Author: Dr Hassan Kabiito

After a stroke, life changes completely both for the patients and their families. 

This section is dedicated to stroke survivors , their families and humanity at large .

A stroke can happen to anyone at any time .

Imagine suddenly being unable to move half of your body , you just can’t walk , talk , work , see ,  take yourself to the bathroom etc.

Stroke survivors therefore need  physical , psychological , emotional , spiritual, financial and social support to optimally live.

This is what rehabilitation is all about !

Communication Challenges After Stroke

Talking ( speech production) is done by the brain , there is a dedicated brain part for this , it’s called Broca’s area , it is named after French physician Pierre Paul Broca.

Stroke can damage the speech production part of the brain (Broca’s area) causing difficulty in talking , stammering or complete inability to talk depending on severity of damage.

In meaningful communication talking is not enough , you must understand what your saying , and also understand what your told ( comprehension) , a special brain part for this is called Wernicke’s area , named after German physician Carl Wernicke.

Stroke can damage the comprehension part of the brain (Wernicke’s area) causing difficulty in understanding what one is being told or what they are saying.

Stroke patients have communication issues ( talking and understanding) , reading and writing can be affected too , we must understand that this is due to brain damage , until we understand this , we shall ignorantly abandon many stroke victims thinking they are silly and ungrateful.

Carl Wernicke and Pierre Paul Broca had their share , I need to find the brain part that makes people feel so entitled and ungrateful, will actually name it Kabiito’s area 😅 .

Physical Effects Of  Of Stroke

1. One sided body paralysis
2. Inability to move
3. Blindness
4. Hearing difficulties ; this is so rare , and mostly seen in stroke patients of advanced age. The hearing difficulties are rather age related.
5. Loss of sensation on side on the body 
6. Prolonged unconsciousness ( coma)
7. Inability to perform activities of daily living like working , going to the bathroom , bathing , dressing up etc.
8. Swallowing difficulties
9. Loss of ability to control bowel and bladder ( incontinence)

Emotional Effects Of Stroke

1. Anger
2. Depression
3.  Feelings of irritability
4. Forgetfulness.
5. Confusion.
6. Low self esteem , imagine an adult having to use diapers

Medical Issues  After Stroke

1. Blood Clots ; Most stroke patients  can not move and may be bedridden , this increases the risk of getting blood clots.

2. Frequent Infections.

3. Bed sores.

4. Challenges with eating or swallowing .

      6. Breathing difficulties.

Sex After Stroke

Sexual pleasure is an indiscribable  source of happiness in life  , but it is sadly ignored in almost all post stroke rehabilitation plans.

Stroke Patients may experience low libido due to stress , depression , anxiety or distorted self image.

Sexual neglect after stroke is a silent cause of emotional conflict , so the medical teams , patient and spouse should have a sincere discussion about the subject.

Stroke patients of child bearing age need family planning packages , for reasons that should be obvious – pregnancy and paralysis (stroke) are a tough call.

Unless a stroke patient takes celibacy vows , descent sex should be part of any sound rehabilitation package.

Financial Effects Of Stroke

Unfortunately most severe stroke patients may never resume work.

Stroke is financially draining ,  and nearly all families of stroke patients have financial distress.

We all need good social support systems and passive income , actually let me leave financial issues alone.

When should stroke rehabilitation begin?

The sooner you begin stroke rehabilitation , the more likely you are to regain lost abilities and skills , stroke is a race against time

It’s common for stroke rehabilitation to start as soon as 24 to 48 hours after stroke, while patient is still hospitalised , and continues for months / years after discharge.

Stroke rehabilitation is a program of different therapies designed to help you re-learn skills lost after a stroke. 

Stroke rehabilitation can help you regain independence and improve your quality of life.

Stroke Rehabilitation Strategies

Depending on the parts of your brain affected by the stroke, rehabilitation can help with ; 

1. Regaining body  movement  ; Called Physiotherapy , done by an expert called physiotherapist.

2. Improving communication ( Speech And Understanding What One Is Being Told ) ; this is called Speech therapy , experts here are called speech therapist.

3. Regaining activities of daily living ; Called occupational therapy , you guessed right to call these guys occupational therapist.

4. Emotional needs ; Family comes handy , counseling and psychological support is a must.

5. Medical strategies to avoid / minimise blood clots , infections , bed sores , mantain good nutrition and hydration etc

Technological Advancements In Stroke Rehabilitation

Rehabilitation is extremely crucial for optimal stroke recovery.

Yes , robots are now used to help stroke patients relearn moving  , as seen in the video below.

The mighty rehabilitation headquarters is home to multiple youtube videos relevant to stroke rehabilitation , renown Dr.Tara Tobias is doing a lot on the subject.

https://www.youtube.com/@rehabhqofficial/search

Now that your finally at the stroke rehabilitation headquarters , a super market of post stroke self help videos , you can do well just watching what is relevant for you or your patient , https://www.youtube.com/watch?v=A1dnz7nRIAc is a must watch  , it provides the much needed complementary insight into the ability of the brain to re-organise after any attack , i don’t want to use the term neuroplasticity.

Expectation From Family And Friends

Effortlessly offer FINANCIAL , EMOTIONAL , SPIRITUAL and PHYSICAL SUPPORT , as much as your faithfully can , tirelessly – I painfuly must add.

I would repeat this humble appeal countless times if I had too .

Am not a rehabilitation expert , so this section nearly drained the stroke vote, this much needed post stroke service is sadly all that is available to 80% of the stroke victims around the world , even those that have their clots removed ( stroke thrombectomy ) will need aggressive rehabilitation.

For sure rehabilitation is not just a few exercises or massage , i believe any team seriously interested in providing gainful stroke rehabilitation should consider a multi-disciplinary approach , anyway to each their own , as longer as you always remember that understanding a stroke patient’s needs is the only way to perform rehabilitation tasks with great aplomb.

Stroke is a brain attack , children too have a brain , so they can unfortunately get a stroke. Stroke signs are often missed in children , largely due to limited awareness .

We all agree that stroke is a brain issue , but majority believe that stroke only targets the elderly !

Is it only the elderly with a brain ? 

Symptoms Of Stroke In Children

1. Extreme Sleepiness 
2. Tendency to use only one side of the body
3. Trouble talking 
4. Difficult in understanding what child is being told
5. Trouble Seeing
6. Sudden confusion 
7. Sudden  difficult in walking 
8. Convulsions, usually on one side of the body
9. Sudden loss of consciousness ( come )

Approach To Stroke

Addressing the underlying cause is the way to go. No two strokes are the same , but common things occur commonly.

Stroke Due To Blood Clots

Some times , a blood clot blocks the blood vessels supplying the brain. This disruption in blood flow to the brain leads to stroke.

Technology now allow us to track devices into the brain without opening the skull , we remove the offending blood clots restoring blood flow to the brain. This is called stroke thrombectomy , and i offer it.

A 3 years old child , parents noted that she suddenly could not climb her bed , had trouble talking , actually could not move the entire half of the body ( left side). Everything here feels like stroke , head scan next , and surely the entire white area ( blue circle ) is brain damage ( stroke).

Fortunately , the parents consented to stroke thrombectomy , i do not know weither  the innocent 3 year old counter consented , anyway they will sort that issue at family level.

Stroke thrombectomy , through a tiny hole in a groin blood vessel , devices were taken into the brain to remove the clot.

After a minute or so , the clot retrieving device was taken out of the brain , thankfully with the entire clot capture.

For those struggling to appreciate the clot ,  it is the orange arrow on the photo below.

A look at blood vessels inside the brain , the skull , hair and eyes and  brain itself are digitally subtracted so that we see the tiny brain vessels without anything obscuring , brain blood vessels appear blood.

Before treatment , a vessel inside the brain is blocked ( orange arrow) , after removing the clot ,we now see open blood vessels 

Stroke Due To Brain Bleeding

The blood vessels in the brain can leak or rapture causing bleeding into the brain. This type of stroke is called hemorrhagic stroke 

Hemorrhagic , because there is hemorrhage, hemorrhage and bleeding are synonymous.

Same rule , find bleeding vessel and repair it , as usual, we do it without opening the skull.

A 6 year old girl with sudden  headache , vomiting and blurring of vision , a typical stroke picture.

Stroke is a brain issue , so a  brain scan was done , a brain bleed (white area inside blue circle ) was evident.

So we had to take her up for detailed brain blood vessel imaging , the best in the world being digital subtraction angiography (one where the skull , hair and eyes and  brain itself are digitally subtracted so that we see the tiny brain vessels without anything obscuring)

A tiny swelling ( aneurysm) on brain vessel had ruptured causing bleeding into the brain. Source of the bleed ( blue arrow)

The head scan below shows a glue cast inside the brain. 

Bleeding vessel sealed , stroke treated , child cured.

Stroke Due To Sickle Cell Disease

We all have blood , and blood has different cells , each with a role to play.

Red blood cells , actually give human blood its red appearance, I think if they were  called “Blue Blood Cells “ , our blood would appear blue !

The normal red blood cells are round or spherical or whatever your shapes teacher says

Sickle cell disease is a hereditary condition that alters the shape of red blood cells , making them moon or sickle shaped. Actually , a sickle is a garden tool.

So sickle cell disease patients have  normal round red blood cells , mixed with abnormally shaped sickle red blood cells.

If you conceptualize blood vessels as pipes  , for they are , everything begins to make perfect sense.

One just has to remember that the size of the blood vessel keeps changing along its course , some segments big , others small.

The normal round red blood cells flow through the pipe well , while the abnormal sickle shaped ones block or clog the body pipes (blood vessels). This perfectly explains most sickle cell disease symptoms 

When the moon (sickle ) shaped cells block tiny  brain blood  vessels , blood flow to the brain reduces or stops ( depending on the degree of blockage )  , resulting into the much dreaded stroke !

Strategies To  Prevent Sickle Cell Disease Related Stroke

With optimal management, stroke in sicklers can be avoided.

Now , there is technology to remove the moon (sickle) cells from the body, and replace them with normal shaped ones.

The joint research center in Uganda has this service, and  all hands are on deck to start a world class bone marrow transplant service , certainly they still stand tall in HIV care and research , for more visit https://jcrc.org.ug/

Sickle cell disease has no cure , THAT IS WHY TESTING YOUR PARTNER’S SICKLE CELL STATUS IS  IMPORTANT , bold and underlined , the choice is yours.

Child Rehabilitation After Stroke

Children usually have a long life ahead of them , so the life long burden of stroke is greater for children than adults.

If the life expectancy is say 120 years , getting a stroke at 10 years means you will have to live with the effects of stroke for the next 110 years.

Therefore all child stroke survivors ought to be provided with fine rehabilitation , so that they optimally live. 

At www.drhassankabiito.com , rehabilitation after stroke is something we are seriously interested in , visit our stroke rehabilitation blog any day , any time.

In essence , children and indeed all human beings have a brain , and can get stroke , timely identifying and treating stroke is all we can offer stroke victims , survivors are or at least should be eternally grateful , anyway it is worth it.

Children too can get stroke , by the way every adult or elderly person is still someone’s child!

I have and will always hail the amazing brain , everything in this world is to do with the brain. The human brain is very soft , its not as hard as ghee , but should be near vaseline in consistency.

Owing to its importance ,and very fragile nature , the brain is kept in a very hard and rigid container of bones called the skull , making it the most protected body organ in the universe 

How Does The Body Respond To Injury ?

It really hurts to be insulted , even verbally , mood changes , we get annoyed , heart races faster , we yell , insult or fight back!

Have you noticed that any body part swells whenever there is injury ? , the magnitude of injury determines how bad the swelling gets.

Simply put , whatever is injured swells !

Brain Response To  Injury (Stroke )

Stroke occurs when a blood vessel in the brain is occluded or narrowed  interfering with blood flow to the brain, thus brain injury.

Stroke may also be due to a ruptured blood vessel in the brain, causing bleeding into the brain.

Stroke patients  have brain damage / injury / insult , we have already agreed that whatever is injured swells , the brain is not an exception.

One must and should  understand that this very fragile brain is stored in hard rigid container ( skull bones ) , so if it must swell after a bad stroke , it needs space !

That is why it is important to understand that some ( definitely not all) stroke patients need emergency removal of part of the very rigid skull bones to give space for the brain to peacefully swell.  

Having the skull of a loved one opened is not a casual matter , but  allowing a very soft brain to swell in a non-open rigid skull  only adds insult to injury.

Real Life Scenario

Apologies in advance , let us look at the brain CT scans of this quadragenarian , story was “ found unconscious in the bathroom ”  , if you are curious why always the bathroom , so am i.

Big insult , Big stroke , we certainly need (not want)  space for the brain to safely swell.

The damage here was extensive , patient did not make it , but is atleast raising awareness on the  role of emergency skull opening in stroke , this much urgently needed surgery is what experts call “ decompressive craniectomy for stroke “.

At times , emergency skull opening tops a stroke patient’s needs , delaying or denying them one only fans the flames.

Some patients actually do well after emergency skull opening , the removed skull bone is safely stored in the abdomen (tummy) in most cases , that way  we won’t lose this much later needed spare part ( removed skull bone). When the dust settles , the removed skull bone is placed back , something called cranioplasty.

The term cranioplasty actually should not cause any un-neccesary confusion  , as cranioplasty = cranio + plasty ;

Cranio = Short form of cranium , with means skull.

Plasty = Repairing

So simply put  cranioplasty is skull defect repairing , show-cased in the  3D picture of the skull below.

For those having trouble , yellow shows you the margins of the replaced skull bone.

Should you or the loved one ever be advised to under go emergency skull opening , do not delay to consent to one , stroke is a race against time.

Just like life , for stroke , we can only do what we have to do , timely – i must add.