Cerebrovascular disease, or what we know by the name "Stroke", is one of the leading causes of death among Thai people, and is also a disease that can make the patient lose the ability to live daily life normally. Treating a stroke correctly and in good time is therefore the most important thing in saving life and reducing the disability that may arise. This article will take you to understand the process of stroke treatment, from knowing the warning signals in time through to long-term rehabilitation, so that you and your family are able to prepare and care for one another suitably.
Know the signals of a stroke in time, before it is too late
Knowing the warning signals of a stroke is the first and most important step in treatment, because the sooner treatment is received, the higher the chance of surviving and of reducing disability will be. Doctors therefore often use the phrase "Time is Brain" in order to emphasise the importance of time in treating this disease.
The main warning signals of a stroke that should be remembered are a crooked face, weakness of the arm and leg on one side or the other, and unclear speech or being unable to speak. Besides this there may also be symptoms of sudden severe headache, dizziness, unclear vision, or loss of balance. If these symptoms are met, the patient should be taken to hospital at once without delay.
The process of diagnosing a stroke precisely and quickly
When the patient arrives at the hospital, the medical team will carry out the diagnosis quickly in order to identify the type of stroke and plan the suitable stroke treatment. This process will begin with taking the history quickly, examining the body preliminarily, and carrying out the further examinations that are necessary.
Radiological examination is important in diagnosing a stroke, particularly taking a CT scan of the brain, which can distinguish whether it is a stroke from a narrowed blood vessel or from a ruptured blood vessel. Blood tests to look at the level of sugar, the ability of the blood to clot, and the working of the kidneys are no less important. Besides this, an electrocardiogram and examination of the blood vessels of the neck with ultrasound may be necessary in some cases.
The approach to stroke treatment in the acute phase
Stroke treatment in the acute phase differs according to the type of the disease, which is divided into two main types, namely a narrowed cerebral blood vessel and a ruptured cerebral blood vessel. Each type requires treatment that is entirely different, and the speed of treatment will have a direct effect on the outcome for the patient.
Treating a narrowed cerebral blood vessel (Ischemic Stroke)
For stroke patients from a narrowed blood vessel, who account for about 80% of all stroke patients, the main goal of the treatment is to open the blocked blood vessel so that blood can flow through to nourish the brain once again. There are two main methods of treatment, which the doctor will consider choosing according to what is suitable for each individual.
Giving the clot-dissolving medicine (rt-PA) within 4.5 hours
Giving rt-PA is the standard method of treatment for stroke patients from a narrowed blood vessel, if the patient arrives at the hospital within 4.5 hours counting from the start of the symptoms. This kind of medicine works by dissolving the clot blocking the cerebral blood vessel, helping the circulation of blood return to normal. However, before giving this medicine, the doctor must assess the risk carefully, since there may be a side effect of bleeding arising in the brain.
Treatment through a catheter (Mechanical Thrombectomy)
For patients who have a large clot blocking a large blood vessel of the brain, the doctor may consider using the method through a catheter in order to draw the clot out directly. This kind of treatment can be carried out within 6-24 hours after the start of the symptoms, depending on the condition of each individual. This method is highly effective in opening the blood vessel and usually gives a better outcome than giving medicine alone.
Treating a ruptured cerebral blood vessel (Hemorrhagic Stroke)
Stroke patients from a ruptured blood vessel require treatment that is entirely different from a narrowed blood vessel, since the problem does not lie in the lack of blood to nourish, but in blood flowing out into the brain, causing the pressure inside the skull to increase. The treatment therefore emphasises controlling the bleeding and reducing the pressure in the brain.
Controlling the blood pressure and the state of bleeding
Controlling the blood pressure so that it is at a suitable level is a very important thing in treating patients with a ruptured cerebral blood vessel. Blood pressure that is too high will cause more bleeding, but if it is controlled so that it is too low, it may mean that the blood nourishing the brain is not enough. Besides this, stopping the anticoagulant medicine that the patient may be taking, and considering giving medicine that helps the blood clot more quickly, may also be necessary in some cases.
Considering brain surgery
In a case where the quantity of blood that has come out in the brain is great, or where the pressure inside the skull has become high, the doctor may consider surgery in order to draw the blood out or reduce the pressure in the brain. This surgery carries a high risk, but in some cases it may be the only choice that will save the patient's life. The decision will depend on many factors, such as the position of the bleeding, the quantity of blood, the age, and the overall bodily condition of the patient.
The heart of rehabilitation, after the point of danger has passed
When the stroke patient has passed through the critical phase, rehabilitation then becomes the important part that will determine the quality of life in the future. Good rehabilitation will help the patient return to living life with quality, reduce dependence on others, and prevent the various complications that may follow.
"Physiotherapy" to restore movement
Physiotherapy is an important foundation in rehabilitating stroke patients, being directed at restoring the working of the muscles and the movement of the joints. The physiotherapist will design a programme of exercise suited to the condition of each patient, beginning with training balance, changing position, and sitting up, through to walking. Training regularly will help the part of the brain that still works normally learn to take on the duty of the damaged part in some measure.
"Occupational therapy" to train the living of daily life
The occupational therapist will help train the patient to be able to carry out the activities of daily life by themselves, such as dressing, eating, bathing, and using the bathroom, as well as using the various assistive devices that will make life easier. This training will help increase the confidence and the independence of the patient, reduce the burden on the carer, and improve the quality of life overall.
"Speech therapy" to restore speech and swallowing
For patients who have a problem in the area of speech, of understanding language, or of swallowing, the speech therapist will come in to help restore these skills. The therapy may include training in making sounds, training in understanding speech, using the language of gesture, or using devices to help in communication. Besides this, training in swallowing safely in order to prevent choking is also an important part of the rehabilitation.
New innovations and technologies in treating and rehabilitating stroke patients
At present, medical technology has developed by leaps and bounds, making the treatment and the rehabilitation of stroke patients more effective. These new innovations not only help increase the chance of recovery, but also help make the process of rehabilitation effective and more interesting.
The walking-training robot
The walking-training robot (Overground Wearable Exoskeleton) is a technology that helps patients with an impairment in walking to train safely and effectively. This instrument will help support the body weight of the patient, control the speed of walking, and adjust the pattern of walking so that it suits the ability of each individual. Using the walking-training robot lets the patient train for longer, be less tired, and be safer than with traditional training.
Stimulating the brain with electromagnetic waves
The device that stimulates the brain with electromagnetism (Transcranial Magnetic Stimulation) is a technique of stimulating the brain by using electromagnetic waves from outside, in order to stimulate the working of the nerve cells in the part that is wanted. This method requires no surgery and is safe, and can help increase the effectiveness of the rehabilitation, particularly in patients who have a problem in the area of movement, of speech, or of memory.
Frequently asked questions (FAQ) about stroke treatment
When stroke treatment is spoken of, many people usually have similar questions, whether about the place of treatment, the cost, or the chance of recovery. Receiving correct information will help the family be able to prepare and plan the care suitably.
Where is a good place for stroke rehabilitation?
Choosing the place for rehabilitation after a stroke is an important thing that will determine the quality of life of the patient in the long term. A good clinic for stroke rehabilitation should have a complete multidisciplinary team, consisting of a rehabilitation physician, a physiotherapist, an occupational therapist, and a speech therapist.
PYONG Rehabilitation Clinic is a clinic specialising in rehabilitation medicine with experience in caring for patients after a stroke, with modern technology. The team of specialist physicians will design a plan of rehabilitation specific to the individual, according to the condition and the needs of each patient.
About how much is the cost of stroke treatment?
The cost of stroke treatment differs according to the severity. Emergency treatment, such as giving medicine or surgery, costs a great deal, but health insurance entitlements will cover most of it. As for long-term rehabilitation, the cost depends on the frequency, so entitlements should be checked and finances planned in advance.
How great or small is the chance of returning to normal after stroke treatment?
The chance of recovery after a stroke depends on the severity and on the period of time in which treatment is given. Patients who receive treatment and rehabilitation quickly tend to recover better, with the first 3-6 months showing the clearest result, and there may be continued improvement for several more years.
In summary
Treating a stroke is a race against time: the sooner treatment is received, the higher the chance of surviving and of reducing disability. Knowing the warning signals, choosing a suitable medical establishment, and rehabilitating continuously are the important keys.
Rehabilitation with modern techniques has an important role in giving back the quality of life. PYONG Rehabilitation Clinic is ready to serve in rehabilitating stroke patients, with a team of specialist physicians and modern technology.
If you want further information about rehabilitation after a stroke, you may contact us