People whose lives have been touched by stroke can attest to its seriousness and long-term impact. For others, the term may conjure up the idea of a debilitating but rare condition, an unlikely possibility. Stroke Awareness Month, observed each May, is an opportunity to reinforce important facts, promote emergency responsiveness, and dispel myths about this leading cause of disability in our country. Because mobility is often impaired, it is also an ideal time for our team to highlight the role of orthotic care in the rehabilitation process.
A stroke, medically described as a cerebrovascular accident (CVA), occurs when blood flow is blocked from reaching the brain, depriving the affected area of oxygen and killing brain cells. According to the Centers for Disease Control and Prevention (CDC), nearly 800,000 Americans suffer from a stroke each year, and roughly 140,000 of these occurrences lead to death.
There are two main types of stroke: ischemic and hemorrhagic. Statistics from the American Stroke Association tell us that about 87% of strokes are ischemic, caused by a blood clot blocking a blood vessel in or leading to the brain. Another 13% are hemorrhagic. In this case, a blood vessel ruptures within the brain.
While statistics show that the risk for stroke doubles with each decade after the age of 55 and the majority occur in older populations, strokes can happen at any age. The National Stroke Association reports that adolescents and young adults account for 15% of ischemic strokes. The association also explains that the perinatal period (which refers to the weeks leading up to and immediately after birth) and the first year of life are considered the greatest risk periods in children, but stroke can happen beyond this time frame with congenital problems, malformed arteries, sickle cell disease, and trauma as examples of causal factors.
Warning Signs & Prompt Treatment
A stroke is always a medical emergency. Knowing the warning signs and seeking immediate emergency care are crucial to saving lives and reducing or reversing long-term effects. The CDC states that outcomes are better for patients who receive emergency treatment within three hours of symptom onset than for those who are not treated within this critical time period.
The FAST mnemonic has long been used to help people remember key symptoms that signal an immediate call for help. The expanded mnemonic BE FAST includes balance and vision changes as additional symptoms that should be reported immediately:
Balance – Sudden loss of balance or coordination
Eyes – Sudden vision change in one or both eyes
Face – Face droops or looks uneven
Arms – Arm weakness; when attempting to lift both arms, one drifts downward
Speech – Speech slurs, difficulty speaking or comprehending speech
Time – Time to Call 911
The consequences of a stroke vary greatly depending on the part(s) of the brain that sustain injury, the timing of medical intervention, and many other factors unique to each individual. A stroke on the left side of the brain will impact the right side of the body and vice versa. In addition to mobility impairments, memory, speech and language, vision, behavioral and emotional effects are all possibilities, emphasizing the importance of a multi-disciplinary approach to rehabilitation.
The Role of Orthotics in Rehabilitation
Because strokes can significantly impact the upper and lower extremities, orthotic intervention is often used to support weakened muscles and encourage correct positioning as an aid to motor recovery and physical and/or occupational therapies. Common physical challenges after a stroke include muscle weakness on one side (hemiparesis) and paralysis on one side (hemiplegia). Patients may experience spasticity, which is a continuous, involuntary tightening of the muscles. Conversely, patients can present with “floppy” muscle tone known as flaccidity. Overall fatigue is another issue many patients face after a stroke that influences their stamina for physical activity.
Orthotic devices are selected based on the individual needs of each patient and the conditions they are experiencing. An orthotic device in and of itself does not restore function; it must be used in conjunction with therapeutic interventions. The nature of this brain injury interferes with how the brain communicates with the body and requires specific, repetitive rehabilitation to relearn skills and regain strength, balance and coordination. Orthotic care supports this process.
A prescription is required for an orthotic device, whether for a custom design or pre-fabricated option. Typically, the order comes from the treating physiatrist (a physician who specializes in physical and rehabilitative medicine) or neurologist (a physician who specializes in disorders, diseases, and injuries to the brain and spinal cord) who works in collaboration with rehabilitation specialists. With the recommendation for a device, we become part of a patient’s team and are committed to supporting the patient throughout their recovery. Our job is to evaluate and design the most appropriate orthosis, ensure it is both comfortable and functional, and educate the patient on proper wear and care of the device and the role it plays in recovery. As patients progress, their anatomy and functional levels are going to change, which will necessitate adjustments along the way.
In the lower extremities, we often treat patients with “drop foot,” a common post-stroke condition. Referred to as the equinovarus position, the toes of the affected side point downward and the foot is turned inward, impacting gait and balance. A patient with this condition will find it difficult to swing the leg when taking a step. The toes drag with little clearance, making walking and negotiating the environment difficult and putting the patient at great risk for tripping and falling. Many patients benefit from an ankle foot orthosis (AFO) to support and correctly position the ankle and foot.
When a stroke impacts the upper extremities, a wrist hand finger orthosis (WHFO) is typically used to support hand positioning, help prevent contractures (permanent tightening or stiffness of the muscles), and assist with therapeutic rehabilitation and task-specific retraining. Orthotic selection depends on therapy goals and the presentation of the muscles and joints. WHFOs are often used to maintain the stretched position that the therapist helps the patient achieve during a session. Since the therapist can’t be there to continually hold the patient’s hand in the stretched position between sessions, the WHFO helps maintain progress until the next session.
Recovery and Prevention
As orthotists, we strive to help stroke patients regain confidence and achieve their mobility goals. At Prosthetic & Orthotic Solutions, we offer a wide range of devices that provide the appropriate
level of support, designing and customizing braces in-house as well as fitting patients for pre-fabricated devices. As with so many of the conditions we treat, team communication is the foundation for successful outcomes.
Working with stroke patients, we see the impact stroke has on the lives of its victims and their caregivers. While many of the statistics are sobering and not all risk factors are within our control, such as age, heredity and race, the American Stroke Association’s emphasis that 80% of strokes are avoidable is a call to action. Lifestyle changes, along with appropriate medical support, can go a long way toward minimizing the risk factors we can control, such as high blood pressure and cholesterol, smoking, poor diet, lack of exercise, obesity, and diabetes.
Please join Prosthetic & Orthotic Solutions in honoring Stroke Awareness Month by taking a closer look at the risks and lifestyle changes that can make a difference in your lives and the lives of loved ones.
American Stroke Association
Centers for Disease Control and Prevention
National Stroke Association