Moving on from Stroke Day Therapy Unit Outpatient Stroke Service - PowerPoint PPT Presentation

Moving on from Stroke Day Therapy Unit Outpatient Stroke Service

WELCOME BACK! Week 2:  Pharmacy  Physiotherapy  Speech Pathology  Neurological Council of WA

MEDICATION AND STROKE MANAGEMENT

OBJECTIVES  Goals of medication management  Medications involved in the treatment of stroke  Lifestyle advice

WHAT IS A STROKE?  Lack of blood flow (oxygen) to the brain caused by a clot or rupture of a blood vessel  Sudden brain damage Ischaemic = clot are the most common, accounts for 87% of strokes, embolic vs thrombotic Haemorrhagic = bleed, bleeding around the brain or into the brain

RISK FACTORS  TIA, age, gender, family history  Irregular pulse – atrial fibrillation  High blood pressure  Smoking  Diabetes  High total cholesterol  Low levels high density lipoprotein (HDL)  Physical inactivity, obesity  Alcohol overuse

STROKE PREVENTION  Medication adherence and healthy lifestyle changes are key to preventing stroke  >50% of older patients sometimes forget to take their medications  Taking medications as prescribed is central to recovery after stroke and preventing further strokes

GOALS OF MEDICATION  To reduce ongoing brain injury  To decrease long-term disability  Prevent further complications  Prevent stroke recurrence

TREATMENT  Acute treatment of an event ideally managed in hospital  Secondary prevention includes:  Blood pressure lowering medications  Cholesterol lowering medications (with statins)  Antiplatelet therapy (except in patients in whom anticoagulant therapy is needed)

HIGH BLOOD PRESSURE  If you have a clinic blood pressure of 140/90 or more and a TIA or stroke - blood pressure medication should be started or increased (Clinical guidelines for stroke management 2017)  High blood pressure may have no symptoms  Reduction in blood pressure results in 25-30% less strokes (Benavente, Coffet et al 2014)  Target blood pressure individualised: 130/80- 140/9

CHOLESTEROL Two different types of cholesterol:  LDL (low-density lipoprotein)  Increases risk of heart attack and stroke  Takes cholesterol into the arteries  HDL (high-density lipoprotein)  Acts as a scavenger to promote reverse cholesterol transport  Takes cholesterol out of the artery and back to the liver so the body can dispose of it

CHOLESTEROL - STATINS  All patients with stroke or TIA are prescribed a statin regardless of baseline lipids if there is reasonable life expectancy and possible atherosclerosis (Clinical guidelines for stroke management 2017)  Medications lower LDL and slightly increase HDL to ↓ risk of stroke by 12% and all vascular events by 25%  Examples: Atorvastatin, rosuvastatin, pravastatin  Seek medical attention if you develop dark urine or have any unusual muscle pain, weakness or tenderness

CHOLESTEROL - OTHERS  Fibrates  Fenofibrate (lipidil)  Seek medical attention if you develop dark urine or have any muscle pain, weakness or tenderness  More common adverse effects are abdominal pain and dyspepsia  Ezetimibe (Ezetrol)  Decreases absorption of cholesterol from the diet  Tell your doctor if you are experiencing any muscle pain, tenderness or weakness. Most common side effect is headache and diarrhoea

ANTIPLATELETS & ANTICOAGULANTS  No previous AF  Stroke and AF  Long term antiplatelets  DOAC preferred if good generally used if not kidney function and non already on anticoagulants valvular atrial fibrillation (Clinical guidelines for stroke management 2017)  Other patients use warfarin

ANTIPLATELET VS. ANTICOAGULANT Antiplatelet Anticoagulant Prevents platelets from sticking together Stops blood from clotting as easily as easily ‘thinning the blood’ Aspirin 100mg daily OR Other conditions determine choice Aspirin + dipyridamole (Asasantin) Warfarin  Coumadin or Marevan- do not change - Should be taken with food - Can cause headaches brands  Regularly monitor INR: between 2 -3  Watch for bleeding, keep food choices similar, food and drug interactions  No more than 2 standard drinks of alcohol OR OR Direct Anticoagulants (DOAC) Clopidogrel (Plavix) Pradaxa, Xarelto, Eliquis. No more than 2 standard alcoholic drinks daily

STROKE PREVENTION GUIDELINES 1. Know your blood pressure. Have it checked at least annually. If it is high, work with your doctor to control it. 2. Find out if you have atrial fibrillation (AF); a type of irregular heartbeat. If you have it, work with your doctor to manage it. 3. If you smoke, stop. See your pharmacist for help – nicotine replacement and support services.

STROKE PREVENTION GUIDELINES 4. If you drink alcohol, do so in moderation. 5. Know your cholesterol number. If it is high, work with your doctor to control it. If you are diabetic, follow your doctor’s 6. recommendations carefully to control your diabetes.

STROKE PREVENTION GUIDELINES 7. Include exercise in your daily routine. 8. Enjoy a lower sodium (salt) diet (to help control blood pressure) and lower fat diet (to help control cholesterol). 9. If you experience any stroke symptoms, call 000 immediately. Every minute matters!

QUESTIONS?

PHYSIOTHERAPY

Which risk factors for stroke can be influenced by exercise?

BENEFITS OF EXERCISE  Diabetes – management of raised blood sugar levels  Reduces blood pressure  Reduces stress  Reduces cholesterol  Prevents/ improves obesity  Improves Depression

EXERCISE TIPS  Find something you enjoy: swimming, walking, cycling, exercise groups…  Make exercise part of your daily routine  Exercise with a friend, meet at set times  Don’t overdo it / Pacing  Ask for assistance HAVE FUN!

EXERCISE RECOMMENDATIONS- AEROBIC EXERCISE  E.g. walking, swimming, cycling  IMPROVE : general fitness, heart and lung function, circulation  30-60 minutes of physical activity on >5 days per week

EXERCISE RECOMMENDATIONS- STRENGTHENING  E.g. resistance exercise, gentle weight training  IMPROVE: bone health, ability to complete day-to-day tasks  2x/week 8-10 exercises of low load (less than 2kg) and high reps (10-15 reps)

EXERCISE RECOMMENDATIONS- BALANCE  E.g. Tai Chi, Balance classes  IMPROVE: balance, reduce risk of falls  2-3x/week (total of 2 hours), gradually increasing difficulty

FALLS RISK IDENTIFICATION AND MANAGEMENT 1. Move Your Body • Build your balance 3. Remove Hazards • Strengthen your body • Make your home safer • Check your eyesight 2. Improve Your Health • Wear safe footwear • Check your medications • Keep a healthy mind • Fuel your body Stay On Your Feet

FALLS RISK IDENTIFICATION AND MANAGEMENT Case Study: 50yr old Sally suffered a stroke 2 years ago. She has reduced strength on her left side and poor sensation in her left foot and ankle. She is able to walk with the assistance of a walking stick. Sally also suffers from type two diabetes and is on regular medication to try to stabilise her blood sugar levels. Sally lives in her own home with her small Jack Russel dog. Sally has two steps to get inside the front door but once in her home is level. What risk factors does Sally have for falling? Stay On Your Feet

MYCLE BRANDY - A 4X STROKE SURVIVOR’S CAMPAIGN  Walked over 10 000km across America  Completed 9 full marathons  All on a walking stick!

QUESTIONS?

SPEECH PATHOLOGY

SWALLOWING AND COMMUNICATING  After a stroke or TIA you may experience:  Difficulty talking  Difficulty understanding others  Difficulty concentrating, especially in noisy and busy places  Difficulty eating and drinking

QUALITY OF LIFE- COMMUNICATION For people with aphasia, these factors can affect their quality of life.

COMMUNICATION - SPEECH  Can be slurred or unclear, mumbly OR sounds can get jumbled up  A speech pathologist can give you exercises to help recovery or give you strategies to make you clearer Talking to others is the best way to improve

SUPPORTING YOUR SPEECH & VOICE Abdominal breathing  Also known as deep breathing  Uses your abdominal muscles to increase the amount of air inhaled and exhaled  Helps to power your voice and make speech clear

COMMUNICATING Some ways we can practice speaking:  Find activities that you enjoy doing!  Ask a friend or family member over for a chat.  Join community or social groups.  Being involved in a communication group 1x a week increases satisfaction and reduces anxiety.

COMMUNICATION - LANGUAGE  It can be difficult to find the right word, make a sentence or understand what others are saying  A speech pathologist can help you recover your language or find other ways to help you communicate

COMMUNICATION  There are many ways to communicate including using gesture , body language , facial expressions and using props .  Pictures and objects can help others understand what you want to say and can help you understand too.