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Table of ContentsChapter 1 - An Introduction To Life After Stroke ................................................. 4 Who This Guide Is For ............................................................................................. 6 How To Use This Guide ........................................................................................... 7Chapter 2 - Immediate Aftereffects Of Stroke ..................................................... 10 Most Common Effects Following Stroke............................................................... 10 Statistics On Life After Stroke................................................................................ 13 Goal Setting Following A Stroke............................................................................ 14 What We Learned ................................................................................................... 18Chapter 3 - Rehabilitation ....................................................................................... 19 Your Mental Health ................................................................................................. 19 Treating Physical Symptoms of Stroke ................................................................. 21Spasticity and Muscle Pain ................................................................................ 22ITB Therapy ......................................................................................................... 23 Rehabilitation For Communication ........................................................................ 23 General Management Tips For Recovery ............................................................ 25 Individual Approach To Rehabilitation .................................................................. 28 What We Learned ................................................................................................... 30Chapter 4 - voiding Future Strokes....................................................................... 32 Dietary Changes ..................................................................................................... 32 Recognize Stroke Risk Factors ............................................................................. 33 What We Learned ................................................................................................... 36Chapter 5 - Friends, Caregivers and Family ....................................................... 37 Finding Support....................................................................................................... 37 Communication and Family Roles ........................................................................ 38 What We Learned ................................................................................................... 40Chapter 6 - Hope For The Future ........................................................................... 42Stroke Resources ..................................................................................................... 443 3. Chapter 1 - Introduction To Life After StrokeCongratulations on investing in your health, recovery and ability to find hope in atunnel of darkness. A Stroke is a debilitating condition affecting millions of peopleevery year. A type of cardiovascular illness, a stroke can affect the arteries andbrain. There are many different types of stroke, but most result from a clot thatinterferes with the passage of blood to the brain or from a ruptured blood vessel,causing the same effect. According to the National Stroke Association, inconjunction with the American Heart Association,stroke is the #3 cause of death in the United Statesalone, preceded only by heart disease and cancerStroke is unique in the way it affects the quality of life of survivors. While it is aleading cause of death, there are millions of people that have a stroke and DOsurvive. If reading this guide, you may be a survivor, or friend, family member orcaregiver of a survivor. Your goal in reading this guide is likely to find ways toimprove your quality of life.When it comes to quality of life, physicians and doctors have worked for sometime to contribute to improved living for survivors of stroke. There are manyquality of life studies formally focusing on patient survivors of stroke. Most ofthese studies focus on assessing and trying to assess ways to improve thequality of life patients experience following a stroke. Why do we repeat this pointin this paragraph?Key to hope, key to survival is the ability of a survivor to maintain an adequateand enjoyable quality of life. Caregivers and family members of stroke survivorsmust also learn to accept a new life, but one that is worth living. This book willhelp guide you in that journey. 4 4. Many of the studies we talk about suggest that survivors of stroke experiencedeclines in their perceived quality of life resulting from multiple factors, includingimpaired functional ability, psychological factors and ability to communicate orlack of ability to communicate with othersi. One can easily understand this giventhe detrimental effects a stroke may have on a persons ability to communicateand function.The quality of life following a stroke is so important to stroke survivors recovery,it is the leading topic and concern of most primary and secondary caregivers.Due to the nature and side effects of strokes however, many caregivers anddoctors find it difficult to assess the impact stroke has on quality of life becauseof physical and functional impairment following stroke, including ones inability tospeak or sometimes understand what others are trying to relay to them. For thisreason, one of the first focuses of rehabilitation for many survivors is speech andlanguage rehabilitation.Many doctors will initially rely on reports given by caregivers or family membersin the early weeks following a stroke to assess a survivors recoveryii. Thesereports can have a dramatic impact on ones recovery in the short and the long-term.Why is this important? A stroke can be one of the most debilitating events thatoccurs on ones life. For that reason it is important doctors and rehabilitationexperts work to improve the perceived quality of life for survivors and theircaregivers. Many survivors may find their exclusion in decisions regarding theirhealth frustrating and intolerable. Because stroke often affects ones ability tocommunicate effectively however, this can be a trying circumstance to overcome.Without hope, many survivors may face rapid decline, little progress and evensuffer from a second stroke, one that may prove fatal. 5 5. Thanks to much effort and advances in modern technology, as well as treatmentprotocols and approaches to stroke recovery, survivors are finding they havemore and more say in their journey toward recovery. There are moreopportunities survivors can look forward to, and more choices healthcareprofessionals can offer patients looking for hope in light of their disease.Caregivers are also finding new hope in support avenues and education aboutcare giving and addressing the needs of stroke survivors.Who This Guide Is ForThis guide is a practical approach to understanding strokes, its effects on thebody and effects on survivors and caregivers. The intent of this book is to helpsurvivors and their family members learn what life may be like following a stroke,and learn what action steps they can take to improve a stroke survivors quality oflife following a stroke.This guide is purposefully designed in a simple-to-follow manner, so survivorsand caregivers can quickly and easily find answers to pressing questions orconcerns they have about the effects of stroke and its impact on ones quality oflife.This book utilizes as little medical slang as possible, making it easy for anyone tounderstand and adopt the concepts and tools applied in this book. Written withthe intent to help survivors and their families maximize their potential forexperiencing a full life, Life After a Stroke really is in many respects, a healingtool for patients and family members.This book does not go into all of the biological factors leading up to and occurringimmediately following a stroke. It does however, include a brief overview of theimmediate effects a stroke has on a survivor, and steps survivors and caregiverscan take to improve the quality of their lives following a stroke.6 6. Not everyone who experiences a stroke will survive. Those that do suffer a strokehowever, often have a good chance to regain much of their ability tocommunicate, function and improve their quality of life. The mission of this bookis to provide survivors and family members with hope, encouragement andinformation. Information and education are after all, two of the best tools anyonecan use to overcome any life challenge.The authors of this book and publisher are not doctors. The information providedin this guide is meant for informational purposes only. You should always rely onthe expertise and guidance of trained and qualified professionals when assessingthe best course of rehabilitation and treatment for a stroke survivor. If you arelooking for positive encouragement and hope however, as well as valuableresources in your journey toward recovery, youve landed in the right place.Remember that doctors and rehabilitation experts become a crucial part of yourhealthcare and wellness team. What stroke survivors need more importantly thananything is a group of caring, supporting and educated people to support themduring the challenging road to recovery.Much of the information gathered for this manual includes insights provided fromThe American Heart Association and American Stroke Association. Suchorganizations are committed to improving the quality of life of patientsovercoming stroke and many related disorders.How To Use This GuideWhether a survivor or caregiver, this guide will provide you with hope in yourjourney toward healing and recovering. This guide will provide you with valuableinformation about the general effects and long-term effects a stroke has onpatients and their families. You will also learn of new treatments on the horizonthat may dramatically improve the lives of patients suffering from the side-effectsof a stroke. 7 7. Included in this guide are links to support groups and knowledgeable sourceswhere survivors and caregivers can find even more information about life after astroke, and links where they can talk with other survivors and family members orcaregivers of patients recovering from stroke.The more you learn about any health condition, the better equipped you becometo face the challenges that lie ahead. Centuries have proven that the mind hasincredible powers to heal. This book will help you discover how powerful the willto survive and thrive can be in your journey toward healing.Use this guidebook as your armor when fighting back against the ill-effects of astroke, so you and/or your loved one can go on to lead the quality of life youdeserve following any debilitating illness.Many doctors and patients alike agree that not knowing is one of the biggestimpedances toward greater health. You will avoid this problem however, byreviewing the information in this guide and learning as much as you can aboutrecovering from stroke and improving the quality of your life.Use this guide to learn as much as you can about stroke and the effects strokehas on a survivors body during the recovery process. Knowledge will make youfeel stronger and more powerful, providing you the impetus you need to conqueryour fears and overcome anything. Believe and you will receive the inspiration you need to show courage in the face of hardship and inspire others to do the same8 8. This book will encourage stroke survivors to think of their lives in terms ofpractical abilities rather than disabilities. Everyone has the power and ability in usto regain a positive outlook on life, from which we may draw strength in the faceof adversity.Keep saying, Yes, I can! and eventually you will create a positive outlook onyour life and hasten your recovery. Everyone at some point in their life will facesome disability, or inability to accomplish or do things in a way they perceive asnormal or ideal. This book will encourage you to view life practically, but alsoto look past any physical or emotional limitations you may have so you can livelife to the fullest and truly learn to enjoy your quality of life, whether a survivor ofa stroke, caregiver or other loved one.So let us now begin our journey by first reviewing some of the more commoneffects survivors experience following a stroke. Please keep in mind that manypatients will experience more dramatic recovery and results depending on theseverity of their stroke and the parts of the brain and body affected by the stroke.Once a patient captures or maintains the ability to communicate and understandeffectively however, their potential for success is limitless. Remember this as youbegin your journey toward better understanding life after stroke.Apply the principles in this guide to everyday life, and find out how, even inthe face of adversity, life can become a truly intriguing place to live, filled withpotential and the ability to recover from almost anything. IF that is, you are willingto put your faith in your recovery, and your ability to help yourself and othersduring the recovery process.Success may not happen overnight, but it will happen if you commit to your life,your quality of life, and your right to enjoy life to the fullest extent possible. Letsbegin by gaining a comprehensive understanding of the immediate effects strokehas on ones life. 9 9. Chapter 2 - Immediate Aftereffects Of AStroke The only way around is through- Robert FrostRobert Frost had it right. You cant simply walk around a stroke to survive. Youcant tiptoe around it. If you suffer from a stroke, you have to learn to walkthrough your disability to recovery to the best extent possible. To walk through,you must learn what to expect following a stroke.To understand what life is like after a stroke, it helps to first understand what themore common immediate effects are of a stroke. The effects of a stroke will varyfrom person to person, depending on the severity of their stroke, and their overallhealth and ability to heal.Remember just as each patient will suffer differing effects, each will also recoverdifferently. The faster you understand this, the more accepting you will find youare of your condition and ability to overcome common challenges. It is alsohelpful for friends, family and caregivers to understand what you are goingthrough following a stroke. By providing them this information, they will have abetter understanding of how to help you and better empathize with your situation.Most Common Effects Following A StrokeMany organizations, including the National Institute of Neurological Disordersand Stroke (also called the NIN) and the American Stroke Association, agree thatsome effects are common among most stroke victims. These effects are listedbelow.10 10. Paralysis that may affect a part of the body (like an arm or a leg) or awhole side of the body, including the face. This paralysis may bepermanent, though some patients recover full or partial mobility in parts ofthe body affected by stroke.Weakness in part of the body, on the whole side of a body or in a limb.Sometimes physical therapists can help strengthen the body throughspecific treatments to help reduce the effects weakness has on onesquality of life.Painful spasms and stiffness of the muscles, or frequent aching andtwitching of these muscles. This is one of the most difficult long-termeffects of stroke many patients must overcome.Difficulty speaking or enunciating or difficulty understanding speech. Forexample, a patient may know what the right words are and want tocommunicate, but may not have the ability to do so vocally or in writing.Transient or constant feelings of numbness, tingling or pain in differentlocations throughout the body. A survivor may experience this for a shorttime, or for years following their stroke.Difficulty swallowing or eating. Sometimes this can lead to fatalcircumstances including malnutrition. Often doctors will try to address thisby providing an alternative source of nutrition if there is a good chance forrecovery.Urinary or bowel incontinence. This may be transient or permanent. 11 11. Emotional distress, including anxiety and depression. This will oftenmanifest immediately following a stroke, and may also manifest amongpeople caring for a stroke survivor. It is important doctors treat depressionand anxiety as well as the physical side-effects stroke has on a survivor.Excessive fatigue. This can result from the constant tightening of musclesin the body, or attempts at healing and recovery.Difficulty balancing, which may lead to trouble walking or falls (which canlead to further injury). Physical therapy is a commonly used approach toaddress this side-effect of stroke.A condition called claw toe where the toe curls resulting from muscleimbalances in the body. This condition may become permanent or difficultto recover from.Constant pain throughout the body, which can be difficult to address orunderstand. A patient may not have the ability to vocalize or articulatetheir pain in the early weeks following stroke, so efforts should be made toascertain a survivors level of pain and establish appropriate treatments toreduce discomfort.Fine motor skill deterioration, to the point where one may have troublepicking up small (or even larger) items. These effects can sometimes bereduced through routine rehabilitation and therapy, but may take sometime to recover from.Limited ability to communicate because of damage to learning centers orcommunication centers of the brain. Some patients may permanently losethe ability to learn new information or communicate at varying levels ofcomplexity. 12 12. Sensation that noises and actions are overwhelming, which can lead to greater depression or anxiety. Doctors may treat this with various medications to try to improve a survivors comfort and ability to heal.Again, it is important to note that not everyone will experience all of the effectslisted above. The extent to which a survivor experiences effects of stroke dependlargely on the severity of their stroke, their genetics, their individual health statusand other important factors.Statistics On Life After A StrokeThe symptoms and effects of stroke listed in the previous section do not affect allpeople the same. Remember that some people, as much as 10 percent of allpatients will experience a full or almost full recovery following a minor strokeiii.Still others will experience moderate to serious impairment that lasts indefinitely,up to 40 percent according to the NIN. There is behavioral, physical andemotional rehabilitation however, that can help patients and caregivers cope withthese effects. We will talk more about rehabilitation in the next section.Roughly one quarter of stroke victims will experience minor problems, which mayinclude muscle weakness or some speech difficulty. Some people are affected soseverely they may need long-term care in a designated facility.The NIN reports roughly 15 percent of patients may die from stroke, or be at riskfor a second or third stroke, which is why prevention of recurrent strokes is veryimportant. Rehabilitation will depend on many factors, including how severe thestroke is and what areas of the body are affected. The more damage to the brain,the more likely an individual is to suffer from physical and communication orbehavioral symptoms. 13 13. Goal Setting Following A StrokeEveryday people set goals for their life. These goals may focus on their desiredcareer path, their desire to change something about their health, their desire tolearn the list goes on. Following a stroke, caregivers and stroke patients mayfind it helpful to set goals for recovery and rehabilitation. Their goals may alsocenter on improving their quality of life or regaining function in certain areas ofthe body damaged by the stroke.If a full recovery is not possible, the first goal a caregiver should have is makingthis clear to the patient, so no false hopes are set. All goals set should berealistic based on the patients illness and potential for recovery.The primary and most important goal a patient should have is to live the bestquality of life they can, and live as independently as they can. Goal setting mayalso include deciding on the best type of treatment and rehabilitation plan for apatient, and follow through to make sure a stroke victim receives the care andloving support he or she deserves.If you are working with a loved one to establish goals for recovery, here are somegreat suggestions to help get you started in the right direction: 1. To be as independent as possible. Many patients suffering milder strokes will find they feel eager to regain full independence as soon as they are comfortable and able. 2. To live a life as full as possible given ones abilities and limitations following a stroke. If one experiences a severe stroke, they may have to reevaluate their definition of a full life and find new ways to enjoy life given the changes their body experienced resulting from the stroke.14 14. 3. To learn how to live life in a new and interesting way, despite the effects a stroke has on ones physical or emotional body. This goal is also helpful for caregivers and supportive friends and family members.4. To support caregivers in a manner that allows them to offer well-informed, guided and supportive care for themselves and their loved one.5. To learn how a stroke affects a person individually, so a survivor can set realistic expectations for recovery. A healthcare professional should work closely with a stroke survivor when setting realistic goals. If it is clear a survivor will have a permanent disability in some part of the body, but may be able to regain near to full function in another, it is important this information is shared with the patient so realistic goal setting can occur.Hope Having and maintaining HOPE after a stroke may seem impossible at first, especially if a survivor is struggling to communicate. However, HOPE is one of the most important factors in ones ability to overcome stroke and the effects it has on the body. Many people assume that following a stroke, ones life is damaged forever in a negative way. While a stroke may have many debilitating effects on ones body, patients who maintain an optimistic outlook are much more likely to experience a positive quality of life following their illness than those that feel hopeless. To establish and maintain hope, all people working with a stroke survivor should feel comfortable being honest about their 15 15. expectations of ones recovery, but also remain optimistic andHOPE for the best.There are incredible stories throughout life of patients recoveringfrom seemingly devastating or life-threatening illnesses. Stories ofpatients that lived and enjoyed a better quality of life even if at onepoint during their life they experienced near-death.Consider for example, the case of Lance Armstrong. LanceArmstrong is a well-known personality. But, in case you didntknow, here is his story. Armstrong is one of the best known bicycleracers of all time. He won the Sports Illustrated and AssociatedPress Sportsman and Athlete of the Year respectively in 2002.Interestingly, just a few years prior, a doctor diagnosed Armstrongwith testicular cancer, which rapidly metastasized, or spreadthroughout his body, including to his lungs and his brain. Mostdoctors predicted Lance had a 60 percent or less chance tosurvive, much less recover fully.One year following his diagnosis however, Armstrongs doctorsclaimed he had fully recovered, and conquered cancer. Armstronghas gone on to live a very full and rewarding life, and to inspireothers to do the same, by having hope and faith.Since this time he has gone on to win the Tour de France a record7 straight times. While Armstrong isnt a stroke survivor, he is amodel of how powerful the mind can be when facing recovery froma life-changing or debilitating condition.16 16. The more in control you become of your disease or illness, the better able you will be to tap into your ability to heal, survive and conquer. The key to a stroke survivors ability to recover well includes their ability to look past the damaging effects a stroke has on their body, and instead focus on their ability to regain their self-esteem about their new body, their new image and lifes new potential and possibilities. There are as many amazing survival tales of patients with stroke as there are patients overcoming diseases like cancer. To help inspire you and give you hope, read about some: strokecenter.org/pat/survivors.htm stroke.lotsahelpinghands.com www.caregiver.org/caregiver/jsp/home.jsp www.strokecenter.orgHope is available to anyone willing to reach out and embrace a new way ofthinking about their life and a new way to approaching life.If you invest in hope, you will find those around you also become more optimisticand that creates positive energy, energy you need to recover to the best of ourability and feel as good as you can.17 17. What We LearnedEver person experiencing a stroke will experience different physical, emotionaland psychological effects. These effects may be minimized depending on theseverity of the stroke, ones willingness to overcome any physical damages totheir body and ones commitment to rehabilitation.Recognizing the effects of a stroke is the first step on ones journey towardrecovery. Another step is goal setting. Through active and reflective goal setting,a patient and his or her caregivers can dramatically improve the quality of lifeexperienced by patients of stroke. In the next section, we will talk more aboutrehabilitation and how rehabilitation affects the wellness and quality of life ofstroke victims.18 18. Chapter 3 - RehabilitationRehabilitation is an important part of recovery for stroke victims. Some patientswill endure a lengthy hospital stay before they fully recover from their stroke. Lifefollowing a stroke may prove very challenging for the stroke survivor and thefamily members of those affected by the stroke. Rehabilitation may start in ahospital, and continue on an out-patient basis for the duration of ones life.Rehabilitation focuses on many different effects of a stroke, including the mentaland emotional effects, the physical effects and any neurological effects. Some ofthe more challenging effects rehabilitation focuses on include communicationdifficulties.One of the most challenging side effects of a stroke is spasticity, where asurvivor experiences uncontrolled muscle tightness resulting in pain and musclecramping in the body. The good news is as a stroke survivor you can learn tocontrol this side-effect and regain much of your normal muscle control with timeand proper rehabilitation.Your Mental HealthRehabilitation starts in the mind. If you prepare yourself for recovery, and knowwhat to expect during recovery, you will dramatically improve the results. I onceworked in a physical therapists office as a young adult. A woman used to come inregularly for physical therapy. She had a very severe stroke that left her withmuch spasticity, pain, inability to talk clearly and an inability to walk.Being so young, I thought the entire experience must be horrible to endure. Thefunny thing was, this remarkable woman was usually the most upbeat person wesaw at the clinic. She was always trying to make us laugh, she laughed when shecouldnt do something, and she laughed when things went awry.19 19. Sure there were times during her rehabilitation she got frustrated, and had a rightto. Every now and again she felt too tired to practice. But nine times out of ten inher mind she knew what she wanted and was happy. And this joy was infectious.And her physical therapists always commented on how quickly she madeprogress, despite the severity of her condition.To succeed in rehabilitation, you have to prepare your mind. You may have toendure a lot of hard work, and the road ahead may first appear gloomy. Butremember, every step you take in rehabilitation is one towards a happier, morecontent and improved quality of life. Rehabilitation And The Mind Many people fail to acknowledge the impact the mind has on ones ability to heal. The mind is one of the most powerful structures in the body. Even when damaged physically, the brain has the capacity to restore itself in remarkable ways. To prepare for rehabilitation, whether a survivor or caregiver, cherished friend or loved one, a person must first begin by addressing their mind. They must look at all the thoughts they have about their disability and transform them into thinking patterns that center on their ability to overcome stressful obstacles and physical limitations. Life is challenging, especially for those surviving stroke. However, with the right mindset, a survivor is more likely to confront any challenges associated with a stroke head on. 20 20. Prepare your mind by thinking positively. Spend some time visualizing the journey toward recovery. Imagine what your life might be like if you were able to communicate clearly. Imagine yourself walking. Even if you do not know exactly how you will get there, the mere power of thinking can help you overcome obstacles to your success and help you achieve greatness in the face of adversity.Your life may never be the same as it was before your stroke, but you can learnto enjoy life in new and different ways. Much of it has to do with the mentalconditioning you do ahead of time. Sometimes therapy and counseling can helpyou overcome the feelings of loss and grief you experience following a stroke. Atrained counselor, one familiar with working with stroke survivors, can help youovercome the limitations you now perceive in your life as a stroke survivor. Theycan also help you affirm your ability to improve the quality of your life througheducation and proper treatment.Treating Physical Symptoms of A StrokeThere are many rehabilitation programs and physical treatments available forstroke survivors. Many of these target specific difficulties stroke survivorsexperience following their stroke. For example, speech and language therapistsmay work with a stroke survivor to help them learn to communicate clearly withothers.A physical therapist may work with a stroke survivor to help restore some controlof muscle spasticity and function. Lets look at some specific physical treatmentsfor some of the more common symptoms and side effects of stroke.21 21. Spasticity and Muscle PainSpasticity and muscle pain or uncontrollable movements of the limbs, arms andmuscles is a common effect following a stroke. There are various treatmentchoices available to patients who engage in rehabilitations. Spasticity typicallyresults from an injury to the patients brain that prevents them from tightening andrelaxing their muscles properly.This condition specifically is one of the more challenging side-effects for strokepatients to overcome. It is also one side-effect of strokes that modern sciencehas created new and innovated rehabilitative treatments for, to improve thequality of life of patients following a stroke.Examples of this condition may include the inability to unclench ones hand, orsomeone experiencing abnormal postures or difficulty walking because their legstighten and cross one another or spasm. With time, this condition may causepain because the muscles are in constant motion.Traditionally, many doctors offer patients oral medications that help relax themuscles so pain becomes less of a problem in stroke survivors. Examples mayinclude Zanaflex or Diazapam. The problem with these medications is for manypatients they often bring on lethargy or fatigue. With time in some patients theseside effects may dissipate iv.Doctors often use these medications to treat generalized spasticity, wheremultiple muscles in the body are affected. For some patients, they will experiencemore localized spasticity, meaning a tightening of the muscles in specific areas ofthe body, as in the limbs. There are new treatments available that can helpreduce this problem in patients.Many doctors, for example, now prescribe Botox for patients who experiencespasticity in small, localized areasv. A doctor may inject this substance into the 22 22. muscle offering relief for extended periods of time, though this practice is notwidely accepted yet as a traditional treatment alternative for stroke patients.Still, new treatments like this are often offered to patients with other conditionsincluding migraines. One of the reasons Botox helps is because it acts to relaxthe muscles in the area surrounding the injection sight. This can lead to reducedspasticity.ITB TherapyOther treatment choices for patients with generalized muscle tightening include atreatment called ITB therapy (short for intrathecal baclofen therapy). Using thistreatment, a doctor implants a pump under a survivors skin connected to an areasurrounding the patients spinal cord. This pump allows delivery of continuousmedication to the patients body, thus relieving muscle tightening in larger areasfor extended periods of time.Many doctors see dramatic results using this treatment. The best part about thistreatment is the doctor or patient can control the amount of medication neededand the time the medication is delivered in the system to achieve optimal results.Baclofen isnt a new medication in itself. Many doctors prescribe this medicationto stroke patients orally. The benefits of using a pump to deliver medicationinclude reduced sedation and less need for high dosing. Patients using ITBtherapy generally experience better results using less medicationvi.Rehabilitation For CommunicationAnother debilitating side-effect of a stroke is the impact it has on ones ability tocommunicate well. Many times a patient experiencing a stroke is unable tocommunicate because they have difficulty finding the right words to use toexpress their thoughts.23 23. Their brains may also have some difficulty interpreting information, leading toconfusion and frustration. Fortunately, there are treatments that also improve thequality of life for stroke patients by helping patients recover much of their abilityto communicate with others and understand others with relative ease.Many times the most difficult problem for a patient to face is knowing what theyneed to say but not being able to tap into the areas of the brain that hold the rightinformation or words they need to express their thoughts. Some physiciansrefer to this trouble as a language problem, while other patients have articulationproblems. These doctors more commonly refer to it as motor problems, where apatient can access the words they want to say, but have difficulty speakingclearly.Most doctors begin speech and language rehabilitation very shortly following astroke, so a patient has the ability to regain some control over their life and theircommunication immediately. This often is among the primary concerns ofpatients, and can lead to better communication and understanding between thesurvivor and caregiver in the months and weeks to follow.For some patients improvement in language and communication developsslowly, while others realize much quicker recovery. Remember, every patient isdifferent as is every patients experience of a stroke.One of the goals of language and speech therapy is to establish goals with thepatient that are realistic, so a patient can know what to expect two, six, twelvemonths down the road and beyond. Some patients may experience gradualimprovements over a matter of years.The good news is most patients will also experience some recovery in the firstfew weeks and months following rehabilitation.24 24. General Management Tips For RecoveryMuch of rehabilitation for stroke patients focuses not simply on reducing pain anddiscomfort and restoring speech and mobility, but more importantly preventingfuture strokes from happening. In the next section we talk comprehensively aboutactive steps stroke survivors can take to help reduce their risk for a secondstroke following the first.Some other problems that place stroke survivors under risk following a strokeinclude vii:Increased risk for deep vein thrombosis, a condition where blood clotsform in the deep veins of the body, which, if left untreated, may be fatal.Treatment and rehabilitation objectives will include encouraging mobilityand movement in the legs and muscles to reduce the risk for clotting.Some doctors may also recommend blood thinning agents to help reducecoagulation of blood or pooling of blood which may contribute to thiscondition.A pulmonary embolism, where a blood clot forms and then dislodges fromits location (usually in the leg or another limb) and lodges in the lung. Thisis a severe complication that may lead again to fatality.Pneumonia due to decreasing immune function and added stress placedon the respiratory system.Additional heart or cardiovascular complications.Urinary tract or kidney infections associated with decreased ability ormuscle spasticity in the pelvic area.25 25. Fortunately, rehabilitation specialists engage in a wide array of tools andtechniques to help alleviate and control a survivors risk factor for these effectsfollowing a stroke. Such actions can dramatically improve their odds of survivaland their perceived quality of life. Is Everyone A Candidate For Rehabilitation? Not everyone is a candidate for all the rehabilitation programs available to stroke survivors. Caregivers and survivors will work closely with trained specialists to assess their suitability for certain procedures. How do you know if you are well-suited to a procedure? There are many elements or factors a healthcare team looks at and reviews when considering rehabilitation treatment choices. With time and recovery, as well as individual response to rehabilitation, these treatment choices may change. Some common considerations when evaluating a patients candidacy for rehabilitation include: 1. How severe a patients stroke is; intense or vigorous training and rehabilitation is not often an option or feasible choice for patients experiencing severe strokes. In this case, the patients may be a candidate for in-house care at an appropriate facility. 2. How mild a stroke is; patients with mild strokes often realize the quickest and most startling recovery and improvements in quality of life by taking advantage of rehabilitation alternatives.26 26. 3. Whether a survivor can sit up, understand and become aware of their surroundings. When a patient is able to do this, they are better prepared for more rigorous rehabilitation and will likely experience more positive results.4. The extent of spasticity. While a patient may not enjoy these tight constrictions of the muscles in the body, often muscle spasticity is a sign that live nerve ability still exists in the body, improving ones odds for effective responses from rigorous intervention and rehabilitation.5. Patients recovery within the first week or two following a stroke. Those patients and survivors that can start moving appendages or limbs in the short weeks following their stroke are good candidates for intensive rehabilitation.6. An active and willing support structure that may include loved ones and family members.Some patients, including those with certain complications from astroke are less likely to benefit from traditional rehabilitation. Forexample, many patients experience an increased risk for mortalitybecause they lose their ability to swallow resulting from a stroke, aside-effect that may lead to malnutrition.Other patients, including those experiencing severe seizuresconsistently following their stroke, may not represent good candidatesfor positive outcomes following even strict rehabilitation.27 27. Individual Approach To RehabilitationStroke survivors and family members working with their loved ones shouldrecognize that each doctor and rehabilitation specialist will take anindividualized approach to rehabilitation. This approach will includeevaluating several factors related to the patients health and wellness.Strokes can affect different parts of a victims brain, so the approach towardrehabilitation may vary depending on which centers of the brain are mostseverely affected.Some common approaches to general rehabilitation for most stroke patientswith a good expected outcome include: Muscle rehabilitation - this will typically include reducing spasticity and tightening of the muscles and training other muscles in the body to perform tasks that impaired muscles can no longer carry out, whether on a short-term or permanent basis. For example, patients experiencing paralysis or decreased mobility on one side of their body, such as the right side, may learn how to use the left side of their body and retrain their muscles accordingly. This is a very common approach to rehabilitation, as many people are either left or right handed, which leads to greater control on the side of the body the person was used to using preceding the stroke. Attention and focusing training this type of rehabilitation focuses on helping survivors learn to refocus their attention so they can perform daily tasks following a stroke. Some patients will have to relearn very common skills including eating, talking, using the bathroom or communicating and listening to others. 28 28. Speech and communication therapy which focuses on restoring ones ability to communicate, whether nonverbally or verbally. Other forms or tools a survivor can learn to use include using a computer or pen and paper to communicate with others. Some patients will have to relearn the alphabet and learn how to communicate and read again. If the stroke is very severe, it is similar to a doctor or rehabilitation specialist teaching a student in elementary school. Medication therapy - this is a common approach for relieving side effects including pain associated with treatment following a stroke. There are also some medications currently available that may help patients improve their ability to articulate words correctly. Other drugs may help improve unusual side-effects, including uncontrollable hiccups, an often unmentioned side-effect affecting many patients that have survived a serious stroke. Emotional rehabilitation - this rehabilitation focuses on helping survivors regain their self-esteem, confidence, independence and ability to fight for a better quality of life. It is very common for stroke survivors to undergo periods of depression. It is important that doctors recognize this and respond to it accordingly. The American Stroke Association indicates that failure to address symptoms of depression my lead to prolonged therapy or a less than ideal response to rehabilitation efforts. Neurological emotionalism - this is a term often given to stroke survivors that describes certain emotional features a patient may exhibit following stroke, including uncontrollable crying. It is neurological, however, rather than a psychological disorder, meaning 29 29. it is not directly tied to the emotions necessarily, but rather changes that occur in the brain following stroke.Also important to address during recovery and rehabilitation is theemotional and physical ability and strength of the stroke survivors primarycaregiver. Many will require support and guidance. Some caregivers mayalso undergo bouts of depression, especially if they are coping with the lossof a loved ones ability to communicate and interact with them intimately.Fortunately, rehabilitation can also work to help caregivers respond andaddress the physical and emotional impacts a loved ones stroke can haveon them as well. Rehabilitation and counseling is often an importantconsideration for caregivers whos loved one may experience abnormalneurological behaviors following a stroke, including dementia or aggressivebehavior.Remember, sometimes it is difficult to determine at first glance how a strokewill manifest in a survivor physically and emotionally. A caregiver shouldwork closely with a qualified team of healthcare professionals to help thestroke survivor decide on the best course of treatment and rehabilitation fora patient.What We LearnedA stroke affects survivors in various ways, depending on the severity of thestroke and the areas of the brain that are damaged or impacted by a stroke.Recovery is critical to ones success and ability to improve their quality oflife, and often starts with prompt, immediate and active rehabilitation.Depending on the severity of a survivors stroke, a patient may beginspeech and language rehabilitation within the first 48 hours following a 30 30. stroke. Many believe communication is the most important ability to recoverfollowing a stroke, allowing a survivor to better communicate and sharetheir needs and their impressions of treatment.Depending on the patient, the caregiver and resources available to them, arehabilitation team is likely to develop a moderate to aggressive approachto rehabilitation depending on a survivors state of mind, condition andwillingness or desire to enter therapy. Often, medication intervention,including treatment for anxiety or depression, may initiate rehabilitativeefforts to help provide stroke survivors with hope for a recovery that willimprove their quality of life and long-term wellness.Because many patients suffering a stroke are at risk for another one, it isimportant to know what steps are necessary to help reduce the odds apatient will experience recurring strokes. In the next section, we will discussvarious risk factors and treatments for patients that may be at risk forexperiencing a subsequent stroke. The more attention one gives to theiroverall health and wellness following a stroke, the more likely they are toregain better control over and improve the quality of their lives.31 31. Chapter 4 - Avoiding Future StrokesThe American Stroke Association, an organization working with the AmericanHeart Association, emphasizes that once one has a stroke their risk of havinganother is higher than someone who has not suffered a stroke. This may seemscary, but the good news is you can control many risk factors and make lifestylechanges that will reduce the odds you will suffer from another debilitating stroke.Much like a person that has a heart attack survives and recovers so too can aperson who suffers a stroke. They can also limit their odds of experiencing futuredisability. This section will focus on ways stroke survivors can reduce theirchances of suffering another stroke. The information provided containsguidelines provided by the American Stroke Association and American HeartAssociation, as well as other organizations committed to improving the quality oflife of individuals following stroke.Dietary ChangesOne simple way anyone can reduce their chances of succumbing to a secondstroke is by eating well. Healthy food choices are important for maintaining yourhearts health and reducing your risk of heart disease and stroke, high bloodpressure and other conditions that can contribute to stroke.Good nutrition will also provide you with more energy, something you will findvery important in the months and years following your stroke. If you suffered astroke and have comorbid conditions, like heart disease or diabetes, it is moreimportant than ever you eat well to nourish your body.Here are some tips for eating well that will help reduce your risk of recurringstrokes: Make sure you invest in lean protein like fish and poultry.32 32. Incorporate many whole grains, fruits and vegetables into your diet. Aim for a serving of each during each meal of the day. Try baking, grilling or broiling foods instead of frying them. Use olive oil in place of butter for seasoning, dressings and flavor, as olive oil has heart healthy ingredients. Avoid foods that are highly processed and foods that contain too much saturated fat (including red meat). Eat these in moderation. The majority of your diet should include wholesome, nutritious and energy producing foods. Try using egg whites when making egg products including omelets. Look at label ingredients when shopping and avoid products containing high fructose corn syrup and products containing lots of sugar.Just as anyone will benefit by eating a diet containing more wholesome,unprocessed foods, so too will a stroke survivor benefit by paying more attentionto their diet, and physical activity, which ultimately serves to improve the life andquality of life of anyone willing to put effort into these critical success factors.Recognize Stroke Risk FactorsIf you recognize physical risk factors of a stroke, you are more likely to takepreventive action.Just by becoming more aware of stroke risk factors, you can help reduce yourrisk of future strokes. Here are some common physical health factors that mayincrease your risk of stroke or recurrent stroke: 33 33. 1. High Blood Pressure One of the leading risk factors for strokes and heart disease alike is high blood pressure. High blood pressure is often a sign of other health problems. A majority of stroke patients have high blood pressure before experiencing their first stroke. Any blood pressure with a systolic reading greater than 130 or diastolic reading greater than 80 may suggest you are at risk for pre-high blood pressure. If you notice your blood pressure creeping up, consult with your doctor and take action to correct it. There are many ways to treat high blood pressure. 1. Exercise is one of the best ways to help lower blood pressure. It will also help restore your energy and can help promote weight loss. 2. Lose weight if you are overweight. Many times simply being overweight increases your odds of high blood pressure or hypertension. 3. Reduce your consumption of alcohol, which can increase your risk for high blood pressure if you are prone to hypertension. 4. See your doctor about blood pressure lowering medications if your blood pressure is very high. 5. Limit or reduce your intake of salt. 6. Increase the amount of fluid or water you drink so you do not retain water, because interestingly this can raise your blood pressure.2. Atrial Fibrillation In this condition the atria or top chambers of the heart do not beat properly. Instead of actively pulsing, they quiver so blood does not move into the ventricles properly. Many patients, up to 20 percent according to conservative estimates, have atrial fibrillation before experiencing a stroke. This is because this condition slows down the flow34 34. of blood, increasing the likelihood that blood will pool in the body and clot. This increases your risk for a stroke and recurring strokes. The good news is your doctor has many treatments available to help keep blood from clotting, including the use of anticoagulants. Many survivors are offered these medications or antiplatelets, to reduce their odds of having another stroke. Some studies, including those by the American Heart Association, also suggest that taking aspirin may reduce the risk of a first time stroke, or reduce the severity of a stroke if taken within the first two days or few hours of a stroke. 3. Atherosclerosis High blood cholesterol or other risk factors increase ones risk of high blood pressure, heart disease and stroke. Often high cholesterol can be controlled through diet alone. If your condition is hereditary, you may have to seek the advice of a doctor who may prescribe a cholesterol lowering drug temporarily to reduce your risk of a stroke or recurring stroke. A diet that increases levels of HDL, or good cholesterol, can decrease your risk of atherosclerosis. 4. Inactivity A simple lack of activity can increase your risk of a recurrent stroke. While it may seem counterintuitive, it actually benefits you to exercise following a stroke. People who are in better shape before a stroke will suffer fewer long-term consequences and often recover faster than their inactive counterparts. You dont have to start running marathons, but you should consult with your doctor for a recommended activity program that will help keep you safe and physically active.There are many other risk factors that may heighten ones susceptibility to futurestrokes, including ones family history and overall wellness and attention torehabilitation. Remember, all survivors are individuals. The more a survivor35 35. understands their risk for recurrence, the more likely they are to take proactivesteps to reduce their odds for another stroke and hasten their recovery.What We LearnedOnce a person suffers from a stroke they automatically are at an increased riskfor another stroke. The good news is simple awareness of this can dramaticallyimprove ones odds for survival and decrease their chances of havingsubsequent strokes.In this chapter you learned how to improve your overall health and lifestylehabits, which can dramatically improve your odds for surviving a stroke andreduce your odds for experiencing a secondary stroke.In the next section, well talk more about the impact a stroke has on friends andfamily, who often become primary caregivers or emotional support figures in thelives of stroke survivors. A stroke survivors ability to recover well often hinges onthe willingness of those around him or her to help support them in their oftendifficult journey to healing.This next section will also help caregivers learn ways they can better care fortheir own health and emotional wellness while grieving for loved ones whovesuffered from a stroke.36 36. Chapter 5 - Friends, Caregivers and FamilyFriends and family members are often involved in taking care of and helpingsomeone recover following a stroke. Many times family members or friends andother caregivers look for support, so they know best how to help their loved one.If you are a stroke victim, and can communicate, the best way to help familymembers is to be honest about your feelings, wants and needs. It never helps tokeep things bottled inside. That said, if you havent suffered a stroke, it is hard tounderstand what having a stroke is like, and how it changes your life.Friends and family will benefit by learning as much as they can about strokes andhow it affects ones life. There are many resources and support groups online forstroke victims, but also for the friends, family and caregivers of people that havesuffered a stroke.Finding SupportMany times a stroke victim feels as if he or she is alone. Family members canalso feel this way as they struggle to find ways to help. One way to find support isby reading about others experiences with strokes and others experienceshelping loved ones overcome the difficulties presented following a stroke.For victims, friends and family members, a wonderful resource to find informationabout support groups is the American Stroke Association. You can access themhere:www.strokeassociation.orgHere you will find personal stories of recovery and care, and support groups forpatients and family members. You can also learn more about recovering from astroke and what you can expect from life following a stroke. This site also offers37 37. caregivers, including family members, special offers including daily journals theycan use to log important information, and provides links to various resourcesspecifically designed to provide caregivers and family members the properknowledge and information they need to care for a stroke victim.The American Heart Association also offers a board and forum offering familialsupport for families caring for a loved one, and for individuals that have sufferedfrom a stroke who are looking for advice and support. Visit:http://my.americanheart.org/jiveforum/index.jspaIn the resources section of this guidebook you will find links to many othersupport groups and forums you can rely on for guidance and additionalinformation during your journey. One thing many family members and caregiversoften forget is to care for themselves while caring for a loved one. It is easy to fallinto the trap of spending so much time caring for your loved one that you forgetto care for yourself. The good news is you can prevent frustration and burnout byremembering that you are important.If you burn out, you wont be any help to your loved one or to yourself. So start bytaking some time out of each day just for you. Take some time to exercise to helprelieve the stresses associated with caring for a loved one.Communication and Family RolesMost importantly, make sure you communicate your needs to your loved one.Just because someone has a stroke, doesnt mean they cant empathize andunderstand that you too must feel stress. When you communicate about yourfears, anxieties and desires, you open the door to better communication and awarmer relationship. This will improve the quality of life for you and the personyou care for. 38 38. Tips For Caregivers & Stroke VictimsWhen someone has a stroke, their life changes dramatically, as does thelives of the people living with the person who has had a stroke. Lets sayfor example, the head of a household has a stroke. The stroke resultsin a disability.What does this do to a family dynamic? It changes it completely. The firststep toward recovery is recognizing how the stroke has affected thefamily dynamic, and the role each member of the family has to take on.Someone else may now step up and act as head of the house. You mayneed to hire additional care or someone to provide in-home, full-timecare depending on the severity of the stroke. You may find you need totake more time to care for yourself as you tire working diligently to attendto the rehabilitative needs of a cherished loved one.One way to go about structuring your life and improving the quality ofyour life, whether a family member or a stroke patient, is to sit down andcommunicate with each other. Map out who is responsible for what.Responsibilities might be as simple as communicating daily or takingfive minutes alone to relieve stress. Every person in the home shouldhave their own role and their own schedule, including the stroke patient.Remember, someone that has a stroke is still an important part of thefamily, and will want to play a role in the planning and execution of familyaffairs. Disabled doesnt mean incompetent. Keep that in mind. Considereach family members skills, abilities, talents and capabilities, and work toconsolidate them to improve the quality of everyones life. 39 39. Your life may change dramatically, but many times it may be for thebetter. Once the initial chaos and confusion wears off, you can pulltogether as a team to overcome just about anything.What We LearnedWhen someone has a stroke, it changes the entire dynamic of a family. Thegood news is this change may seem at first like something bad, buteventually with proper support, communication and understanding, everyonecan pull together to create a loving, supportive and nurturing environment.Every member of the family, including a primary caregiver, needs supportfollowing a stroke. If you or a loved one suffers from a stroke, seek help andguidance. Dont go it alone. This will help reduce the chaos and fears thatoften accompany a dynamic change in ones routine and living environment.For more information and family support, for caregivers and family, trycontacting the Stroke Family Support Network. They can help you clarifyeach persons role in the family, and direct you to local resources and helpwhen needed. There number is 1-888-4-STROKE.Here are some additional resources for family members: National Association of Area Agencies on Agingo Visit them at www.aoa.dhhs.gov/elderpage/locator.html National Family Caregivers Association provides direct links to people and access to resources for family caregivers caring for victims of stroke and other diseases.o Visit them at www.nfcacares.org 40 40. National Easter Seal Society offers many programs and rehabilitation services for adults with disabilities including stroke.o Visit them at www.easter-seals.orgMost hospitals and healthcare facilities also offer links to local andcommunity organizations and support groups that can help caregivers findsupport and help stroke survivors find support following their illness.In the next section, we will wrap up our discussion of rehabilitation and lifeafter a stroke by offering survivors and their families hope for the future. Nomatter how debilitating any illness, it is important that caregivers, patientsand loved ones recognize that there is always hope for the future.Technology and modern medicine continue to bring new and interestingtechniques and strategies for hastening recovery and restoring ones abilityto live a full and rewarding life following stroke. Lets take some time to lookat what the future has to offer stroke survivors and their families. 41 41. Chapter 6 - Hope For The FutureHope is the single most important thing one must hold onto during theirrecovery from a strokeUnless one is a victim of a stroke, one can never really understand what astroke survivor will undergo during the recovery process. As frustrating asrecovery may sometimes feel for caregivers, it is equally if not morefrustrating for patients. Patients may want nothing more than to restore theirlife to the state it was in before their stroke.Most patients suffering a stroke however, will have to learn a new way toadapt to their life. They will have to learn new ways of coping with newdisabilities, and new ways of thinking about their bodys and their minds.As technology and modern medicine continue to converge they will open thedoor for new possibilities for stroke victims and their families. A key to astroke survivors recovery is their ability to recognize the physical changes astroke will have on their body. The more knowledge one has of an illness, thebetter able one is to recover from it.The same holds true for caregivers. The life of a caregiver for any patientwith a disability can be challenging. Caregivers have a duty to themselves totake care of their own physical and emotional health as they do to care forothers. Some survivors will suffer severe physical and emotional damagerequiring permanent in-house care in a competent and caring facility.If this is the case, a loved one will often need to seek support from otherfamilies and perhaps even counseling to learn how to cope with the changesin life brought on by a stroke. This is often the case when a patientpermanently losses the ability to communicate clearly or understand others.42 42. The good news is many patients will recover from their stroke. They may notlive the same life they did before having a stroke. They do however, have theability to learn and discover a new way of living life. Medical treatments canhelp reduce pain and discomfort. Speech and language therapy can help anindividual regain their capacity to communicate well with others.Emotional and psychological rehabilitation and counseling can help strokesurvivors learn to look at their lives in new and challenging ways. Remember,with proper support and a positive outlook, anything is possible. If you keepthe hope alive, you will have the best chances for success, happiness andcomfort as you learn to life with life after a stroke.We hope you found this guide helpful to you in your journey toward recovery.Remember that life is constantly evolving and changing, as are all people asindividuals. A stroke will represent a dramatic change in the way you liveyour life, but can also present you with new challenges and opportunities tolive a healthier, better and more rewarding life.Many blessings to you on your journey toward health and wellness 43 43. Stroke ResourcesThere are many resources available to patients, professionals and caregiversof survivors of stroke. Many of them are listed throughout this guide. To helpyou find information quickly and easily, a list of resources is provided belowyou can use anytime.American Heart Associationhttp://www.americanheart.org1-800-242-8721This site provides information for patients, healthcare providers, caregiversand family members looking for information about rehabilitation, stroke,recovery and support. Many feel this is the best starting point to findinformation about health and recovery. You can also find detailed informationabout what stroke is and how it affects the body using this website.American Stroke Associationhttp://www.americanheart.org1-888-478-7653Like the American Heart Association, the American Stroke Associationcommits itself to providing ongoing support, education and information topatients, family members, caregivers and professionals interested in learningmore about stroke. This site is a division of the American Heart Association,so you will find many references linking the two together. You can also findlinks for online risk assessment for stroke and other heart related healthproblems.Congestive Heart Failurehttp://www.americanheart.org/chfAs part of the American Stroke Association, this site targets patients andtheir caregivers specifically. You can find information and many free tools 44 44. that assess your risk for stroke and keys to prevention for recurrent infectionsor illnesses.Nutrition Informationhttp://www.deliciousdecisions.orgAs you know, good health starts with good nutrition. Patients can reduce theirrisk of recurrent stroke by adopting a heart healthy diet. This site,recommended by the American Stroke Association, is a non-profit entityproviding recipes and nutrition advice for adopting a healthy and nutritiouslifestyle.Brain Basicshttp://www.ninds.nih.gov/health_and_medical/pubs/preventing_stroke.htmPart of the National Institutes of Health, this informative article providesinformation on preventing stroke in healthy individuals. You can also link toother articles and resources about cardiovascular and heart health for menand women, as well as children.Generation S: Young Stroke Survivorshttp://www.orgsites.com/pa/generation-sStroke is not an illness that affects young and old alike. Young people,including children, can fall victim to stroke and survive. This innovativeyoung and hip website targets young people affected by stroke, offeringsupport and guidance.Stroke Information Directoryhttp://www.stroke-info.com/This site offers even more links to centers and organizations providinginformation, articles and support details for patients, caregivers and providersinterested in learning more about stroke. 45 45. National Institute of Neurological Disorders and Strokehttp://www.ninds.nih.gov/A government funded site, part of the National Institutes of Health, providingresources and information on various neurological disorders including stroke.Also provides links to resources for primary caregivers.National Stroke Associationhttp://www.stroke.orgLike the American Stroke Association, provides national support for patients,caregivers and family members seeking more information about stroke andrecovery. For links to local support groups in your area you can visit forsupport, whether a survivor or caregiver, visithttp://www.strok.org/supportsearch.cfmThe National Rehabilitation Information Centerhttp://www.naric.comThis site provides details about rehabilitation and new treatment alternativesfor patients facing many illnesses and acute diseases including stroke. Hereyou can find detailed information about specific therapies you may have aninterest in learning more about that center on prevention and recovery.Stroke Networkhttp://www.strokenetwork.orgThe Stroke Network is an online community committed to providingcaregivers and survivors support and guidance during their journey towardrecovery. You can buy stroke awareness gifts to help increase the publicsknowledge and awareness of heart health and stroke. This site is rated a top-notch website in 2007 for stroke survivors and health providers by Dorlands.Health professionals are also invited to take part in discussions. A non-profitorganization, the Stroke Network is a support group whose members anddirectors include survivors of stroke or those whose lives have been affected46 46. by a family members suffering and joyous recovery or painful loss. Manyconsider this truly unique organization a blossoming addition to the family ofsupport networks available to stroke survivors, caregivers, healthprofessionals and family.i Haan, D.R., Limburg, M. Van Der Meulen, J., et. Al. (1995). Quality of life after stroke: impact of stroketype and lesion location. Stroke, 26: 402-408; Sneeuw, K.C., Aaronson, R., Haan, J., Limburg, M. (1997).Assessing Quality of Life After Stroke. Stroke, 28: 1541-1549.iiOp Cit Ibid;iiiAmerican Heart Association.ivNational Stroke Association.vAmerican Stroke Association.viOp.Cit.Ibid; ASA; http://www.poststrokehelp.com/viihttp://www.nym.org/ 47