LIMITING THE HARM IN STROKE PATIENTS

Stroke is among the primary causes of severe disability and is among the leading causes of death in the world. There are two main types of strokes: hemorrhagic, where a blood vessel in the brain bursts, and ischemic, where a clot obstructs blood flow to the brain. The most crucial aspect of any stroke is ensuring that the patient receives prompt treatment. In cases where a major artery is blocked, over two million neurons die every minute, and once the tissue is damaged, it is irreversible. Individuals who could typically walk, dress themselves, and feed themselves may suddenly find themselves incapacitated by a stroke. Dr. Menor is the director of UCLA's innovative mobile stroke unit, which shaves off valuable minutes in providing assistance to patients. The unit is equipped with a doctor, paramedics, clinical nurse, telecommunication to stroke specialists at the hospital, a mobile lab, and a CT scan for accurate diagnosis. The goal is to transform stroke care systems by bringing the hospital to the patient instead of waiting for the patient to arrive at the hospital. On-site doctors can administer medication promptly to halt bleeding or dissolve a clot, while larger clots can be removed at the hospital using a minimally invasive catheter guided through an artery into the brain to extract the blockage. This can make a significant difference in a patient's quality of life, potentially allowing them to continue enjoying time with their family rather than being confined to a nursing home. It is crucial to recognize the symptoms of a stroke, with experts using the FAST method: looking for face drooping, arm weakness, and speech difficulties.

HOW TO POSITION A STROKE PATIENT

Positioning a stroke patient is crucial due to the potential paralysis in one part of the body, which can make movement in bed challenging. It is essential to ensure that patients are positioned comfortably and correctly, while also changing their positions regularly to reduce the risk of skin breakdown, contractures, chest complications, and to perform range of motion exercises for the lower limb.

To provide hip joint support, hold the thigh with one hand and the leg with the other. Bend the hip by bringing the knee towards the patient's head as far as possible. Next, with the same hand, bring the leg away from the other leg and hold for 20 seconds. Bend the knee and hip to 90 degrees, fix the knee, and rotate the leg in and out, holding for 20 seconds each.

Support the knee straight with one hand and the leg near the ankle with the other hand. Gradually lift the straightened leg up away from the bed until you feel resistance, holding the stretch for 20 seconds. For ankle support, place the hand under the heel in the shown position. Keep the knee straight using body weight, stretch the ankle by bringing the foot upwards towards the head, and hold for 20 seconds.

Stabilize the foot and move the toes by bending them forwards and backwards, repeating 10 times for each movement before moving on to the next. For patients with stiffness, the set of exercises can be repeated more than once a day. Remember to support the joints well during movement and avoid forcing any joint. Monitor for pain or discomfort during each movement, performing them slowly without bouncing.

During these exercises it is imperative to ensure the maintenance of proper airway and oxygenation, as well as provide support to prevent hypoxia. It is crucial to guarantee sufficient oxygen supply, considering the fact that hypoxia and elevated CO2 levels act as vasodilators. Additionally, it is essential to avoid causing cerebral edema in the patient.

If unsure about the exercises, consult a physiotherapist for guidance. Additionally, ask the doctor for a referral to a neurological physiotherapist, as this service is available in all hospitals in Singapore, as well as in rehabilitation centers.