Cerebrovascular Accident (CVA)

What is a Cerebrovascular Accident (CVA)?

A CVA is a brain attack. It happens when the blood supply to part of your brain is cut off, usually due to a blocked or burst blood vessel. Without a blood supply your brain cells are deprived of oxygen and begin to die. When brain cells die during a CVA, the abilities that are controlled by that area of the brain are lost. The onset of CVA is sudden and the effects on the body are immediate. The effects a person may experience following a CVA will depend on the area of the brain that has been damaged and the extent of that damage. No two people will experience exactly the same problems.

There are different types of CVA

Most CVAs are caused by a blockage cutting off the blood supply to the brain. This is an ischaemic CVA. CVAs can also be caused by a bleeding in or around the brain. This is a haemorrhagic CVA. A transient ischaemic attack or TIA is also known as an mini-CVA. It is the same as a CVA, except that the symptoms last for a short amount of time and no longer than 24 hours. This is because the blockage that stops the blood getting to your brain is temporary. CVA is one of the leading causes of death and significant disability in today’s world.

Common symptoms include:

• Sudden numbness or weakness of the 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
• Sudden severe headache with no known cause slurred speech or difficulty finding some words

What causes CVA?

As we age our arteries become harder and narrower and more likely to become blocked. However, certain medical conditions and lifestyle factors can speed up this process and increase your risk of having a CVA.

These include:

• High blood pressure (hypertension) Heart disease
• Diabetes Alcohol intake
• High cholesterol Smoking
• Circulation problems Poor diet
• Family history of CVA Atrial fibrillation
• Being overweight

The effects of CVA

No two people are affected by CVA in the same way. The effect of a CVA on a person depends on which part of the brain has been affected and how much damage has been caused.

Problems with movement and balance:

• Muscle weakness (hemiparesis/hemiplegia)
• muscle tightness (spasticity)
• loss of co-ordination and balance
• Altered sensation
• Pain and headaches
• Visual problems
• Reduced awareness of affected side of the body (Neglect)
• Swallowing problems (Dysphagia)
• Problems controlling bladder and bowels (Incontinence)
• Excessive tiredness (Fatigue)
• Thought process and understanding might be affected ( cognition, memory, concentration, perception)
• Communication problems (Dysarthria, Dysphasia/ Aphasia)
• Emotional and behavioral changes
• Depression

Can you recover from CVA?

All CVAs are different. For some people the effects may be minor and may not last long. Others may be left with more serious problems that make them dependent on other people. Not everyone survives a CVA. Around one in eight people die within 30 days of having a CVA. That’s why it’s so important to be able to recognize the symptoms and get medical help as quickly as possible. The quicker you receive treatment, the better your chances for a good recovery. Unfortunately, about 3/1 of people who have a CVA will have another CVA within 5 years. Making major lifestyle changes and taking appropriate medications will reduce the risk of this happening again.

Medications after CVA depending on the type of CVA you have had, doctors may prescribe drugs to reduce the risk of a CVA occurring again. If you have had an ischaemic CVA (a ‘blockage’ in a blood vessel in the brain) it is likely the doctors will prescribe blood thinning medicines. These are drugs that help to prevent clots forming in your blood. If you have had a hemorrhagic CVA (a bleed in the brain), blood-thinning medicines should not be prescribed as they can make this type of CVA worse. However, if you’ve had a hemorrhagic CVA, but you also have a very high risk of having an ischaemic CVA, your doctor may recommend that the benefits of taking bloodstaining medication would outweigh the risks.

There are two types of blood-thinning medicines:

antiplatelet medication and anticoagulants. They work in different ways:

Antiplatelet medication

There are small cells in your blood called platelets. When a blood vessel becomes damaged, these platelets stick together to form a blood clot. Antiplatelet drugs stop platelets from sticking together as easily, which reduces the risk of blood clots forming. Some common antiplatelet drugs are aspirin, dipyridamole and clopidogrel.

Anticoagulants

Anticoagulants also stop your blood from being able to clot as easily. They do this by stopping your blood from producing certain proteins, which platelets need to help them form a clot. Anticoagulants also make existing blood clots more stable and less likely to break off and travel to other parts of your body. Some common anticoagulants are warfarin, dabigatran etexilate, rivaroxaban and apixaban.

How do you get on with life after a CVA?

CVA changes lives. It can have a huge effect on you and your family. But there is life after CVA. With the right help and support your CVA doesn’t have to stop you from doing anything that you want to do.

Here in Cambridge Medical and Rehabilitation Center, our team will be your partner for your CVA recovery. We’ll work with you and the people you care about to identify your needs and plan how these will be met, enabling you to make the best possible recovery. The sooner you begin CVA rehabilitation, after your medical condition has stabilize, the more likely you are to regain lost abilities and skills. Rehabilitation will be influenced by the severity of your CVA and the resulting problems. CVA are often preventable. By focusing on controlling your CVA risk factors, you can greatly reduce your risk of having a CVA. Most of these factors can be controlled by living a generally healthy lifestyle. Maintaining a healthy diet and exercise regimen is a great start. This includes eating more vegetables and less red meat and processed foods, as well as consuming a healthy number of calories daily. Additional types of foods to avoid include those high in sodium, sugar, solid fats and refined grain. Since excess weight puts a strain on the circulatory system, it’s important to keep it off. Also, avoid alcohol and tobacco as much as possible, as they can raise your risk of CVA.

Care and Rehabilitation at CMRC CVA rehabilitation requires time, patience and expertise. Here in CMRC, residents are cared for by our multidisciplinary team. Following assessment, the team works out an individual rehabilitation program, aimed at helping people regain as much independence as possible, by relearning skills they have lost, learning new skills and finding ways to manage any permanent disabilities. You are the Patient. Your rehabilitation program is built around your goals. As a team, we are here to support you physically and emotionally in achieving your goals. A Physiatrist a Specialized Physician in Rehabilitation Medicine who assesses and treats patients with functional impairments.

The Physiatrist is responsible for medical evaluation of the patient to determine their ability to undergo therapy programs and to advise appropriate treatment programs like medication interventions, soft tissue infiltrations, nerve blocks. Based on the patients goals and wishes and the physical abilities, the Physiatrist along with a team of Physiotherapists, Occupational therapists and Speech Language therapists,
Rehabilitation Nurses, Dietician and Respiratory therapists, devise a plan of care to achieve those goals.

Rehabilitation also includes managing neurogenic bowel bladder, spasticity and taking care of any other medical conditions you may have such as Diabetes, hypertension or high cholesterol, to ensure you can participate fully in your rehabilitation program. The occupational therapist’s (OT) role focuses on a person’s ability to participate in activities of daily living. These activities vary from person to person according to abilities and age. The OT looks at the person’s cognitive abilities, movement, and the ability to complete functional tasks. Your day to day rehabilitation with your OT may focus on day to day tasks such as washing and dressing, eating and drinking, writing or building the strength in your limbs to be able to complete tasks that are important to you in the future. We may focus on improving concentration, memory or problem solving if these have been affected. An occupational therapist will help you identify roles that you wish to return to participating in.

This may be caring for your children, driving, returning to work or anything that is identified by the patient that is achievable and realistic. The occupational therapist may wish to visit your home or work environment (with your consent) to establish any obstacles or barriers that may make returning there difficult. It is the occupational therapists job to try to find solutions to any issues that may arise. This may be recommending equipment, adaptations and changes to the environment.

The physiotherapist aims to re-educate movement, sensation and balance to enable you to reach your potential for functional mobility. They will complete comprehensive assessments of your physical abilities. Your day to day rehabilitation program with a physiotherapist will focus on:

• relearning how to perform basic movements, such as getting out of bed, standing and walking (gait retraining)
• therapeutic exercises to aid in your recovery by strengthening weak muscles, improving your balance and coordination
• teaching you new ways to complete tasks (task-specific training)
• training on how to use of devices (orthosis, prosthesis, wheelchairs, canes and walkers) to keep you mobile
• fall prevention and falls management

All therapy will focus on the goals established on admission. They may use a variety of techniques such as body weight activities, weights and exercise machines such as a stationary bike or treadmill to promote strength and control. They may provide you with an exercise program to complete independently.

The speech and language therapist can help if you have communication or swallowing problems after a CVA. If problems are identified in these areas, they may establish a treatment plan to work on goals you have identified. Your therapist will work with you, the patient, as well as your family and carers. The aim of therapy is to help you recover as much of your speech and language as possible, they may also aim to find alternative ways of communicating, for example; using technology such as an iPad. The amount of therapy will depend on the extent of your difficulties and how well you are able to concentrate. Swallowing problems can affect your safety when food or drink is going down the wrong way into your lungs instead of your stomach.

This can put you at high risk of chest infections and pneumonia, and in some cases you may not be safe to eat or drink. Difficulties with chewing and swallowing may also affect your enjoyment of food so the speech therapist may recommend an altered diet such as soft or minced food or thickened drinks. Your therapist may develop a treatment program to strengthen your swallow.

Rehabilitation aides assist the occupational therapists, physiotherapists and speech and language therapists. They work hard to help the therapists complete the best treatments possible in a timely and efficient manner. Sometimes 2 pairs of hands are better than one. Our Rehab Aides also help patient practice transfers, walk with aids and attending sessions on time.

Our Dietitians are trained healthcare professionals who assess a patient’s energy and nutrient requirements and develop effective treatment plans for feeding. They calculate and prescribe the appropriate quantities of calories and nutrients in artificial feeding, modified consistency diets/fluids and normal oral diets. Our Dietitian ensures that your nutritional needs are being met and can support you to make positive changes to your diet. The body needs good quality nutrition to repair after injury and it is vital that you understand how to fuel your body to help your performance throughout the day. The dietician’s role is to help you start healthy habits for the future, maintain or achieve a healthy weight and make sure you are receiving a balanced and healthy diet during your stay in CMRC.

Our physician team (GP-doctors) and nurses look after your well-being and progress in day to day care and discuss and help you and your family day and night in medical and non-medical problems and care.

The rehabilitation team are highly skilled and knowledgeable in the assessment and treatment of CVA. The team follows gold standard practice to ensure your rehabilitation is to the highest standard and practicing in accordance to the most up to date research.

On admission to CMRC, you will be assessed by the rehabilitation team as soon as possible.

The therapists will assess:

• If you can swallow safely and arrange feeding according to the assessment
• Safe and effective transfers (for example, from bed to chair)
• communication, including your ability to understand and follow instructions and to convey needs and wishes
• cognition (attention, memory, spatial awareness, apraxia, perception),
• vision and hearing
• Muscle strength, sensation and balance.
• Your previous functional abilities
• Your mood

The team will regularly complete Outcome Measures. These are tools that are used worldwide with people who have had a CVA. These help us to measure how you are progressing.

The Post-Acute Rehabilitation Programme (PAR) depending on the therapists assessments, treatment plans and goals will be set with you.