroke from
occurring in others lives. I tell my story all over
the
nation, so that people everywhere will learn the symptoms
of
Stroke and take them as seriously as they do heart attacks.
Stroke
is the third leading cause of death behind heart
disease
and cancer. Stroke is the leading cause of disability
in the
United States. Stroke affects more women than breast
cancer
and MS put together! The risk of stroke doubles every
ten
years after the age of 55. Age is a risk factor we cannot
control.
Heredity is another uncontrollable risk factor. But
there
are things we can control like diabetes, high cholesterol,
blood
pressure, and excessive weight.
Today,
there is a drug called TPA that can be given to prevent
further
brain damage in certain cases. But there’s a catch! It
must be
administered within four hours of the onset. Time is
critical!
Learn the symptoms of stroke.
Sudden numbness or weakness of face, arm, or
leg, especially
on one side of the body
Sudden confusion, trouble speaking or
understanding speech
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of
balance or
Coordination
Don’t
have a Stroke.
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Communicating With Our Caregivers,
by Paulina Perez
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We often have to learn the art of working together
and often
must teach it to our caregivers too. This type of
relationship
is built on mutual trust, respect, valuing the
contributions
and knowledge of others and working toward common
goals.
This requires a balance of power and understanding
of roles.
Mutual and Professional Trust
Medical professionals rely on each other’s observations,
assessments, diagnoses and abilities. All of these
people
must work interdependently toward the common goal of
obtaining the best outcome for us as a
client/patient.
Human communication is messages between two people
in
face to face communication. It is important to
remember
that which has been communicated cannot be
uncommunicated.
It can only be built upon. Clients/patients and
their
caregivers must have not only effective but
exemplary
communication skills to make health care work more
effectively.
All of our communication takes place within the
context of
time, place and history. Our conversation involves
both
verbal and non-verbal communication . Sometimes our
non-verbal communication contradicts what is being
said
verbally(ie: when saying “Do you have any more
concerns”
while reaching for the door knob).
Communication requires adaptability on everyone’s
part. When
we are communicating with health professionals we
are
interacting on two levels- content which is objective
and
relationships which are subjective.
Managed care has taken a toll on our ability to
communicate
effectively. The health professional often has no
history
with us as a client/patient and that changes the way
we both
communicate. Health care often involves taking a
risk. How
can you take a risk when you don’t know the person
you are
talking to? If either of us doesn’t feel safe it
changes
they way we BOTH communicate.
The Three Types of Communication
Passive
Passive communication often involves: no eye
contact,
sing-song quality of voice, very soft voice,
leaning-out
posture. They often see themselves as powerless.
Aggressive
Aggressive communication often involves: sarcastic
tone,
abrupt, condescending words, charging posture.
Aggressive
communication is intimidating and overwhelming.
Those who
use the type of communication are driven by a need
to
demonstrate that they are right. As they see it you
are
someone who doesn’t need to be paid attention to.
This
behavior arouses mental and physical confusion,
frustration,
a sense of helplessness. The most common reactions
are to
run or fight back. These reactions rob us of the
ability to
deal coolly and competently with the situation. To
deal
with an aggressive communicator you should be
friendly but,
you must stand up for yourself and not let yourself
be pushed
around. Get them to sit down, let them run down and
when
they lose momentum, hold your position, look
directly at
them and speak from your point of view. If they
interrupt
you say very firmly “ I wasn’t finished and you
interrupted
me.” Avoid a head-on fight as this is a win-lose
situation.
Assertive
Assertive communication expresses feelings and wants
honesty
and involves: firm eye contact, relaxed posture. It
denotes
mutual respect. Assertive communication gives you
energy,
improves relationships, improves decision-making,
and
achieves results.
Another communication skill that is helpful is
active
listening where you acknowledge what the other
person said
as this lets them know that you understood and took
them
seriously. The easiest way to do that is to
paraphrase what
you think their main points were.
The hardest emotion to deal with is when someone is
angry. It
might help to use following strategies:
Be calm
Lower your voice
Distance yourself a little
Use calming words
Use silence
Use restatement
Use reflection
Clarify
Set limits
Gather information
Be precise and accurate.
Remember the acronym- CAR
Commonality
Let
the person know you have mutual respect
Acknowledge
Show you
understand his point of view
even
though you don’t agree
Redirect
Distract
the person or gradually change
the
conversation
Deal with one situation at a time
Make “I” statements
Be clear and direct
Don’t insist on your own way
Do not get stuck on the problem. Look for a method
to resolve
the problem.
Empower not overpower
Develop solutions together.
Keep in mind that people feel significant
Remember we have the same goal in mind- restoring
the
client/patient’s health.
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Rehabilitation
“Plateaus” by Stephen J. Page, Ph.D
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Q:
A loved one recently experienced a stroke, but has been
told
that he/she has reached a plateau. What does “reaching
a
plateau” mean? Is there such a thing in therapy/
rehabilitation?
A: Following
a stroke, comprehensive rehabilitation
conveys improvements. Medically, the phrase
“plateau” usually
refers to the shape of the motor recovery curve when
someone
is no longer thought to be improving. A common
clinical belief
is that, while motor function initially improves
with
participation in therapy regimens, after a certain
amount of
time (it is usually thought to be a year), the
improvement
will decrease (i.e., the curve will “plateau”) and
there will
not be additional improvement, even if the
individual continues
to participate in therapy. When a patient reaches
this point,
the physician or therapist will frequently state
that the
patient has “plateaued.” Because it is believed that
therapy
will not produce additional improvements, it may be
recommended
that therapy should be reduced or, in many cases,
terminated
entirely.
Indeed, patients do go through periods when their recoveries
slow or may even stop. However, exercise studies
with healthy
subjects have shown that such periods are frequently
indicative
of the body adapting to a certain mode of exercise,
rather
than indicating that an individual’s capacity for
improvement
has diminished. In these cases, it is usually
recommended
that the individual attempt a different or new mode
of
exercise. For example, if an individual has been
running for
a period of time, he/she may exhibit initial
improvements
that are quite impressive, followed by improvements
of
smaller and smaller amounts. Such decreases in
his/her rates
of improvement do not mean that the individual’s
capacity for
improvement has vanished, however. In many cases,
the
individual’s body may have adapted to the exercise
program,
necessitating that a different mode of exercise be
attempted.
Many principles governing exercise can also be applied
to
activity therapy regimens. In the current case,
there are
indeed studies showing that a great deal of stroke
recovery
occurs during the first year after a stroke (e.g.,
Duncan,
et al., 1992; Ferucci, et al., 1993), and it is
fairly well
established that the most dramatic improvements
generally
occur within the first 30 days after a stroke.
However, it
is reasonable to believe that many chronic stroke
patients
(individuals who are more than one year post-stroke)
who have
“plateaued” may benefit – and even show improvements
- from
participation in different or alternative therapy
regimens.
For example, most patients remain at the same clinic
for
their entire course of outpatient therapy. It is,
thus,
unclear to what extent “plateaus” are attributable
to
patients’ inability to show further improvement
versus their
adaptation to the exercise program or environment.
The
exercise science literature is replete with studies
suggesting that periodization (organizing training
regimens
into several separate cycles with different goals,
tasks, and
content) of exercise delays adaptation to exercise
regimens.
It is plausible that periodizing therapy regimens
may delay
the onset of adaptation. Perhaps more importantly,
recent
studies have shown that chronic stroke patients can benefit
from therapy regimens that are new to them or that
offer
something above and beyond what they previously
received.
An excellent example is the recent work on
constraint-induced
therapy (e.g., van der Lee, et al., 1999), which has
shown
that chronic stroke patients exhibit behavioral
improvements
(e.g., increases in arm function and arm use), as
well as
treatment-induced reorganizations in the motor
cortex
(Liepert, et al., 2000). Other examples of chronic
stroke
patients with stable motor deficits displaying
improvement
include trials of traditional rehabilitation
techniques with
chronic stroke patients (e.g., Dam, et al, 1993;
Tangeman,
et al., 1990), functional neuromuscular stimulation
(e.g.,
Caraugh, et al., 2000; Daly & Ruff, 2000),
strength and
locomotor training programs for the lower
extremities (e.g.,
Dean, et al., 2000; Teixeira-Salmela, et al., 1999)
and recent
applications of imagery (e.g., Page, in press).
Although many individuals who experience stroke
exhibit
substantial recovery, many are left with some
residual
impairments. It is commonly believed that, after a
certain
period of time, motor recovery is less likely.
Furthermore,
some of the aforementioned studies have
methodological
limitations, including low sample sizes, lack of
randomized,
controlled methodologies, and/or lack of a
population-based
sample. Nonetheless, results of recent studies in
rehabilitation and related disciplines suggest that
new or
different exercise modalities may offer additional
opportunities for chronic stroke patients to recover
some
lost function.
Caraugh,
J., Light, K., Kim, S., Thigpen, M., &
Behrman, A. (2000). Chronic motor dysfunction after
stroke:
Recovering wrist and finger extension by
electromyography-
triggered neuromuscular stimulation. Stroke, 31
(6), 1360-1364.
Daly, J.J.,
& Ruff, R.L. (2000). Electrically-induced
recovery of gait components for older patients with
chronic
stroke. American Journal of Physical Medicne and
Rehabilitation,
79
(4), 349-360.
Dam, M.,
Tonin, P., Casson, S., et al. (1993). The effects
of long-term rehabilitation therapy on poststroke
hemiplegic
patients. Stroke, 24, 1186-1191.
Dean, C.M.,
Richards, C.L., & Malouin, F. (2000). Task-
related circuit training improves performance of
locomotor
tasks in chronic stroke: A randomized, controlled
pilot
trial. Archives of Physical medicine and
Rehabilitation,
81 (4), 409-417.
Duncan,
P.W., Goldstein, L.B., Matchar, D., et al.
1992). Measurement of motor recovery after stroke:
Outcome
assessment and sample size requirements. Stroke,
23, 1084-1089.
Ferrucci,
L., Bandinelli, S., Guralnik, J.M., Lamponi, M.,
Bertini, C., Falchini, M., & Baroni, A. (1993).
Recovery of
functional status after stroke: A
post-rehabilitation follow-up
study. Stroke, 24 (2), 200-205.
Liepert,
J., Bauder, H., Miltner, W.H.R., Taub, E.,
Weiller, C. (2000). Treatment induced cortical
reorganization after stroke in humans. Stroke, 31, 1210-1216.
Page, S.J.
(in press). Imagery improves upper extremity
motor function in chronic stroke patients: A pilot
study.
Occupational Therapy Journal of Research.
Tangeman,
P.T., Banaitis, D.A., & Williams, A.K. (1990).
Rehabilitation of chronic stroke patients: Changes
in
functional performance. Archives of Physical
Medicine
and Rehabilitation, 71,
876-880.
Teixera-Salmela, L.F., Olney, S.J., Nadeau, S., &
Brouwer, B. (1999). Muscle strengthening and
physical
conditioning to reduce impairment and disability in
chronic
stroke survivors. Archives of Physical Medicine
and
Rehabilitation, 80 (1),
1211-1218.
van der Lee, J.H., Wagenaar, R.C., Lankhorst, G.J.,
et al. (1999). Forced use of the upper extremity in chronic
stroke patients: Results from a single-blind randomized
clinical trial. Stroke, 30, 2369-2375.
Biography
Stephen
J. Page, Ph.D. is a Research Scientist at Kessler
Medical
Rehabilitation Research and Education Corporation
(KMRREC),
and an Assistant Professor of Physical Medicine
and
Rehabilitation at UMDNJ/NJMS. Currently, Page is the PI
of
numerous grants and projects funded by such agencies as
The
American Heart Association, the Dana Foundation, the
Retirement
Research Foundation, The National Institute on
Disability
and Rehabilitation Research, and the Wallerstein
Foundation
for Geriatric Life Improvement, and is the
primary
author of articles appearing in such peer-reviewed
journals
as: The Archives of Physical Medicine and
Rehabilitation, The Occupational
Therapy Journal of Research,
Topics
in Stroke Rehabilitation, Journal of Head Trauma
Rehabilitation, Clinical Rehabilitation,
Journal of
Rehabilitation
Research & Development, Physical Therapy,
Brain
Injury, Adapted
Physical Activity Quarterly, The Sport
Psychologist, and The Journal of Sport
and Social Issues.
Page
also served as Co-Editor for issue 16 (1) of The Journal
of
Head Trauma Rehabilitation, is an issue editor of an
upcoming
issue of Topics in Stroke Rehabilitation, is a member
of
the Program and Membership Committees for The American
Congress
of Rehabilitation Medicine, and is a reviewer for
6
journals. At KMRREC, Page performs research concerning
restoration
of upper limb function following stroke, outcomes
research,
motor learning trials in stroke and traumatic brain
injury,
and research concerning the psychosocial aspects of
participation
in exercise and sport among individuals with
disabilities.
Dr. Page graduated with a Bachelor’s Degree from The College
of Wooster in Wooster, Ohio in 1993, completed a Master of
Science Degree in exercise science and sport psychology from
Ball State University in 1995, and graduated with a Doctor of
Philosophy degree in motor learning and control from The
University of Tennessee in 1998. At Wooster, Page was named
to the Top Ten for the “Outstanding Senior Male Award,” and,
at both Ball State University and The University of Tennessee,
Page
was honored as “Outstanding Graduate Student.”
------------------------------------------------------------
Web Site Review
by Barbara Layne
------------------------------------------------------------
This month I have found a site -- www.healthlinkusa.com --
that virtually anyone can find easy to navigate. It
enables
you to search information from thousands of health
sites. It
deals with treatment, cures, prevention, diagnosis,
risk
factors, research, support groups, email lists, and
personal
stories and it updates on a regular basis. Not only
will
you find just about anything you need or want to
know about
stroke, you will find information on other factors
or
conditions that might be related to your particular
case.
There is a Talk
Health Forum, which enables you to discuss
health questions and exchange information with
others. You
can also register to be notified when there have
been any
updates to your specific health topic. You can also
take
health quizzes, register for a free Talk Health newsletter,
check on drugs you are taking or are considering,
and visit
the HealthlinkUSA library. There is even a section
where
you can search for a physician!
The topics are in alphabetical order and easy to
access.
Once you have chosen a topic, you will be sent to a
“home”
Page, which gives you a number of pages to explore
on that
given topic.
Remember to take precautions in the summer
heat! Have a
safe and healthy July!!
------------------------------------------------------------
Copyright
Information
This
newsletter is the copyright of the Stroke Network and may
not be
copied without the express written permission of the
editor,
Steve Mallory, mailto:SMallory@strokenetwork.org
------------------------------------------------------------
Copyright
2001 The Stroke Network
------------------------------------------------------------
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------------------------------------------------------------------
Steve Mallory
President & CEO
The Stroke Network
mailto:SMallory@strokenetwork.org
Stroke Awareness for Everyone