Transcription:
Stroke Awareness, Prevention and Rehabilitation

Melanie Cole (Host):  In the United States, more than 795,000 strokes occur each year. Stroke can happen to anyone at any age. In fact, research shows strokes are on the rise among younger people. It’s important to know these risk factors and work to prevent those that can be managed, such as high blood pressure and high cholesterol. If you or a loved one experiences a stroke, early and intensive rehabilitation is key to achieving the best outcomes. My guest today is Dr. Ford Vox. He’s a staff physiatrist with a subspecialty board certification in brain injury medicine at Shepherd Center. Welcome to the show, Dr. Vox. Tell us a little bit about stroke. Give us the symptoms of stroke and what risk factors should we be on the lookout for? 

Dr. Ford Vox (Guest):  Well, stroke can present in many different ways. In many ways, that’s one of the most difficult things that people recognize about the condition and the reason why some people don’t present as early as they should directly after symptoms began. Any new neurological symptom should potentially be concerning for stroke. This includes any type of sensory loss, any vision loss, any weakness. In particular, some types of strokes may affect the speech. For example, the speech may become slurred. A person may be having trouble speaking. You could see weakness in the face, may have trouble walking and so forth, any new symptom in terms of a person’s primary functions, the sensation, motor function, thinking or speech. That could be a stroke. 

Melanie:  Are there certain risk factors that predisposes, as genetic? Are there risk factors we can change or control?

Dr. Vox:  Yes. Fortunately, there are many risk factors that we can control and significantly lower our risk of stroke. Top among those is hypertension. That’s really the leading risk factor. Just bringing your blood pressure down about 10 points will reduce your individual risk on average about 33 percent, which is really impressive, but far and away, hypertension is the leading cause for both the two major types of stroke, whether ischemic, those strokes caused by a blockage; or bleeding types of strokes. Beyond that, controlling one’s dietary intake in terms of the amount of cholesterol and fat, having a good lipid level; certainly, if you have a chronic condition such as diabetes, keeping your blood sugar under control is key and avoiding things like smoking and excessive alcohol intake. And, of course, exercise is key. 

Melanie:  As soon as a stroke starts to occur and if you notice those symptoms that you discussed, time is brain with stroke. Correct, Dr. Vox? How fast can you get treatment? What happens? 

Dr. Vox:  That’s right. Well, now for the first four-and-a-half hours after a stroke has presented, we do have the option in certain patients, if you meet some of the qualification criteria that lower the risk of adverse event, of using one of these clot-busting drugs. Chief among them is tissue plasminogen activator. If you get to a stroke center quick enough, the amount of time is certainly within that four-and-a-hour window, that’s a possibility if you have one of those blockage types of strokes, one of the ischemic strokes. Beyond that, some more subspecialized stroke centers are able to offer interventional treatments that are increasingly becoming the standard in order to actually retrieve clots and perform stent and we have a great institution here in Atlanta that saves many patients who are then able to come to a center like Shepherd for rehabilitation, patients who may not have even survived before, because of the advanced treatments they are able to get in a city like Atlanta.

Melanie:  Based on the treatments, how fast they got in, what is after-stroke life like? What kind of rehab is available at Shepherd Center? What can people expect? 

Dr. Vox:  Well, Shepherd Center is known for taking a range of stroke cases, among some of the toughest out there. We will treat patients who have been so severely affected by their stroke that maybe they’re on a ventilator or maybe their consciousness is not even fully restored. We’re treating patients who may have language difficulty in addition to paralysis on entire side of their body, for example, sensory and vision loss or some variation or bits of those things. We treat patients who may just have a bit of weakness on an arm or a leg, all the way up to people who have profound disabilities. The important thing to recognize about stroke and stroke recovery is that the first few months after the stroke is critical. Certainly, the entire first year is a time of rebuilding new connections, but we think about the first three months as really the most ideal period where we’re seeing really dramatic changes when we intervene in each of the deficit areas that the patient has. We work here with large multidisciplinary teams. It’s not something I or any other physician here can do ourselves. We’re tackling each of the problems that may be related to a particular person’s stroke, and sometimes the list can be quite large.

Melanie:  There are different types of stroke centers, Dr. Vox, primary versus a comprehensive stroke center. What’s the difference? 

Dr. Vox:  That’s right. Well, there’s the acute care and then the post-acute care. In terms of the acute care, not everyone is able to provide some of the more interventional treatments that are available in certain dedicated centers. Again, like for example, Grady Memorial Hospital here in Atlanta. When you talk about the post-acute care, perhaps some patients may need neurosurgery even, for example, or monitoring of intracerebral pressures, and there’s a whole array of physical things that can cascade and need to be monitored on the acute side under intensive ICU. But after that, when the patient is deemed stable enough to proceed with medical rehabilitation, that’s when it’s key to look at centers who have subspecialty certification in stroke care, folks who treat a high number of this population and can recognize some of the secondary effects that need to be diagnosed and treated acutely and manage complications. Unfortunately, many patients can be fragile for months after a stroke and even suffer second and third strokes or have other complications related to anger and so forth. It’s very important to be treated by highly trained clinicians including the therapist who understand and can pick up on important symptoms that you may be having. Of course, the availability of the modern technologies now that we have to rehabilitate stroke including some of the robotic interventions and other ways to keep patients engaged.

Melanie:  I’ve heard that strokes are on the rise in young people. Why do you think, in your opinion, Dr. Vox, that this might be the case? 

Dr. Vox:  That’s right. Right now, we have kind of the statistical epidemiological information coming from places like the CDC and other people gathering the statistics and we see these numbers on the increase. This type of data, unfortunately, can’t be drilled down to the point that we know for sure exactly what the risk factors are, but we see other trends changing in the population. We see rates of obesity increasing. We see kids being diagnosed themselves with hypertension earlier. We do see more sedentary lifestyles. Obviously computer uses certainly are recent among kids as well, you know, kids staying in front of video game machines, computers, and not being as active as previously. I do think there is something to that. We can see changes in our lifestyle becoming more sedentary. In addition, obviously, we’re all eating more processed foods, higher in salt, fats, and so forth and foods that aren’t fresh as much. I think that unfortunately is a big factor as well. I think we’re seeing a decline in our diet and a decline in our physical activity and that is, in turn, leading to our children to suffer this as well. 

Melanie:  Tell us a little bit about the clinical trial that involves stimulating the brain before rehab starts and what that could yield as outcomes for patients.  

Dr. Vox:  That’s right. We are engaged right now in a clinical trial of what you call transcranial magnetic stimulation. The magnetic portion of that kind of throws people off and they think about an actual magnet, but it’s an electromagnet and what we’re doing is electrically stimulating the cortex of the brain. Now, this particular trial is for people who are three months post up to 12 months post in their strokes, so most patients certainly will have some early rehabilitation before enrolling in a trial such as this. Patients, of course, like any trial, have to meet certain criteria. Not all patients that I would love to send to the trial are able to qualify for it for various reasons. In this trial, we are trying to rebalance the activity of the two hemispheres of the brain. We’ve understood more in the past 10 to 15 years about the process of rehabilitation after a stroke and what is going on in terms of the brain activity and we recognize there’s kind of a competition between the hemispheres of the brain. A stroke typically occurs on one side, leaving the other side intact. Part of what’s happening when we look at the activity of the brain, with the scanners that we have now, is we see that the intact side is actually competing with the more impaired and injured side and pushing down its activity, and so what we’re actually doing is attenuating or bringing down the activity of the more intact side of the brain using the electrical stimulation in order to allow the injured side of the brain to become more active in combining this with rehabilitation.

Melanie:  That’s fascinating, Dr. Vox, and so exciting hope for stroke patients. In just the last minute, please give your best advice for stroke awareness month and really what you want the listeners to know and why they should come to Shepherd Center for their stroke care.

Dr. Vox:  Well, I do want people to recognize that we are all at risk. There are genetic factors that we don’t all understand. I see perfectly healthy people who are doing everything right in terms of their own eating and lifestyle and everything, but still they can have a defect such as an aneurysm or spontaneous tear in an artery. No one should feel invincible from this, and so we should all have some level of awareness of the types of symptoms that we discussed at the beginning of the program that mean that you should seek immediate medical attention. Beyond that, understand that stroke is obviously essentially a life-altering condition. It’s very important that you seek out the best, both acute and post-acute care, and really seek out providers who are able to treat the whole person. Obviously our goal is to increase that person’s function to the point that they’re able to return to life as independently as previously and return to work and so forth. We are able to achieve that for many cases, obviously not all. Regardless of where people end up on the spectrum, our goal is to improve quality of life. I think that’s what you want to look for in terms of other centers that are going to provide care for yourself or a loved one. 

Melanie:  Thank you so much, Dr. Vox, for great information. You are listening to Shepherd Center Radio. For more information, you can go to shepherd.org. That’s shepherd.org. This is Melanie Cole. Thanks so much for listening.