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  • 1. Stroke A Guide to Information & Resources in Delaware 2004-2005 Sponsored by Third Editionwww.destroke.org
  • 2. Looking for the best in stroke services? Check out Christiana Care. RT CARD 2004 REPO e To p 5 % R a n k e d in th fo r tr y in th e C o u n c e ll e n c e C li n ic a l E x RE IN D E L AWA RANKED #1 e S e rv ic e s # 1 fo r S tr o k o n a ll y in th e R a n k e d N a ti es tr o k e S e rv ic To p 5 % fo r S n a l P ro v id e r O N LY R e g io R R a ti n g w it h a 5 -S TA e rv ic e s * fo r S tr o k e SChristiana Care has been nationally recognized with the HealthGrades®2004 Distinguished Hospital Award for Clinical Excellence.TMwww.christianacare.org Trust your health to experience.* ”Areas” or “Regions” are as defined on www.healthgrades.com
  • 3. CONTENTS Introduction 2 Delaware Stroke Initiative 3 Stroke Education 6 Contributed Articles Stroke is Brain Attack 10 The Basics of Brain Attack 12 A 10-Point Plan for Ischemic Stroke 13 Preventing Stroke 15 Quit Smoking to Reduce Stroke Risk 17 Atrial Fibrillation: Understanding & Managing an Irregular Heartbeat 19 Having a Stroke 21 My Stroke 22 Call 911 at the First Sign of Brain Attack/Stroke 23 Emergency Management of Stroke 25 Stroke Centers Help Reduce Death and Disability 27 The Role of Surgery in Stroke Prevention and Treatment 28 Neurologists Specialize in Treatment of Stroke 29 Neuropsychological Assessment of Stroke 30 Stroke Treatments: Hope for the Future? 32 St. Francis Specializes in Stroke Care 34 Healthy Spirituality & Well-Being 36 Physical Rehabilitation After Stroke 37 Recovery: A Time of Relearning 39 Aging with a Disability 40 Caregivers Need Care, Too! 44 Stroke Information Resources 46 Resources include a glossary of terms, suggested reading list, web sites, national organizations, state and local organizations, adult day care, care or case management, companion programs, counseling/mental health services, elder law programs, employment, home health care agencies, exercise programs, transportation, senior services and health organizations, stroke support groups, accessible activities, technology, telephone reassurance programs, and other resources and products. Stroke Risk Screening Questionnaire 65 DSI Stroke Resource Guide Order Form & Free Listings 67 Delaware Stroke Initiative Membership & Volunteer Form 68 Stroke: A Guide to Information and Resources in Delaware 1
  • 4. INTRODUCTIONThe purpose of this resource guide published by the Delaware Stroke Initiative (DSI) is to provide strokesurvivors as well as their families, friends, and caregivers with useful information to help them adjust to lifefollowing a stroke or brain attack. It also provides information about prevention for those who may be atrisk for stroke and how to prevent another stroke after recovering from a stroke.It has been estimated that approximately one-third of all stroke survivors will have another stroke within5 years of their initial stroke. In American today, approximately four out of five families will be touchedby a stroke. According to the Framingham Study data collected in 1991 and published by the AmericanHeart Association in 1996, approximately 31% of stroke survivors will require assistance following a stroke;about 20% will require help walking and 16% become institutionalized; and 1/3 of stroke survivors will beimpaired, 1/3 will be moderately impaired and 1/3 severely impaired.The guide includes educational information about the types of stroke, warning signs of stroke, stroke risksas well as a collection of articles that address prevention, personal experiences, diagnosis and treatmentof stroke. Resources listed in this publication include a glossary of stroke terms, suggested readingmaterial, web sites, and national and state organizations that provide information, social activities andassistance for stroke survivors.The Delaware Stroke Initiative (DSI), a 501 (c)(3) non-profit association, was founded by Ellen Barker in1999 as the only non-profit organization in Delaware that is totally dedicated to stroke. DSI’s mission is toreduce the incidence of stroke and to improve outcomes. The organization is comprised of a Board ofDirectors (BOD) with representation from the medical community, corporate sponsors, support groups,local businesses, stroke survivors and a passionate base of volunteers. DSI recognizes stroke as a majorhealth problem and the third leading cause of death in Delaware and the leading cause of adult disability.With the knowledge that more women die each year from stroke than die of beast cancer and that everyminute in the United States someone experiences a stroke, DSI is committed to reducing death, disabilityand dependency from stroke in Delaware. The best treatment is prevention.For more information about DSI, visit our Web site at: www.destroke.org, call the DSI office at (302) 633-9313, email us at: destrokeinitiative@earthlink.net or visit our office at the Metroform Medical Complex,620 Stanton-Christiana Road, Suite 302 in Newark, Delaware.NOTE: This publication is presented for the purpose of education about stroke. Nothing herein should beconstrued as medical diagnosis or treatment advice. The information contained should not be used in theplace of calling your physician or health care provider. Please contact your physician or health care providerfor your individualized health care, questions or additional information about stroke.2 Delaware Stroke Initiative
  • 5. DELAWARE STROKE INITIATIVEIn 1998, a group of concerned Delawareans recognized the need for a non-profit organization dedicatedsolely to stroke prevention, risk assessment and recovery within the state of Delaware. The organizationwould serve to create increased public awareness that stroke is a “brain attack” and a major healthproblem in our state. Stroke is the third leading cause of death after heart disease and cancer and thenumber one cause of adult disability in Delaware that commonly affects individuals over the age of 55,often with permanent, life-long neurological deficits or disabilities. Stroke affects not only the individual,but the entire family with serious economic and emotional burdens. Of particular concern was the minoritypopulations which have a higher stroke rate than Caucasians.Despite medical advances and the approvalof tissue Plasminogen Activator (tPA) in 1996 Our Missionas the first drug to treat acute ischemic stroke, The Delaware Stoke Initiative’s missionindividuals with symptoms of stroke fail to arrive at is to improve stroke prevention, riska hospital emergency department within the three- assessment and recovery throughhour treatment time for the best outcome. Public education, support and advocacy.education on how to recognize the warning signs andthe need to call 911 for immediate transportation to Our Goalsthe hospital has not been effective. It is important to educate the public that stroke is a life-threatening “Brain Attack.”Ellen Barker, a neuroscience nurse, founded the For our goals, DSI endeavors to:Delaware Stroke Initiative (DSI) with support from g Foster awareness that many strokea dedicated group of members that included can be preventedphysicians, health care providers, business and g Increase awareness that strokes needcorporate interests, and very importantly, stroke to be treated as an emergencysurvivors. The non-profit association was formed g Educate the public to recognize thewith guidance from Jeffery Dano, MD, president of warning signs of strokethe Philadelphia Stroke Organization. Nicholas Teti, g Encourage the public to call 911president and CEO of DuPont Pharmaceuticals, at the first symptoms for rapidbecame the first president. In 1999, the IRS granted transportation and medical careDSI tax exempt, non-profit status as a Delaware g Promote free stroke risk screenings tocharity. identify individuals at risk and for risk reductionSince DSI’s inception, its mission has been to g Promote recovery and rehabilitationprevent stroke, offer risk assessment with free Stroke g Develop and implement programs toScreening, and improve the clinical management of advance our mission and goalsthose hospitalized. Programs have included annual g Strengthen and expand partnershipseducational conferences for medical professionals, that share our goals and missionfamily health fairs, free stroke screenings, the“Thumbs Up” free stroke support group, a Stroke Stroke: A Guide to Information and Resources in Delaware 3
  • 6. Resource Guide and a speaker’s bureau for community groups interested in stroke prevention or how toreduce death and disability from stroke. DSI has served Delaware with many programs and activities tofurther its mission to improve education, risk assessment and recovery, through education, support andadvocacy. The Board of Directors has consistently maintained a strong belief that because of its single-mindedfocus on stroke, DSI is uniquely capable of collaborating with other organizations in the state to marshalresources, activities and commitment to deliver consistent and complementary stroke programs for strokewithin the state of Delaware.DSI “Thumbs Up” Support GroupsFollowing a stroke, individuals may need support in understanding and dealing with stroke-relatedeffects and physical and social functioning. Stroke survivors may be young or older adults, minimally orseverely physically or cognitively impaired, employed or unemployed, and have few family and communityresources available to them. Successful recovery from a stroke is not limited to physical recovery orreturn to the pre-stroke level. Reintegration to normal life at home may require many adjustments. There may be very subtle orvery noticeable changes in personality after a stroke that affect mood, sexual functioning, problem-solving, and sensory changes that affect the quality of life. DSI is pleased to support the “Thumbs Up”support group as an important community service to help stroke survivors and their families learn aboutcommunity resources, get educational information and share their personal experiences in a positive andsupportive environment. Anyone who has recovered from a stroke, their families and friends are welcome to attend. Healthcare professionals are also invited to attend and participate in meetings. Parking and all meetings arefree of charge. The facility is on the first floor and is wheelchair accessibleIf you would like to be considered as a speaker or if your agency would like to sponsor an activity,special lecture or presentation for the DSI support group, please call the DSI office and leave a messagefor Ms. Johnson.Facilitator: Lola Johnson, MS, RN, CS, an advanced practice nurseMeetings: Second and fourth Thursdays of the month, September through June.Time: 7:00 p.m.Location: NewArk United Church of Christ, 300 East Main Street, Newark, DelawareInformation: Call (302) 633-9313 or visit our web site at www.destroke.org4 Delaware Stroke Initiative
  • 7. 2004-2005 DSI BOARD OF DIRECTORSOFFICERS Yakov Koyfman, M.D.Executive Board of Directors NeurosurgeonChair: Lee Dresser, MD Jeffery H. McMahonWilmington Neurology Consultants Financial AdvisorVice Chair: Ross Megargel, DO Anne Murray, MS, RNState of Delaware Emergency Services Director, Emergency Parish Nurse Representative and LiaisonDepartment Physician Edward Sobel, D.O.Secretary/Treasurer: Ellen Barker, MSN, APN Neuroscience Quality Insights of Delaware and Family Practice PhysicianNursing Consultants John Scholz, PhD University of Delaware Physical Therapy and Biomechanics &EXECUTIVE DIRECTOR Movement Disorders Science Doctoral ProgramSusan G. Whitehead Elvce Tavarni Wilmington Trust CompanyMEMBERS OF THE BOARDSandi Bihary, MSN, RN DSI ADVISORY BOARDDirector of Pubic Relations ALLY Development Public Affairs, Jerry Castellano, PharmDAstraZeneca Corporate Director, Institutional Review Board, Christiana Care CorporationBernadette Burns-DayStroke Survivor Linda Swartley, RN, JD Contracts, Christiana Care Visiting Nurse AssociationKathryn M. Curtis, RN, APNChristiana Care Health System, Liaison for the DelawareNurses Association (DNA) Advanced Practice Nurse Council Board MeetingsTodd FellenbaumClinical Specialist/Vascular Division Genetech The Delaware Stroke Initiative (DSI) Board of Director meets quarterly on the first Tuesday ofVance A. Funk, III, Esquire March, June, September and December. All BoardStroke Survivor and Mayor of Newark of Directors’ dinner meetings are held at 6:15 p.m.Glen D. Greenberg, PhD at St. Francis Hospital, 7th and Clayton Streets inClinical Psychologist, N& G Neurobehavioral Group Wilmington.Alberta Iaia, M.D. The public part of the meeting is open toNeuroradiologist anyone who would like to attend. We request that you call the DSI office at (302) 633-9313 at leastKathy Janvier, RN, PhDDelaware Technical Community College three days prior to the meeting so that additional food can be ordered for the number of guestsLola Johnson, MS, RN, CS attending.DSI Support Group FacilitatorMoonyeen Klopfenstein, RN, MSChristiana Care Health System Stroke: A Guide to Information and Resources in Delaware 5
  • 8. STROKE EDUCATIONWhat is a Stroke? The brain is responsible for coordinating how we move, think, speak, hear, see, feel, and behave. Tofunction properly, brain cells must have a continuous supply of oxygen and other nutrients from the blood.When the blood supply is disrupted, even for a few minutes, areas of the brain may be damaged and aperson may suddenly lose some of the functions controlled by that region of the brain. This sudden lossof function is referred to as a stroke. Blood is continuously pumped from the heart to the brain via several artery groups. Within the brain,these arteries branch into smaller and smaller arteries and then into tiny thin-walled vessels (calledcapillaries) which supply the oxygen and nutrients that the brain tissue needs. It is when this continuousblood supply is disrupted that brain cells die and a stroke results. A stroke is the result of a suddenblockage caused by a clot, narrowing of an artery, or bursting of a blood vessel. It is this distinction thatdefines the main types of stroke.Types of Stroke The two main kinds of strokes are known as ischemic and hemorrhagic.Ischemic Stroke Ischemic is the most common type of stroke andconstitutes an estimated 80 percent of all strokes. An An estimated 80 percentischemic stroke results when a blood vessel leading to the of all strokes are ischemic,brain becomes blocked. This type of stroke may occur for resulting when a bloodthree main reasons: vessel leading to the brain 1) A blood clot (or thrombus) forms inside an artery in the brain, blocking the flow of blood. Referred to becomes blocked. as thrombotic stroke, this is the most common type of ischemic stroke. Blood clots form most often in arteries damaged by atheroscelerosis, a disease in which rough fatty deposits, or plaque, build up on the walls of the artery and can break off. These de-posits slow the blood flow and provide a surface that supports the formation of blood clots. 2) A clot forms in the blood, but unlike thrombotic stroke, it originates somewhere other than the brain. This type of stroke is referred to as an embolic stroke and occurs when a piece of clot (an embolus) or plaque fragment breaks loose and is carried in the bloodstream to the brain. An embolus can form in many places in the body, including the heart and the arteries of the neck that transport blood to the brain. The embolus travels through the arteries, which branch off into smaller vessels. When it reaches a point where it can go no further, it plugs the vessel and cuts off the blood supply to the area of the brain that is supplied by that vessel.6 Delaware Stroke Initiative
  • 9. Note: Both thrombotic and embolic strokes are referred to as ischemic because the Warning Signs and blood supply has been blocked to the brain area. You may hear of the term Symptoms of Stroke cerebral infarction in connection with Symptoms of stroke may vary greatly thrombotic and emobolic types of stroke. depending on the cause of the stroke, the Cerebral refers to the brain. An infarct is an specific part of the brain affected, and the area of tissue death due to a blockage of amount of damage. Some common signs blood flow, such as a blood clot. It is also and symptoms following a stroke include: a result of ischemia, which refers to an inadequate blood (and therefore oxygen) g Sudden weakness, numbness, or supply to a certain part of the body. paralysis of the face, arm, or leg— 3) Blood flow decreases to the brain which especially affecting one side of the can result from poor overall blood flow body (hemiplegia, hemiparesis) in the body due to heart damage or g Loss of speech or difficulty talking dysrhythmia (irregular heart rhythm that or forming words, the inability to makes pumping inefficient or ineffective). understand what others are saying This less common type of ischemic stroke (apraxia, aphasia, dysarthria) is called systemic hypoperfusion. g Temporary loss of memory;Hemorrhagic Stroke forgetfulness; amnesia The second main type of stroke is hemorrhagic g Confusionand occurs when a blood vessel in or around thebrain ruptures or explodes. This rupture not only g Sudden blurring or loss of vision,denies the blood from reaching its destination, it particularly in only one eyealso causes a leakage of blood into the brain or the g Sudden severe headaches with noarea surrounding the brain. When this happens, the apparent causecells nourished by the artery are unable to obtain g Unexplained dizziness, loss of balancetheir normal supply or coordination, unsteadiness, orof nutrients and stop functioning properly. Blood sudden falls (especially if associatedbegins to accumulate and clot soon after the rupture with any of the above symptoms)of the artery, causing a disruption of brain functionand potentially increased pressure on the brainitself. Cerebral hemorrhage is most likely to occur inpeople who suffer from a combination of atheroscle-rosis and high blood pressure. Stroke: A Guide to Information and Resources in Delaware 7
  • 10. Transient Ischemic Attack (TIA) About one-third of all strokes are preceded by one or more transient ischemic attacks (TIAs) or whatare sometimes referred to as “mini-strokes.” TIAs can occur days, weeks, or even months before a strokeand are caused by temporary interruptions in the blood supply to the brain. The symptoms resemblethose of a stroke, but occur quickly and last a relatively short time. Because TIAs are temporary and quickly allow the body to return to complete recovery, it is easy toignore them or to believe the problem has disappeared. However, the underlying problem that caused theTIA continues to exist. Therefore, attention must be paid to these symptoms and a TIA must be viewed asan early warning sign of a potentially serious stroke in the future. If you or someone you know experiences a TIA, it is important to seek the assistance of a healthcare professional. Call your doctor immediately or go to the closest emergency department, even if thesymptoms seem to be disappearing or getting better.Risk Factors Some of the most common risk factors, which may increase the likelihood of a stroke, are listed below.It is possible that lifestyle modification or medical treatment can change these factors. g High blood pressure g Irregular heartbeat (atrial fibrillation) g Narrowing of the arteries of the neck (carotid) g Heart disease g Previous stroke or TIA Easter Seals Has Your Stroke Solutions. If you or your loved-one has had a stroke, recovery will require multiple therapies. Easter Seals offers physical, occupational, and speech therapies as well as Adult Day Health Services and Assistive Technology all in one convenient location. Adult Day Health Services Outpatient Rehabilitation Therapies Adult Day Health Services provides a safe alternative to long Physical Therapy - treatment to improve strength, flexibil- term care for stroke survivors that should not be home alone. ity, tone or balance and coordination in walking or moving. The program includes activities, meals, and nursing Occupational Therapy - Finding new ways to use your supervision in a comfortable and dignified environment. hands and upper body to perform tasks like dressing, eating, bathing, or preparing meals. Assistive Technology Services Assistive Technology, referred to as AT, is devices or tech- Speech Language Therapy - Help with communicating with language or speech, and exploring alternative means niques used to increase, maintain or improve functional of communication. capabilities of individuals with disabilities. For more information call 800-677-3800 Easter Seals is a proud recipient of United Way www.de.easterseals.com support through designated contributions.8 Delaware Stroke Initiative
  • 11. g Diabetes g Smoking g Excessive alcohol use g High cholesterol level g Obesity and failure to exercise 30 minutes daily three times per week g Prolonged and extreme stress g Substance abuse (cocaine, crack, heroin, speed, amphetamines, diet pills or ecstasy) g Use of oral contraceptives (especially for women who smoke) There are some risk factors based on hereditary factors, which cannot be controlled by lifestylechanges or medication. These factors relate to demographic categories for which thereis an increased likelihood of experiencing a stroke. g Age—Two thirds of strokes occur in persons over the age of 65 g Gender—Stroke is 25 percent more common in men than women g Race—African Americans have a higher rate of stroke than Caucasians and more often suffer strokes at an earlier age g Sickle Cell diseaseReducing Your Risk Below is a list of suggested measures to controlyour stroke risk through medical treatment as well ashealthy lifestyle modifications. g Regular medical check-ups g Control blood pressure g Stop smoking g Improve diet—avoid excess fat and sodium g Limit alcohol intake g Engage in appropriate exercise 30 minutes per day, three times per week g Take medicines as directed g Reduce and better manage stress g Never use drugs such as cocaine, crack, heroin, ecstasy or speed g Control diabetes Stroke: A Guide to Information and Resources in Delaware 9
  • 12. STROKE IS A BRAIN ATTACKby Cynthia CallaghanPublic Affairs, AstraZeneca Pharmaceuticals LP By the time you finish reading this article, three Americans will suffer and one will die from a brainattack/stroke. Annually, brain attacks are the leading cause of serious, long-term disability in the UnitedStates and the third leading cause of death (160,000 fatalities annually). Brain attacks strike approximately750,000 Americans every year, with the highest rates occurring in the southeastern part of the UnitedStates, commonly referred to as the Stroke Belt. As a communication professional, my job is to create educational initiatives that convey importantinformation and key messages to targeted audiences through national and local media efforts, andgrassroots programs (e.g., the Delaware Stroke Initiative). This dedicated group of volunteers provideaccurate information about prevention, detection, and treatment of the disease. In the case of brainattack, the key messages we deliver inform the public about risk factors, symptoms, and treatmentoptions.Reducing the Risk of Brain Attack DSI develops educational materials to reach the public Brain attacks strikethrough various communication vehicles, such as the media. approximately 750,000These vehicles provide individuals with tools and information Americans every year,that can empower them to change their lifestyles (e.g. quit with the highest ratessmoking, lose weight, reduce high cholesterol and excessivealcohol consumption, and stop illegal drug use). We encourage occurring in thepeople to see their doctors and health care providers about southwestern part oftreatment for modifiable risks (e.g. hyper-tension, diabetes, the United States,atrial fibrillation, carotid artery disease, and transient ischemic commonly referred to asattacks). Of course, some risk factors are uncontrollable, such the Stroke Belt.as age, gender, race, and family history, but we strive to ensurethat those at risk are aware.Stroke is a Brain Attack and a Treatable Emergency Since time between onset of brain attack symptoms and treatment is critical to survival andminimization of disability, the public needs to be well informed of the symptoms and the urgency to call911 if they feel the onset of symptoms. The warning signs that accompany a brain attack occur suddenlyand can include: g Sudden numbness or weakness of the face, arm or leg, especially on one side of the body; g Sudden confusion or trouble speaking or understanding speech g Sudden vision problems in one or both eyes; g Sudden trouble walking, dizziness, or loss of balance or coordination; and g Sudden severe headache with unknown cause.10 Delaware Stroke Initiative
  • 13. Treatment Options Exist For those who suffer a brain attack and reach the hospital within three hours, treatment options areavailable. The type of treatment administered will depend on the type of stroke and the length of timesince onset. Therefore, it is important that individuals be aware of when their symptoms began andreceive medical attention as quickly as possible. For example, if an individual experiences an ischemicbrain attack (blood vessel blockage in the brain) and reports to a hospital within three hours, he/she maybe eligible for intravenous thrombolytic therapy. However, thrombolytic medications, such as t-PA (tissueplasminogen activator), should not be given to those experiencing a hemorrhagic brain attack/stroke(rupture of a blood vessel).New Treatments on the Horizon Patients should also be aware that there are new treatments under investigation called neuro-protective agents, which minimize the effects of an ischemic cascade. These agents provide acomplementary clot busting and brain protection mechanism and may be a benchmark for the future ofacute stroke treatment. At the Delaware Stroke Initiative, our most important job is not just communicating what we knowabout brain attack, but rather to support research that will help us better understand the disease whiledeveloping new, innovative medications to treat and minimize its long-term effects. In the interim, we willcontinue to provide the public with accurate information through our ongoing commitment to brain attackresearch, awareness, and treatment. WILMINGTON NEUROLOGY C O N S U L T A N T S, P. A. WILLIAMS SOMMERS, D.O.* LEE P. DRESSER, M.D.* ■ ▲ PAUL A. MELNICK, M.O. *✝ RICHARD J. SCHUMANN, JR., M.D.* WILLIAMS SCHRANDT, M.D.* ■ ● N. JOSEPH SOMMERS, D.O. LEE P. LVIN LLOYDM.D. * K. A DRESSER, , M.D. N. JOSEPH SCHRANDT, M.D. RICHARD J. SCHUMANN, JR., M.D. K. ALVIN LLOYD, M.D. Main Office METROFORM MEDICAL COMPLEX 620 Stantion-Christiana Road, Suite 302 • Newark, DE 19713 302.892.9400 Main Office phone • 302.892.9407 fax METROFORM MEDICAL COMPLEX Other Locations 620 Stanton-Christiana Road, Suite 302 • Newark, DE 19713 ST. FRANCIS MEDICAL OFFICE BUILDING phone • (302) UNION Hfax (302) 892-9400 892-9407 OSPITAL OF CECIL COUNTY 7th and Clayton Streets, Suite 217 106 Bow Street Wilmington, DE 19805 Other Location Elkton, MD 21921 ST. FRANCIS MEDICAL OFFICE BUILDING * Diplomate American Board of Neurology • ✝Diplomate American 217 of Electrodiagnostic Medicine 7th & Clayton Streets, Suite Board ■ Wilmington, DE 19805 Added Qualifications in Neurophysiology • ●American Board of Clinical Neurophysiology ▲ American Board of Sleep Medicine Stroke: A Guide to Information and Resources in Delaware 11
  • 14. THE BASICS OF BRAIN ATTACKby Yakov Koyfman, M.D.Delaware Neurosurgical Group A stroke is a “Brain Attack” or a cerebrovascular event caused by an interruption of blood flow to thebrain—from either a clot inside the artery (ischemic stroke) or from a rupture of an artery in the brain(hemorrhagic stroke). When the blood flow to the brain is interrupted, the affected brain cells are impairedand can no longer function. The brain requires about 50 percent of the total blood supply that flowsthrough the body. The brain lacks the capacity to store glucose, or sugar, that is converted to energy thathelps the brain to function. The brain is unable to store oxygen and needs a steady supply to keep thebrain healthy and functioning normally.Circulation of Blood in the Brain Normally, the brain receives a constant supply of blood that provides essential nutrition and energy(glucose) as well as oxygen. If the brain does not receive a constant flow of blood, brain cells begin tostarve and fail to function. This is called ischemia. During a brain attack/stroke, blood flow is cut off orreduced to the core, or important parts of the brain, supplied by the artery that is obstructed by theblood clot (infarction). In this core ischemic area, brain cells die within 3-5 minutes! There is a large areasurrounding the core known as the penumbra. Brain cells in this area are stunned and disabled, but stillalive. It is very important to know that brain cells can survive in this ischemic penumbra for up to 3-6hours before dying. This is the area emergency teams try to salvage and treat when the patient is broughtin following a stroke.Early Warning Signs The most prominent warning sign of hemorrhagic stroke is a severe headache—“the worst headacheof my life!” To help distinguish this headache from common headaches, we use the saying: “First, Worst,and Cursed!” It is absolutely imperative to seek medical attention if this is the first severe headache, worstsevere headache, or if you feel cursed with these symptoms. Sentinel headaches are much harder to rec-ognize. These headaches are often caused by much smaller or “mini leaks” of blood in the subarachnoidspace of the brain or by the effects of an aneurysm enlarging. Most individuals are unaware of an aneu-rysm in the brain until it leaks or ruptures. If there is something unusual about a headache, it is absolutelymandatory to call the doctor.12 Delaware Stroke Initiative
  • 15. A 10-POINT PLAN FORISCHEMIC STROKEby Robert N. Albino The risk of stroke increases with age, especially after age 65. My mother and father at ages 72 and 69years, respectively, are moving onto the steep part of the curve for stroke. Like others in their age group,they are fearful of strokes, and for good reason. While they are more likely to die of a heart attack, theyare much more likely to be seriously disabled by stroke. Their concern was heightened after the recentstroke of a long-time friend, who they saw reduced from vigorous health to significant impairment in amatter of days. Knowing of my work in stroke, they asked me what they could do to reduce the risk ofstroke and what they should do in the event of a stroke. This is the Ten-point Plan for Ischemic Stroke thatI developed for them.1. Manage your Risk FactorsPersonal behaviors that increase stroke risk are essentially the same as for heart disease: a high-fat diet,smoking, excessive alcohol consumption, a sedentary life-style, and illicit drug use. Also, uncontrolled orunmanaged high blood pressure, diabetes mellitus and atrial fibrillation or other cardiac or peripheralartery disease contribute to stroke risk.2. Know the Signs and SymptomsSymptoms include: Sudden weakness or numbness of the face, arms or legs, especially on one side;sudden difficulty seeing, especially out of one eye; sudden confusion, trouble speaking or understanding;and nausea, headache or dizziness with sudden onset.3. Don’t Ignore TIAsA “TIA” or transient ischemic attack or “mini-stroke” is a stroke in which the signs and symptoms resolverelatively promptly without apparent permanent effect. Don’t ignore even a single TIA; it indicates thatconditions are ripe for a stroke and is a strong predictor of future stroke. Usually, it is only a matter of timeuntil the “big one.” In the event of a TIA, see your doctor promptly.4. Involve Your PhysicianMany physicians are very attentive to stroke risk factors, other aren’t. Raise the subject yourself. Ask forhim to listen to your carotid (neck) arteries for telltale signs of narrowing. Ask if any brain imaging studiesare appropriate, and, if you have any of the diseases that add to stroke risk ask if it is appropriate to usemedical therapy to reduce that risk.5. Know Where to Go in the Event of a StrokeHospitals are not equal when it comes to treating stroke. Look for a hospital with a dedicated strokecenter, preferably headed by a stroke neurologist. The facility must absolutely have 24-hour access to CTscanning (including a CT technician) and experience in administering tPA for stroke. Ask the hospital, askyour doctor, and visit the hospital. Do it now—not when you need it. Stroke: A Guide to Information and Resources in Delaware 13
  • 16. 6. Know How to Get ThereAmbulance has certain advantages and disadvantages. First, it takes time for the ambulance to get toyour location. Second, not all ambulances will take you to the facility of your choice. Some localities havea “closest facility” policy and that could cost valuable time if you have to be taken to a second facilityto receive tPA. Also, even when ambulances will normally take you to the facility you specify, or to adesignated stroke facility, that facility may be on “diversion,” meaning that they are temporarily sendingpatients to an alternate facility. If you learn that the policies in your area don’t meet your needs, makeother arrangements to get to the hospital.7. Know How Long You HaveStroke is a progressive process. The earlier you intervene, the better your chances for a favorableoutcome. The only approved medical therapy for stroke is the “clot buster” tPA, which must beadministered within three hours of stroke onset. Considering it takes about an hour for the best ofhospitals to do the necessary tests to determine whether or not you qualify for tPA, you need to reach thehospital within two hours of onset at the absolute latest. But don’t run the clock down.I suggest you have no more than 15 minutes to decide whether your symptoms constitute a TIA or thereal thing. If the signs and symptoms have not resolved completely within this time, go to the hospital.(NOTE: At the first sign of stroke, write down the time that symptoms began, put it in your pocket, and takeit with you to the hospital. More than a few patients have failed to receive tPA solely because it could notbe conclusively determined when the stroke began.)8. Know What to do at the HospitalBe sure you are getting prompt attention. You should be treated with the same urgency as a heart attackpatient. If you aren’t, speak up. Loudly. In order to receive tPA you will need a physical exam, medicalhistory, certain blood tests and a CT scan (not necessarily in that order). Make sure these are startedpromptly, certainly within 15 minutes of arriving at the hospital.9. Participate in TrialsIf for some reason you are ineligible to receive tPA and are offered an alternative, take it. Many hospitalswith stroke centers participate in clinical trials of new, experimental therapies—and there is little to loseand potentially much to gain from such therapies. If you are offered a non-medical therapeutic option, Iwould give you the same advice. Trust the hospital and the treating physician to recommend a therapythat is the best available in your situation.10. Do Your RehabIf you do have a stroke that results in any deficit, you will almost certainly be prescribed therapy toimprove function. Do the therapy. Religiously. The sooner therapy starts the more effective it is.14 Delaware Stroke Initiative
  • 17. PREVENTING STROKEby Robert W. Frelick, M.D.DSI Board of Directors The most common type of stroke is caused by lack of blood supply to one or more vessels of thebrain. A stroke is more likely to occur after the age of 50. It is often associated with a history of highblood pressure (hypertension) and a disturbance of the blood lipids (most commonly measured by thelevel of cholesterol in the blood). Those lipids develop into plaques that slowly grow to obstruct one of the main arteries to the brain, or within one of the smaller end arteries to an area of the brain. These smaller arteries A stroke is more likely to in the brain are called “end arteries” because they lack the occur after the age of 50. risk capillary network found in most other parts of the body. It is most often associated An obstruction of one of these small end arteries causes with a history of high damage to the part of the brain that it supplies. blood pressure and a Bleeding from a leak in one or more of the blood disturbance of the blood vessels to the brain may also cause the lack of blood to the brain. This frequently can be related to a small “bubble” or lipids (measured by the aneurysm on a blood vessel. Such a finding may be present level of cholesterol). because of a genetic abnormality or blood infection, or the cause may be unknown. The aneurysm may rupture at any age but more frequently occurs after age 50. Such bleedingcan be stimulated by high blood pressure, stress or a blow to the head. A brain tumor—whether a primarycancer or secondary to cancer elsewhere in the body—can also cause obstruction to a blood vessel andcause a stroke-like attack.Brain Attack/Stroke Risk Factors Abnormal blood pressure (hypertension), increased weight or obesity, elevated cholesterol, and highblood sugars are risk factors that are often present years before a stroke. Surgeon General David Satcher, M.D., reported recently that approximately 300,000 American die eachyear from illnesses caused or worsened by obesity. Satcher estimates that approximately 60 percent ofadults are overweight. Certain drugs and chemicals can also increase the risks for brain attack/stroke; e.g., nicotinefrom tobacco, estrogen in birth control pills and the use of certain illicit drugs. People using warfarin(Coumadin) for atrial fibrillation should carefully control their medication to prevent complications. Lack of oxygen to the brain, whether mountain climbing, scuba diving, or from smoke inhalation from afire can also have adverse effects and stimulate a brain attack/stroke.Following safety guidelines during these activities and avoiding “risk taking” is recommended. Early preventive measures can reduce the risk of a stroke or delay its appearance.The carotid arteries and other major blood vessels in the neck can also be tested to determine if ablockage is present. The blockage must be more than 70 percent to significantly reduce the blood supplyto the brain. A neurosurgical consultation is indicated to review treatment options. Stroke: A Guide to Information and Resources in Delaware 15
  • 18. Other Diseases Associated With Brain Attack/Stroke Certain diseases have been associated with a brain attack/stroke; e.g., diabetes, heart disease,hypertension, renal problems, sickle cell disease, diseases of the blood vessels, Lupus, and certaincancers. These diseases are tied to genetic factors and can often be anticipated based on family history.This is especially true for hemangiomas and aneurysms. Individuals experiencing any of the above riskfactors should consult their physician or health care provider.Healthy Lifestyles Adopting a healthy lifestyle can reduce the risk of stroke as well as many other chronic diseases.An important part of good health is diet. Eat a nutritious diet that is relatively low in saturated fats andexcessive sugars. Select reasonable portions, reduce calories, and increase fresh fruits and vegetables inthe daily diet. It is time to “get off the couch” and engage in daily exercise activities. Use nearby sidewalks andwalking trails, and identify and include physical activity on the job. Set a goal of exercising at least30 minutes at least three times each week. Keeping physically active is recognized as an importantpreventive measure against stroke. The wisdom of avoiding exposure to tobacco products (cigarettes, cigars, chewing tobacco) andabuse of alcohol (more than two drinks of liquor, two glasses of wine, or two beers) and addicting drugs(Cocaine, Crack, Heroin, Speed, Amphetamines, diet pills or Ecstasy) is clear.Annual Physical Exams and Medical Follow-up Seek expert medical advice. Have regular check ups and stay under medical surveillance. Follow theadvice of your physician and other health care providers regarding diet, cholesterol and lipids, weight,diabetes, blood pressure control and cardiovascular diseases (e.g. brain attack/stroke and heart disease)to reduce known and modifiable risk factors. Some people may be prescribed a baby aspirin a day, orother medications, to reduce the risk of a stroke or heart attack.Taking Action When You Have Symptoms It is very important to be aware of and take immediate action to seek help in a hospital emergencydepartment at the first signs of a brain attack/stroke. They include: g Sudden weakness or numbness g Sudden change in vision g Sudden difficulty speaking g Sudden unusual headache g Sudden dizziness Do not wait for such symptoms to go away before taking action because they may gradually becomeworse. Call 911 immediately for transport to the nearest hospital emergency department that treatsbrain attack/stroke. Remember that there is a 3-hour time period for the most effective treatments bycompetent medical help to be effective for the best outcome.16 Delaware Stroke Initiative
  • 19. QUIT SMOKING TO REDUCE STROKE RISKby Linda Swartley, RN, JDAdvisory Board, Delaware Stroke Initiative Cigarette smoking is a known risk factor for stroke. Quitting smoking is the single most important stepyou can take to lower your chances of stroke, cancer, and heart attack. Once you make up your mind to quit, set a date one-week from today and mark it on your calendar.Prepare to stop smoking by gradually cutting down 1 to 2 cigarettes per day. When you reach the quitdate on your calendar, get rid of all your cigarettes, ashtrays and smoking paraphernalia. Tell your family,friends and coworkers you want their support to quit. Ask them not to leave cigarettes around, and not tosmoke around you. Change your habits and remove all cigarettes, lighters, and ashtrays from your home,car, and anywhere else you usually smoke. Talk to your health care provider about aids to assist you tostop smoking. The Food and Drug Administration has approved nicotine substitutes as aids to stop smokingincluding the nicotine gum and nicotine patch, available over the counter, and the nicotine inhaler, andnicotine nasal spray inhaler, available by prescription. Bupropion SR also called Zyban is available byprescription as well. Talk to your health care provider and read the product literature carefully. Thesemedications will double your chances of success in quitting. Programs are available at hospitals and health centers andthrough the American Lung Association and the American HeartAssociation. Hypnosis and acupuncture are options if given by a For online supportreputable provider. Some of these offer telephone support and to quit smoking, visitfollow-up. the American Lung Be prepared for difficult situations and relapses. Most Association web siterelapses occur within the first three months. When temptation at www.lungusa.orgstrikes, don’t smoke—not even a puff. Beware of situationsthat lessen your resolve: being around other smokers, drinkingalcohol, and weight gain. Many smokers gain weight—usually lessthan 10 pounds. Don’t let weight gain distract you from the main goal of quitting. As Mark Twain once said,“Giving up smoking is easy, I’ve done it a thousand times.” Learn new coping behaviors. Change your routine. Reduce your stress by exercising, reading a goodbook, or taking a hot bath. Reward yourself by doing something enjoyable every day or buy yourself somesmall treat with all the money you save by not smoking. When you are tempted to smoke, remember theurge will pass, usually within 15-20 seconds. Brush your teeth so your mouth feels fresh. Every day gets alittle easier. If you do relapse, get right back on track and don’t give in or give up. Quitting takes a lot ofhard effort, but you can quit. You will realize the benefits almost immediately, and you will have reducedyour risk for having a stroke. Stroke: A Guide to Information and Resources in Delaware 17
  • 20. THE FAMILY PHYSICIAN’S ROLEby Edward R. Sobel, D.O.Director, Health Care Quality Improvement Program, Quality Insights of DelawareFamily Practice Physician The family physician is among the most frequent medical contacts for the patient who may be at riskfor a stroke. If we believe that the best stroke is the one that doesn’t happen, then the patient’s primarycare physician is the most appropriate health care provider to do aggressive screening of patients at riskfor stroke. When the risk factors have been identified through careful evaluation, there is much that canbe done to benefit the patient. Monitoring for stroke risk is not a one-time event. Because health is a fluid condition, it requires two-way, ongoing communication between the patient and the physician. Patients generally provide a historyand assessment when they initially see a physician. It is important for the physician to inquire and thepatient to provide ongoing updates on both personal and family history for conditions that would suggestincreased risk of stroke. Nor should stroke screening be considered an isolatedproblem, since the risk factors for stroke are also risk factorsfor heart disease and many other conditions. It is important to Monitoring for strokehave frank discussion and treatment of these risk factors and risk is not a one-timeconditions. event. It requires There are important risk factors for stroke which cannot two-way, ongoingbe modified, including age, gender, heredity, race, previous communication betweenstroke or heart attack. However, working together, the patient the patient andand physician can significantly modify risk factors such as high physician.blood pressure, diabetes, carotid or other artery disease, atrialfibrillation, heart failure, cardiomyopathies, TIAs, certain blooddisorders, and high cholesterol that are amenable to treatment.Aggressive management of these risk factors will significantly reduce the risk of stroke. Other risk factors that require a personal decision to make lifestyle changes include tobacco use,physical inactivity, obesity, excessive alcohol use and use of illegal drugs. There are resources within themedical and general communities to help patients reduce their risk for illness. Unfortunately, once a stroke occurs, patients often express remorse at not doing more to reduce theirrisk before the event. Most commonly, the factors that can be modified must be addressed in a preventivefashion over a long period of time to be effective. This requires commitment by the patient and guidanceby the physician. It is often difficult for patients to set and maintain long-term risk reduction goals, butawareness of the potentially catastrophic change that stroke causes in families can be a strong reminderof the importance of long-term goal setting. It is therefore important that patients and physicians set goalsearly in life to reduce the risk of this often-disabling disease.18 Delaware Stroke Initiative
  • 21. ATRIAL FIBRILLATION: UNDERSTANDING &MANAGING AN IRREGULAR HEARTBEATby John Pergolini You may have experienced a relatively common heart disorder called atrial fibrillation (also known asAF or A-Fib). AF can be a dangerous condition if not diagnosed, treated, and monitored. In AF, the upperchambers of the heart contract rapidly and irregularly. This can lead to the formation of small clots inthe heart. If the clot is pumped to the brain, it may travel in the small vessels of the brain until it ends upblocking blood flow to that part of the brain. The clot in the artery is known as an “infarct” and preventsthat part of the brain from working normally, resulting in a “brain attack.” AF is, therefore, considered amajor risk for stroke, particularly in older adults.Check for an Irregular Pulse 1) Place your left hand on a flat surface, palm Symptoms of AF side up. 2) Run two fingers of your right hand along the Unless an irregular pulse is identified, AF outer edge of your left wrist below the thumb, may occur without noticeable symptoms. to just below where your hand and wrist When the heart beats too fast with the meet. irregular rhythm, it may cause the following: 3) Press down with your fingers until you feel g Heart palpitations: a sudden pounding, your pulse. DO NOT press too hard or you will fluttering, or racing sensation in your not be able to feel the pulsation. Move your chest, which may feel like “butterflies.” fingers until the pulse is easiest to feel. 4) Continue to feel for one minute. As you feel g Dizziness: feeling light-headed, like your pulse beat, begin tapping your foot to you’re going to faint. The best response the beat of your pulse in a steady rhythm. is to sit or lie down until the feeling 5) Notice if your pulse is beating in the same passes. regular rhythm as your foot (or a clock). g Chest pain: a highly variable sensation 6) If your pulse drops a beat, skips or speeds of discomfort, pressure, or pain in the up without a pattern, make an appointment chest. with your health care provider as soon as g Shortness of breath. possible and provide this information. If you experience any of these symptoms, check your pulse and contact a health care provider. Remember that AF can cause a stroke. Stroke: A Guide to Information and Resources in Delaware 19
  • 22. Who Gets AF? Atrial fibrillation affects more than 2 million Americans. In fact, as many as 9 percent of Americansover the age of 65 may have AF, which can be associated with rheumatic heart disease, myocardialinfarction (MI) and heart surgery.How Do You Get AF? AF can occur in healthy individuals. But most cases are associated with underlying heart disease inolder adults. AF can also occur following valve replacement and heart surgery, infections of the heartcalled endocarditis, certain cardiac procedures and, occasionally, in individuals with thyroid disorders.When Should You Suspect AF? Not everyone with AF experiences the same symptoms. In fact, some people may have AF for yearswithout really knowing it. It is important to recognize the symptoms of AF so you can discuss them withyour health care provider and receive appropriate treatment to prevent a stroke.What are the Risks of AF? Even in cases where symptoms are barely noticeable, the consequences of AF can be serious if it isleft untreated. AF may increase your risk of stroke by more than five times. It can also lead to heart failure,a condition in which the heart is unable to pump enough blood to support the rest of the tissues of thebody. Management of AF The good news is that AF can be managed. Many people continue to live normal lives with AF. Returning your heart rate to normal with electrical stimulation or medication can restore your normal heart rhythm or slow the heart rate. Anticoagulants can prevent harmful clots from forming in the heart and help reduce the risk of stroke. Your doctor may use one or more methods to manage your AF. Be sure you understand all the risks and responsibilities involved before you begin any treatment. Know the early warning signs of stroke. Treatment for AF and stroke can be more effective if given quickly. When it comes to Atrial Fibrillation and stroke, “Time is brain.”20 Delaware Stroke Initiative
  • 23. HAVING A STROKEby Vance Funk, Esq.Mayor of Newark, Delaware Having a stroke is a unique experience. At age 50, within10 minutes of experiencing my stroke, I was totally paralyzed A few weeks before myon the right side of my body. There was bleeding in the brain, stroke, my right eye wasthe fear of death, but no white lights. I was alive and wondering very blurry and for a fewwhat happened and how it could happen to me. seconds it seemed like After 8 years in a row without one sick day, my healthseemed to be fine. A few weeks before my stroke, my right eye I lost my vision...was very blurry and for a few seconds it seemed like I lost myvision. It went away, but it was enough of a scare for me to callmy eye doctor. He examined my eye, gave me a prescription for reading glasses and, although blurredvision is a classic early warning sign for stroke, did not send me to the hospital. He did ask me when wasthe last time I had a physical (1971 when I came back from Vietnam) and told me to get a physical. The importance of detecting the early warning signs of a stroke cannot be understated. A clearunderstanding of the signs and prompt medical attention will go a long way toward reducing the numberof strokes and the damage they cause. Those signs are: 1) Weakness, numbness or paralysis of arms or legs. 2) Sudden blurred vision or blindness in one eye. 3) Difficulty speaking or slurring of speech. 4) A severe headache that occurs without apparent reason. 5) Loss of balance or falling without apparent reason. It is not necessary to have more than onesymptom. In my case, blurred vision in my right eyehappened several days before the paralysis occurredin my right arm and leg. An understanding of thestroke signs could have prevented some of thedamage that followed. The next time you, your friend or relativeexperiences a stroke sign, call 911 immediately. Youmay save a life and improve the quality of that life. Stroke: A Guide to Information and Resources in Delaware 21
  • 24. MY STROKEby M. Bernadette Burns Day I remember my stroke like it was yesterday, and it has been 19 years. I was young—23 years old–andhad a 5-year-old son. I enjoyed cruising with my girlfriends in my like-new yellow Camaro, and I lovedto dance! I was also one week away from marrying my Junior High School sweetheart. Part of mypreparation for my wedding involved losing weight and I unwisely combined diet pills with birth controlpills. My stroke took me completely by surprise. Although I was “warned” with horrific headaches almostevery day for about a week, in my naivete I ignored them. My son and I were returning to the home weshared with my grandmother in a New Castle suburb when I became nauseated. Fortunately, I had to pullover to correct my son’s behavior, and it was then that the stroke struck. I spent several days in the hospital, then transferred to a rehabilitation hospital for physical andoccupational therapy. It was there the realization began to sink in: I could not use my left hand or leg.I became angry and bitter and tormented with “Why me?” I hated being in rehabilitation and ultimatelycheated myself by cheating on my occupational therapy—using my right hand instead my left when noone was looking. More years of therapy followed, most recently with therapy students at the Universityof Delaware who helped me improve my gait. I had to learn to focus intently on my walking, which issometimes impossible in the fast paced world of today. But still, the “why me?” haunted my thoughts foryears to come. I married and had two more boys, and now have two grandsons. I also divorced and found acareer in Real Estate that I am passionate about. I found and married a wonderful man, acquiring threestepchildren. But something was still missing: WHY did I have a stroke? Two years ago I found the answer. In August of 1999, I happened to read an article in the News Journalabout a conference sponsored by the Delaware Stroke Initiative’s Board of Directors featuring SenatorJoseph Biden to discuss what the State of Delaware could do to promote statewide education andprevention through our hospital system. I “crashed” the luncheon at the Hotel du Pont and came away witha tremendous amount of information including DSI’s mission and their goals of education, prevention, andbest practice management of stroke. After learning what DSI is, and that there would be opportunities to talk with recent stroke victimsabout life after stroke, I wanted in. I drafted a letter to Ellen Barker, the founder of DSI, requesting to be onthe Board. She accepted my proposal and I joined the DSI Board of Directors, recruiting others like myselfand helping with DSI activities and fundraising. Although I cannot dance like I used to, my passion now is showing other stroke survivors that there islife after stroke. I am living proof.22 Delaware Stroke Initiative
  • 25. CALL 911 AT THE FIRST SIGN OFA BRAIN ATTACK/STROKEby Ellen Barker, MSN, APNNeuroscience Nursing ConsultantsFounder of Delaware Stroke Initiative Most Americans immediately recognize the signs and symptoms of a heart attack, or myocardialinfarction (MI). They may have crushing, viselike chest pain that radiates down the arm or neck, feelinglike they have acute indigestion, turning ashen in color, sweating or feeling clammy, faint and anxious— a“feeling of doom.” Many patients having a heart attack have described the event as feeling like deathis imminent. Bystanders usually are able to see visible signs that a person is having a heart attack. Therecognition of a possible heart attack by the individual or observers prompts a quick call to 911. Stateemergency medical system (EMS) paramedics respond in minutes for rapid transport of the individual tothe emergency department (ED) for treatment. In stark contrast, few Americans recognize the early signs and symptoms of stroke. The stroke is eithernot recognized or not understood as a medical emergency. Only about 50 percent of patients having astroke call 911 for emergency transport. Today, stroke is considered a “brain attack.” A brain attack is a medical emergency and the EMSin Delaware are well prepared to respond and transport the patient with a brain attack with the sameurgency as they transport a patient having a heart attack. The first drug approved by the Food and Drug Administration (FDA) for the emergency treatment ofstroke was Activase, a tissue plasminogen activator commonly known as tPA. This medication is called a“thrombolytic.” When given intravenously (IV), the drug has the ability to dissolve the clot caused by anacute ischemic stroke (AIS) or a blood clot that is obstructing the flow of blood in the brain. An important part of emergency treatment is to give tPA within three hours of the onset of the strokesymptoms. One of the side effects of tPA is that a small percentage of patients get bleeding in the brain.When tPA is administered beyond the three-hour time frame, the incidence of bleeding may increaseand the beneficial effects of tPA are not predictable. Therefore, patients who are having a stroke causedby a clot that is preventing normal circulation to the brain and are a candidate for tPA must arrive in theemergency department within three hours! Thrombolytic treatment is not indicated unless the following conditions are met: 1) The diagnosis of AIS can be established by a physician who has expertise in the diagnosis of brain attack/stroke. 2) A CT of the head is completed with a reading by a physician with expertise in evaluating a head CT. 3) The treating hospital Emergency Department is readily able to handle the treatment and potential complications that may develop. 4) The treating hospital ED has adequate emergency resources for patient management. Stroke: A Guide to Information and Resources in Delaware 23
  • 26. In Delaware, both the paramedics and the EMS dispatchers who receive the 911 call have been taughthow to respond appropriately to callers who are having a brain attack/stroke. As soon as they arrive at thescene, the paramedics will check to protect the patient’s airway, administer oxygen, protect a paralyzedarm or leg, elevate the head of the stretcher, provide emergency care and reassure the patient. Theyare able to provide rapid on-the-scene identification or diagnosis of a brain attack/stroke and rapidevacuation. “Time is brain.” The paramedics will attempt to determine the exact time of onset. The three-hour window of opportunity begins with their timing of the first symptoms described by the patient orfamily. Family members are urged to come to the hospital because history and information about the patientis important to the treating ED team The receiving hospital will be notified by the paramedics that apatient is enroute. This call alerts the ED staff to prepare the team of experts for emergency treatment ofthe patient with a brain attack/stroke. A checklist to perform thrombolytic or tPA therapy is prepared. If the patient has had a previous brain attack/stroke caused by a hemorrhage in the brain at any time, a previous ischemic stroke from a blood clot within An important part of the past year, a known brain tumor, active bleeding anywhere emergency treatment in the body, or a suspected aortic dissection, tPA will not be is to give tPa within given. There are other relative contraindications that could also three hours of the onset prevent the patient from receiving tPA. These will be carefully of stroke symptoms to reviewed. If the patient begins to display rapid improvement dissolve the clot that and is experiencing a mini-stroke or transient ischemic attack is preventing normal (TIA), tPA will not be necessary. Only a hospital emergency department is prepared circulation of blood to provide emergency treatment for a brain attack/stroke. to the brain. To receive appropriate emergent care, call 911 for rapid transportation and treatment.Call 911 ImmediatelyIf someone is experiencing any of the early warning signs of brain attack/stroke, call 911 immediately.Stroke warning signs include: g Sudden weakness, numbness, or paralysis of the face, arm, or leg on one or both sides of the body g Sudden blurred vision, or blindness in one or both eyes g Sudden difficulty speaking, slurring or speech or difficulty understanding g Sudden severe headache with onset that occurs without apparent reason g Sudden loss of balance, dizziness, or falling without any apparent reason24 Delaware Stroke Initiative
  • 27. EMERGENCY MANAGEMENT OF STROKEby Howard A. Rubinstein, M.DEmergency Medicine Physician Eileen Smith was washing the dishes when she dropped the plate out of her right hand. Her hand feltsuddenly weak and numb. She went to sit down and found her right foot scrapping on the floor. She triedcalling her husband and noticed that she was having difficulty getting words out. She knew what shewanted to say but the actual words were escaping her. Her husband wanted to take her to the hospitalbut she refused. She just wanted to rest. After about an hour, the symptoms started to disappear andMrs. Smith decided to make a doctor’s appointment to have a check up. One week later she suffered amassive stroke and remains paralyzed on her right side. She has been placed in a skilled nursing facility,as her husband is not able to care for her at home. Does the above scenario sound believable? It should, as it’s a story we hear many times in theEmergency Department (ED). A large percentage of the people do as Mrs. Smith did in the abovescenario. They wait at home, hoping that the symptoms will disappear. Most do not get any additionalmedical care because of denial, fear, or ignorance. Stroke is the third leading cause of death in the United States and the leading cause of adult disability.Every 53 seconds a stroke occurs in the U.S. Every 3.3 minutes someone dies as a result of stroke.Until recently, the outcome from ischemic stroke (the type caused by a clot or embolism rather thanan aneurysm or bleeding) was determined by its natural course with the additional medical supportivemeasures. This has changed over the past five years. Not only is detection and prevention improved, butnew treatments for the acute stroke are also available. Prevention is the mainstay of stroke treatment. Ms. Smith was having a TIA (transient ischemic attackalso known as a “mini-stroke”). By definition, a TIA is brief, lasting only 7–10 minutes. At the time of a TIA,medical attention should be sought as soon as possible. There are a number of reasons for this: 1) It isunknown if this is truly a TIA or the beginning of a full stoke; 2) the source of the embolus must be found;and 3) treatment such as anticoagulation may be necessary to prevent further TIA’s or strokes. Theseemboli can come from the heart or carotid arteries, or can indicate a problem in the natural clotting of theblood. In the Emergency Department, a number of tests are quickly performed on the stroke/TIA patient. Theamount and order of the tests are determined by the severity of the symptoms. A CT scan of the brain isimmediately done to be certain that no bleeding has occurred. Blood and other tests such as ultrasoundmay also be performed. Depending on the results of these tests, a drug such as heparin (which is aanticoagulant or “blood thinner”) may be started in the ED to protect against further emboli or clots.Specialists such as neurologists and neurosurgeons will be called in consultation with both the ED andthe patient’s private physician. The most significant and exciting advancement in the treatment of brain attack/stroke is the use ofthrombolytics or “clot busting” drugs. Tissue Plasminogen Activator tPA or is the same drug that is usedin treating heart attacks. If the brain attack/stroke is caused by a blood clot, this drug will dissolve theclot and allow increased blood flow to the area of the brain originally affected by the clot. This is the first Stroke: A Guide to Information and Resources in Delaware 25
  • 28. real treatment for patients who are actively having a brain attack/stroke. Studies have shown that 15-20 percent more patients will attain a favorable outcome at three months when tPA is used. However,not every patient is a candidate for tPA therapy. There is a strict three-hour window from onset ofsymptoms in which tPA can be given. Thus, it is very important to come to the ED as soon as possibleafter the symptoms begins. Additionally, there are a number of things that will exclude a patient from receiving thrombolytictherapy. Some of these include evidence of intercranial bleeding on the CT scan, uncontrolled highblood pressure, major surgery within 14 days, pregnancy, and a known aneurysm, among other things.The apparent size of the stroke may also influence the decision to use tPA. Using tPA is not without some risk. Studies have shown a 6–7 percent incidence of intercranialbleeding after the use of tPA. While these numbers are significant, one must remember thedevastating effects that a major stroke will have on a person’s lifestyle or even survival. By carefullyusing the accepted criteria, the ED physician will determine if the patient is eligible for this treatmentand keep the risks to a minimum. In addition to tPA, a number of new drugs are under development including “neuroprotective”drugs which are designed to protect the brain and lessen the damage sustained during a stroke. Thekey to conquering stroke is to recognize the symptoms early and seek medical care immediately tomaximize the treatment options available to ED physicians as well as initiating preventive measures. Helping Seniors Preserve Helping People Preserve Their Independence Through: Independence Through: OU 10th R YEA R! • Health Care & Financial Planning • Case Management Via • Guardianship • Durable Power of Attorney • Health Care Power of Attorney • Daily Money Management • Consultation SENIOR PARTNER Financial and Health Care Management Call us today. We can help. James R. Reynolds, LCSW www.seniorpartner.com 302 - 764 - 788026 Delaware Stroke Initiative
  • 29. STROKE CENTERS HELP REDUCEDEATH AND DISABILITYby Ryan DiezClinical Representative, Genentech, Inc.Former Delaware Stroke Initiative Board Member Many hospitals still lack the necessary staff and In the June 21, 2000 issue of the Journal of the American equipment to triage andMedical Association (JAMA), members of the National Brain treat stroke patientsAttack Coalition announced its recommendation that all within the three-hourhospitals establish a stroke center or other programs to reducedeaths and disabilities from stroke. The Brain Attack Coalition time frame foris a group of professionals, volunteers and government clot-busting therapy.organizations dedicated to improving stroke treatment andprevention. Mark J. Alberts, M.D., the author of the article, serves as the chairman of the Stroke Belt Consortium,director of the stroke acute care unit at Duke University Medical Center in Durham, N.C., and a leader inThe Brain Attack Coalition. Dr. Alberts maintains that the goals of the Brain Attack Coalition are similarto those of trauma centers—getting patients to facilities where specialists and the hospital have theresources to evaluate and treat individuals quickly. Their position has been that, if hospitals can puttogether resources to treat trauma patients, why can’t they do the same for stroke patients? Since the Food and Drug Administration (FDA) approved a clot-busting medicine called tissueplasminogen activator or tPA in 1996 for the treatment of acute ischemic stroke (AIS), physicians have hada treatment for AIS (which accounts for about 80 percent of all strokes in the U.S.). Yet, many hospitalsstill lack the necessary staff and equipment to triage and treat stroke patients within the three-hour timeframe that the clot-busting therapy must be administered in to be safe and effective. The two major goals of the stroke center recommendations are: 1) To improve the level of care provided to stroke patients. 2) To standardize some aspects of acute care for patients who have a stroke. The article by Dr. Alberts presents a blueprint and includes estimated costs. The authors expresstheir hope that the adoption of these recommendations will increase the use of appropriate diagnosticand therapeutic resources to reduce the complications from stroke. Michael D. Walker, M.D., the BrainAttack Coalition’s chair and former director of stroke disorders at the National Institutes of Health (NIH),described a way for hospitals to significantly improve outcomes for stroke patients by dedicating theresources necessary to diagnose and treat stroke patients quickly. Dr. Walker defined two types of strokecenters to be established: 1) Primary Stroke Centers to stabilize and provide emergency care to stroke patients 2) Comprehensive Stoke Centers to provide extensive care for the most complicated cases The Delaware Stroke Initiative will be working closely with the professional organizations and groupsdescribed in the article to learn and promote best practices for the prevention, diagnosis, treatment andrehabilitation of brain attack/stroke. Stroke: A Guide to Information and Resources in Delaware 27
  • 30. THE ROLE OF SURGERY IN STROKEPREVENTION AND TREATMENTby Yakov Koyfman, M.D.Delaware Neurosurgical Group If detected before a major hemorrhage, the hemorrhagic brain attack/stroke is most often a subjectfor conservative treatment. High blood pressure must be controlled and carefully regulated to preventfurther damage. Medications, diet, exercise, and reduction of stress can help to lower blood pressure. Following a hemorrhage, however, neurosurgery is an option. Sometimes the clots can be surgicallyremoved if done quickly, usually within six hours of the bleeding. An AVM, which is an abnormalconnection between arteries and veins that form a tangle of fragile blood vessels, can rupture and causean intra-cerebral hemorrhage. The individual may experience a severe headache or seizure. The AVMcan be surgically removed. Because of the devastating effects of an AVM, the neurosurgeon treats AVMsbefore the major rupture, if detected. Aneurysmal treatment may involve the clipping of the aneurysm where the neurosurgeon places asmall clip around the neck of the aneurysm to pinch it and cut off the blood supply that circulates in theoutpouching or weakened area in the artery. Neuro-endovascular techniques treat the aneurysm from inside the blood vessel with a catheter thatis inserted in the groin. The technique involves placing tiny coils inside the aneurysm to reduce the bloodflow to the aneurysm sac and prevent rupture and hemorrhage. The good news about prevention is that carotid stenosis, for example, is very detectable and verytreatable. If less than 50 percent of stenosis is found, antiplatelet medications, e.g., aspirin, remain thecornerstone of treatment to reduce brain attack/stroke. For patients with greater than 50 percent stenosisshown on diagnostic testing, a surgical procedure called a carotid endarterectomy may be required.Studies have shown this to be a safe and effective way of reducing the risk of a brain attack/stroke.During the procedure, the plaque in the artery of the neck is removed, the blood flow is improved, and thepatient returns home from the hospital within 48 hours. Another procedure, neuro-endovascular stenting, is currently being evaluated as an alternative tocarotid endarterectomy. A special small angioplasty balloon catheter is inserted as the balloon is inflatedthe stent expands, locks in place and forms a rigid support to hold the artery open. The stent remains inthe artery permanently. This is a brief description of the current roles of a neurosurgeon in the treatment of brain attack/stroke. There are new and exciting treatments for all types of brain attacks/stroke. As technology andscience continue to discover new therapies, the future looks optimistic. The role of the neurosurgeon issubstantial as developments continue into the 21st century.28 Delaware Stroke Initiative
  • 31. NEUROLOGISTS SPECIALIZE INTREATMENT OF STROKEby Lee Dresser, MDWilmington Neurology Consultants Neurologists are medical doctors who are trained in the treatment of diseases of the nervous system.They have experience in managing stroke and are familiar with the functions of different parts of the brainand how those areas are affected by stroke. Neurologists are expert at recognizing the warning signs andsymptoms for stroke and evaluating persons at risk for stroke. Once a stroke occurs, it is important to minimize the damage to the brain, determine why the strokeoccurred, help the patient in the early recovery, and prevent future strokes. Almost as big a problem asthe injury to the brain from the stroke are the resulting complications. The neurologist takes the lead in managing all of the above facets of stroke care. Diagnosing strokecan sometimes be complicated. A neurologist is the best prepared to make this diagnosis. Otherconditions such as seizure, brain tumor and migraine often need to be considered. Once the diagnosis ismade of stroke, which is usually caused by interruption of blood flow to the brain, it is important that bloodpressure be managed carefully. While high blood pressure (hypertension) is the most common contributingfactor to stroke, it is usually best immediately after a stroke to keep the blood pressure high. This ensuresthe injured brain receives all the oxygen and nutrients it requires. Treatment of stroke is now possible witha clot dissolving medicine called tPA. While tPA can be helpful in reversing the effects of a stroke, it isalso a potentially very dangerous medication. Emergency department physicians almost always consultwith neurologists before using tPA for patients suffering from stroke. Stroke patients frequently requireevaluation with specialized tests. These include brain CT and MRI scans, ultrasound evaluations of theblood vessels of the neck and heart, and blood tests to check for conditions which make atherosclerosisand abnormal clotting more likely. The neurologist is usually consulted to help determine which tests arenecessary and when they should be performed. The risk of stroke is often decreased by the use of certain medications to help prevent bloodclots. Aspirin and similar medications, as well as stronger blood thinners, are available for use. Theideal medication to use depends on the cause of the stroke and the patient’s other medical problems.Additionally, some stroke patients may benefit from surgery to open narrowed blood vessels or,infrequently, operations on the heart for abnormal valves or to close holes between the heart’s chambers.The decision of which medication to use or when to refer a patient for surgery is often made by theneurologist. Neurologists also provide valuable input on how best to prevent complications from occurringafter stroke, such as pneumonia from swallowing difficulties, other infections, blood clots in the legs, orbedsores. New and better methods to diagnose and treat stroke will become available in the near future, and itis neurologists who will be using these tools to best aid patients. Stroke: A Guide to Information and Resources in Delaware 29
  • 32. NEUROPSYCHOLOGICAL ASSESSMENTOF STROKEby Glen D. Greenberg, PhDN & G Neurobehavioral Group The brain is the organ of behavior. Behavior, broadly defined, is everything that we do, from thewords we speak and memories we form to the mood we are in and the activities we engage in everyday.Therefore, a stroke has the potential to affect any part of who we are and result in problems in cognition(intellectual abilities), emotions (e.g., depression), and personality.Cognitive ImpairmentsDepending on where a stroke occurs in the brain very different problems may arise. The most commoncognitive problem occur in the following areas: Speech and Language include expressive language (problems finding the right word to say, namingobjects correctly, fluency of speech) and receptive language (comprehension) such as one’s abilityto understand what others say. Some people experience problems in related skills such as math(dyscalculia), reading (alexia) or writing (dysgraphia). Memory can be affected by stroke in a variety of ways. Most strokes affect recent memory, or shortterm recall. Stokes affecting the temporal lobe area of the brain can affect encoding so that memoriesare not stored at all or very poorly. Therefore, giving someone a hint or reminding them of somethingwill not help them remember. Other strokes can affect retrieval of memories that have been stored. Inthese cases, giving the person a cue or association to latch onto the memory can help them remember.Strokes that affect the left side of the brain can affect verbal memory, such as items on a shopping list,while strokes in the right side of brain can affect visual memory, such as recall for faces. Another class ofmemory is involved in recalling facts versus recalling pre-learned skills. Thus, one can have post-strokeproblems recalling information but still learn and retain new skills (e.g., how to operate a wheelchair). Executive functions are complex skills associated with the front part of the brain. They includeplanning, adapting to new situations, being flexible in our thinking, problem solving, exercising self-control,and understanding and managing time. The executive system monitors what we do and it providesongoing feedback so there is a constant communication system traveling from the front of the brain tothe back and then returning to the front. This leadership and control mechanism is crucial to successfulfunctioning in everyday life. Visuoperceptual skills: In some cases, a stroke can affect one’s ability to pay attention to one side ofvisual space despite intact eyesight. A person may therefore bump into walls while walking or have trafficaccidents. This “neglect” of space can be so severe that a person may deny that a body part belongs tothem, or in less severe cases, may not use one side of their body despite intact physical ability. When theright side of the brain has been impaired by a stroke, we will often see problems with drawing or solvingnonverbal problems (e.g., puzzles). Other people may fail to recognize objects they should know (agnosia).When there is a defect in the visual system the individual may fail to read sections of labels or pages inbooks.30 Delaware Stroke Initiative
  • 33. Emotional functioning: Depression occurs in 30-50 percent of the 750,000 people who suffer astroke each year. Recovery from a stroke is poorer in people who are depressed. The individual who lostexpressive language skills may not be able to express their sense of distress, but depression may thenbe expressed nonverbally (e.g., lack of interest or motivation in rehabilitation, low frustration tolerance) andthe depression can be quantified by using depression questionnaires. If a person is failing to progress intheir rehabilitation program it can be a red flag that depression is present. Personality changes: The two most common types of changes in personality are disinhibition (doingthings without thinking, loss of social graces or social inappropriateness) to a complete lack of driveor interest in activities. This lack of drive can often appear to be depression, but in many instances itrepresents dysfunction in the executive system where initiative and planning begins. Discussion with thefamily about changes in the person’s mood and personality is often a very important part of post-strokeclinical care.Neuropsychological TestingA neuropsychological evaluation is a method by which one’s abilities are assessed after a stroke. Acomprehensive evaluation can take several hours to evaluate all of the important skills and produce a fullpicture of the personal strengths and weaknesses. A doctor may refer a person who has had a stroke to aneuropsychologist for several reasons: g Can the individual continue to work, and if so, what modifications or accommodations are required? What will be the impact of the stroke on functioning in the home? g Impaired reaction time, visual processing or memory can affect skills such as driving. An assessment can help the physician determine if driving may or may not be possible. g A stroke affects some skills but not others. In some cases a person can compensate using preserved skills, such as writing and organizational skills to help with forgetfulness. g Neuropsychological testing can complement neuroimaging results (CT or MRI scans) to assess functional capabilities. The relationship between what we see on a CT or MRI scan and the functional problems is not always perfect. Some people may have large areas of damage on a scan but quite modest cognitive or behavioral deficits, while other people who have small but strategically placed lesions can experience much more difficulty in activities of daily living. g With the information from a neuropsychological assessment, suggestions for a cognitive rehabilitation program can be developed. This information is often used as part of a comprehensive treatment program that may include a team of many professionals (psychiatrist, neurologist, speech/language therapist, occupational therapist, physical therapist, social worker) so that the neurologic, cognitive, behavioral, emotional and social aspects of the stroke can all be understood and addressed.The more information that an individual who has experienced a stroke can learn about the brain, theeasier it may be to seek the right health care professionals for assistance in recovery. A stroke can occurquickly, but the recovery process can take a long time as the brain takes time to heal. Each person whohas a stroke is an individual and recovers individually. Learning about this process will make it easier toregain lost abilities and maximum recovery. Stroke: A Guide to Information and Resources in Delaware 31
  • 34. STROKE TREATMENTS:HOPE FOR THE FUTURE?by Bruce Shook Despite many years and billions of dollars in research, there remains only one FDA-approved treatmentfor acute ischemic stroke. Neuroprotectants, whose goal is to keep oxygen-starved cells alive longeror make them more resistant to low levels of oxygen, have a disappointing history of failed humanclinical trials. The use of a blood-dissolving (or “thrombolytic”) agent to reduce or remove the clot fromthe affected artery in the brain offers some hope. The only FDA approved treatment for acute stroke isone such drug: tissue plasminogen activator (or “tPA”). However, patients must get to the hospital withinthree hours for this therapy to be administered. There is a critical unmet need for an effective treatmentfor this disease that is the number three cause of death and number one cause of disability in theU.S. Researchers and patients are not without hope, however, as there are many promising therapiesundergoing clinical trials.Hypothermia or Cooling the Body One potential approach is the use of systemic hypothermia, or “total body cooling” to reduce thebrain’s need for oxygen while perhaps also helping the brain avoid the often fatal brain swelling that canoccur after a major stroke. The use of this technique has been supported by many animal studies thathave shown that reducing the body’s core, or internal, temperature reduces the size of the brain damage(“the infarct”) after a stroke. The hope is that this will lead to improved outcomes for patients, and thatthose who receive the hypothermia will improve more than those who were not made cold. Methods forcooling include catheters placed inside a major blood vessel to cool the blood directly, and “blankets”placed over the body to cool from the outside in. Patients have also been packed in ice and given chilledintravenous fluids. The blankets and catheters can effectively reduce the body’s temperature and thehope is that this reduced temperature reduces or prevents stroke damage. This technique has beenshown to have some effect in animal studies, and is now being studied in human clinical trials. Hypothermia is not without drawbacks, however, as the body is not designed to react well to the deepcold necessary for this therapy, and cooling of only a few degrees can lead to irregular heart beat andblood clotting disorders. In addition, because the body is designed to function within a very narrow rangeof “normothermia,” temperatures below a certain point induce the body to respond by trying its best toraise body temperature; shivering, raising the hair on one’s arms to trap warm air, and increasing heartrate are all ways in which the body tries to raise its temperature. These effects have just the opposite ofwhat is hoped; rather than cooling down the body, these reactions increase metabolism and the need foroxygen in the attempt to keep warm. Patients undergoing systemic hypothermia therapy must thereforebe aggressively treated to avoid the body’s natural responses to cold. Patients often need to be heavily sedated to prevent these reactions to the cold. Some of the newertherapies attempt to override the body’s thermoregulatory defense system by “tricking” the mind intothinking the body is warm by keeping the skin of the torso warm or placing a warming blanket around32 Delaware Stroke Initiative
  • 35. the patient’s face. Clinical trials now underway hope to provide an answer regarding the effectiveness ofreducing stroke damage in the brain by keeping patients cold.Open the Blocked Blood Vessel Another area of promise is to physically open the blocked blood vessel and restore blood and oxygenflow to the brain after a stroke. Numerous ideas are being pursued here, including direct delivery ofthrombolytic agents into the offending blood clot using micro-catheters, and catheters that deliver energyinto the blood clot using laseror ultrasound technology tohelp break the clot up. Allthese therapies are intendedto clear the blockage thatcaused the stroke, thusminimizing damage to thebrain in the hours following theevent.Summary Human clinical trials inacute stroke treatment haveproven difficult to conduct.One reason for this is that“time is brain” and the longerit takes to begin a therapy, Need a Doctor?the more brain tissue willbe damaged. All thesepromising therapies need tobe administered as rapidlyas possible to have themost positive effect. General Call 1-866-BAY-DOCSawareness of stroke signs and Call Bayhealth’s Physician Referral and Information Linesymptoms and quick action for Kent General Hospital, Milford Memorial Hospital,to bring patients to stroke Middletown Medical Center and the St. Jones Center for Behavioral Health.centers are the most critical We’ll match you with the physicians best suited to meet your needs.steps toward developing new We call it the Bayhealth Link.treatments. Join the Bayhealth team! Call (302) 744-7143 We’re here for life 640 South State Street, Dover, Delaware 19901 • 21 West Clarke Avenue, Milford, Delaware 19963 Toll Free (866) 229-3627 • www.bayhealth.org Stroke: A Guide to Information and Resources in Delaware 33
  • 36. ST. FRANCIS SPECIALIZES IN STROKE CAREby Lee Dresser, M.D. The doctors, administration and staff at Saint Francis Hospital in Wilmington realize that stroke is adevastating medical problem. Stroke is the third leading cause of death in our country and the numberone cause of disability for adults. With our aging population, stroke will become an even bigger healthproblem for our country and our community. St. Francis is committed to continuing its tradition ofexcellence in prevention, evaluation, treatment and rehabilitation of stroke. St. Francis Hospital is proud to be a strong supporter We applaud and actively of the Delaware Stroke Initiative (DSI) in its efforts to support the efforts by DSI prevent stroke in Delaware. We have provided financial to increase the awareness and logistical support to DSI because we know the best of the signs and symptoms treatment for stroke is prevention. To help prevent stroke, of stroke. We know that if St. Francis has active programs to assist patients with a person suffers a stroke smoking cessation, control of diabetes, and recognition his or her best chance and treatment of hypertension. We applaud and actively for recovery is to be support the efforts by DSI to increase the awareness immediately transported of the signs and symptoms of stroke. We know that if to a hospital that a person suffers a stroke his or her best chance for specializes in stroke care. recovery is to be immediately transported to a hospital that specializes in stroke care. The physicians and nurses on staff at St. Francis are specially trained to recognize and treat stroke.When a patient with a possible stroke arrives in the Emergency Department, he or she is rapidly evaluatedfor treatment with blood clot dissolving medications that can protect the brain from further injury. Thismeans that patients will be more likely to talk, walk, and use their hands to lead independent, productiveand enjoyable lives.St. Francis has state-of-the-art CT and MRI scanners available 24 hours a day, which allow our doctorsto quickly and accurately determine what caused a stroke and how best to prevent future strokes. Ourhospital is staffed with highly trained neurologists and neurosurgeons who are expert in the treatmentof stroke. Special ultrasound equipment employed by skilled doctors and technicians allows detectionof blood clots in the heart or blockages in blood vessels that may cause strokes. Highly trained nurses34 Delaware Stroke Initiative
  • 37. constantly monitor patients to help prevent complications and worsening of stroke symptoms. This special care helps minimize the time spent in the hospital and maximizes return of brain function. Stroke patients often need special rehabilitation therapy. St. Francis offers a full complement of rehabilitation services, including physical therapy, occupational therapy and speech therapy. If it is required, we have an entire unit dedicatedWhen a possible stroke patient arrives at the St. Francis Emergency to inpatient rehabilitationDepartment, he or she is rapidly evaluated for treatment with blood clot directed by doctors who aredissolving medications that can protect the brain from further injury. expert in helping stroke patients maximize their recovery. Strokepatients often also have heart disease and St. Francis is proud to offer the best cardiac care in the state,with experienced cardiac surgeons and cardiologists who have state of the art diagnostic and treatmentequipment and facilities.St. Francis Hospital is firmly committed to helping prevent stroke in Delaware and to providing the bestpossible care when stroke occurs. We encourage you to learn the risk factors for stroke detailed in thisguide and the signs and symptoms of stroke. Please share this information with your friends and family.Help educate people that a stroke is an emergency, and when a stroke is suspected, you must dial 9-1-1for help. With your assistance, St. Francis Hospital and DSI can prevent strokes from happening and helpstroke patients receive the quick specialized care that can save a life. Stroke: A Guide to Information and Resources in Delaware 35
  • 38. HEALTHY SPIRITUALITY & WELL-BEINGby Anne Murray MS, RNParish NurseDelaware Stroke Initiative Board Member Recovering from a stroke is a struggle that challenges all aspects of a persons being—physical,mental and spiritual. Physical therapy, speech therapy, learning a new way to dress, working to rememberhow to make a sandwich can all be discouraging. It is easy to become overwhelmed and frustrated. As humans we are naturally spiritual beings, whether or not we are connected to any organizedreligion. Our spirituality affects our physical and emotional well-being every day, and spiritual health is thataspect of our well being which is most basic to our wholeness. It organizes our values, beliefs and hopesinto some meaning and purpose. When one’s spiritual health is strong, often one finds grace and strengthto keep going, to cope and adapt and find joy in the daily journey that is life. Help for your physical, emotional and spiritual health may be nearer than you think. Parish nursingis being included by faith communities across the country and in our area. It is a part of the larger ideaof health ministry, or whole person health. Parish nurses are professional nurses whose practice has aspiritual emphasis as well as a physical and emotional dimension. Parish nurses: g Believe, regardless of the faith tradition, that all persons are sacred and must be treated as such. g Are not from any one religion and practice in any faith community. g Work with clergy to care for those who need care. g May provide care for a patient upon discharge from the hospital or rehabilitation center. g Often provide support, spiritually centered care, and education after a persons health benefits have expired. Inquire about parish nurses and other health ministry programs in your faith community-or one nearyou, your hospital or neighborhood. For more information on health ministry and parish nursing in ourarea, contact one of the following organizations:DE Regional Health Ministries785 Cherry Tree Rd. Apt. E9, Aston, PA 19019Jane Connolly, 610-485-7533DE Region Parish Nurse Network709 Whitebriar Road, Hockessin, DE 19707Joan Nelson, 302-239-2392Christiana Care Health SystemHealth Ministries NurseLaVaida Owens-White, 302-765-455736 Delaware Stroke Initiative
  • 39. PHYSICAL REHABILITATION AFTER STROKEby John P. Scholz, P.T., Ph.D.University of Delaware, Department of Physical Therapy A brain attack or stroke can have a devastating effect on the patient as well as his/her family. Motorand sometimes cognitive functions that were once performed automatically now require great effortand new strategies, if they can be performed at all. The patient’s family is often torn between sympathycombined with the compulsion to do as much as possible for the patient and anger at the additionalburden this tragedy brings to their own lives. In the early stages following a stroke, the patient is often bewildered by the sudden loss of even themost basic functions. As initial recovery progresses, he/she becomes understandably torn between theexpectation that full recovery is only a matter of timeand the frequent reality that some functional deficitis likely inevitable. What can the patient expect from For recovery of motorrehabilitation? function following stroke, Immediately after the stroke, the focus of the medical rehabilitation should:staff is to medically stabilize the patient. At this stage, 1) Begin as soon as possiblephysical therapy (PT) consists largely of attempts to 2) Practice functionalprevent the loss of joint range of motion (ROM) and, to activity on the affected sidea lesser extent, to prevent muscle wasting. As soon asthe patient’s medical condition has stabilized, however, 3) Be as challenging asaggressive therapy becomes an essential ingredient to possible to the patientpromote the patient’s long-term recovery. Because of the rising cost of health care, initial PTtreatment is often focused on teaching the patient to compensate for the loss of control on the involvedside by developing new strategies to use the intact side (that is, get the patient transferring and walkingas independently as possible so that he/she can be discharged in the shortest time possible). Theresult is often the beginning of learned disuse of the involved side of the body by the time the patient istransferred to rehabilitation or home. At this stage, therapy is resumed on a daily basis in rehab or, quiteoften, one to a few days per week by a home health therapist. Such therapy is typically aimed at helpingthe patient to further improve his/her function, partly by learning to use the affected side more effectively.By this time, however, an important window of opportunity may have already closed. Thus, early attemptsto get the patient ready for discharge must be tempered by an understanding of the need to foster useof the involved side of the body as much as possible. The lessons to be gained from our present knowledge about recovery of motor function followingstroke is that rehabilitation should: 1) Begin as soon as possible following a stroke (i.e. once the patient is stable medically). 2) Focus on the practice of functional activities using the involved side of the body, in addition to exercises that address specific motor impairments (e.g. muscle weakness). 3) Be as challenging as possible to the patient, while taking care to maintain safety. Stroke: A Guide to Information and Resources in Delaware 37
  • 40. Although therapy frequently focuses on the problems that the patient has controlling the extremities,the development of adequate trunk control is critical to the success of long-term recovery. The trunk isessential for postural stability in sitting and standing, serves as a base from which the arms and legs areable to work, and allows the extension of the functional use of our extremities when objects are beyondour typical reach. The trunk is often floppy but may be especially stiff on the involved side following a stroke. Poortrunk control will affect the ability to optimally use the intact extremities for function, not only the involvedextremities. Thus, early rehabilitation should give priority to retraining the trunk to perform these essentialfunctions. In addition, weight bearing on the affected arm and leg should begin as early as possible sothat the patient develops some confidence that they can use these extremities while helping to facilitateresponses from the muscles of the affected limb in a functional patterns. The Physical Therapy Department at the University of Delaware is engaged in ongoing research aimedat better understanding the functional motor deficits that result from stroke and, eventually, evaluating anddeveloping more effective treatment procedures. If you have an interest in participating in these studies,or would like to know more about them, please call Darcy Reisman, M.P.T. or Yaweng Tseng, P.T., at (302)831-4646 or Dr. Scholz at (302) 831-6281. NEUROSURGERY CONSULTANTS, P.A. BIKASH BOSE, M.D. C-79 Omega Drive Newark, DE 19713 (302) 738-9145 www.bikashbose.com Practice of Neurological Surgery, Microneurosurgery, Cerebrovascular Surgery and Pediatric Neurosurgery BOARD CERTIFIED Adult and Pediatric Brain, Spine, Peripheral Nerve and Cerebrovascular38 Delaware Stroke Initiative
  • 41. RECOVERY: A TIME OF RELEARNINGby Cheryl HeiksDirector of Marketing and Business DevelopmentDelaware Curative Physical Therapy & Rehabilitation Centers After a stroke, individuals can struggle to regain work and personal related skills they once took forgranted. Recovery is a time of relearning and Physical, Occupational and Speech Therapists understandand can help. Together with the patient and their caregivers they will find the right combination of toolsand techniques to aid recovery and maximize independence. Rehabilitation that begins as soon aspossible after a stroke, can provide the greatest amount of benefit. Often known as the “Pain Relief Specialists,” physical therapists are acknowledged experts in helpingindividuals recovering from a stroke deal with a general lack of function. They provide the therapy andinstruction needed to begin to use limbs productively. Physical therapists specialize in treating injuriesor disabilities that result in muscle, spine or sensory loss of function. They utilize a variety of types oftreatments or modalities to aid in that process. They work on strength and range of motion developmentand will emphasize increased activity, motion, endurance and retention of relearned abilities. Somemethods used by physical therapists include: gait analysis and retraining, spasticicty treatment, aquatictherapy, balance and vestibular rehabilitation, joint mobilization to restore range of motion and function,soft tissue manipulation and deep tissue friction of a muscle to promote proper movement. Physicalagents used include ultrasound, fluidtherapy, electrical stimulation and whirlpool. Occupational Therapists assist individuals of all ages whose lives are affected by illness or injury.Treatments are designed to allow clients to engage fully in every day activities or occupations, improvingindependence and maximizing pain-free function. They work to improve fine and large motor activitiesbut concentrate on the skills someone would need for self care, household or work occupations, driving,and other “activities of daily living.” They perform home and office safety assessments and often candetermine the appropriate type of assistive devices necessary to encourage improved function, suchas specially outfitted clothing, cooking items, telephones, canes, walkers, wheelchairs and grab bars inbathrooms. Speech-language pathologists help stroke survivors learn how to use language or develop alternativemeans of communication. The ability to speak can be one of the most damaged areas when someonesuffers a stroke. They may not remember common names of people or things, or may sound garbledor leave out parts of speech. Speech-language pathologists use specialized therapeutic techniquesto assist people and can often rapidly improve comprehension. It is possible to use compensatorytechniques like symbols, sign language or computers to aide in communication. They also help peopleimprove their ability to swallow, which can often be a problem for stroke victims. For more information visit www.delawarecurative.com. Some of the material contained in this articlecomes from the American Physical Therapy Association, the American Occupational Therapy Association,and the American Speech-Language-Hearing Association. Stroke: A Guide to Information and Resources in Delaware 39
  • 42. AGING WITH A DISABILITYby Ellen Barker, MSN, APNNeuroscience Nursing ConsultantsFounder, Delaware Stroke Initiative The average life span of adults in the U.S. is now estimated to be 77 years. Many Americans areexpected to live longer than the average with an increasing number of people living 100 years or longer.The average older adult in America enjoys a relatively high quality of life. This, however, depends onmaintaining a healthy lifestyle. There are predictable changes that come with aging that older adultsshould understand. Aging with a disability also has some predictable outcomes.Normal Aging The normal process of aging may result in some of the following changes: g Progressive loss of smell g Diminished vision—vision loss is among the top 10 impairments of older adults, especially after age 70; older adults require up to three times more light to see g Decreased perception of taste (especially sweets) g Initial loss of high tones in hearing, followed by loss in all frequencies g Reduced blood flow in the brain with alterations in selected mental functions g Decrease in body temperature with impairment of the ability to adapt to environmental temperature g Loss of physical vigor with changes in gait and walking as well as diminished strength and agility g Wear and tear on bones and joints with signs of arthritis that may be accompanied by discomfort, stiffness and pain g Poor ability to maintain balance with sluggish reflexes and a slowing of reaction time g Tiredness and interrupted sleep with insomnia These normal changes in life cause some older adults to slow down their tempo and to adjust andadapt to a new lifestyle. With a routine that includes a healthy diet, adequate rest and sleep, sufficientexercise, and an annual health check-up, many people can cope with the normal aging changes as theycontinue to live full, happy and productive lives.Disabilities After an illness such as stroke, some individuals are left with permanent disabilities, including: g Permanent weakness or paralysis on one or both sides of the body that may cause problems with walking or the need for a wheelchair g Diminished vision or blindness in one or both eyes g Problems with speech, eating and swallowing that may lead to weight loss and less energy g Trouble with thinking, memory and problem solving that may lead to dementia, such as Alzheimer’s g The need for personal assistance with eating, bathing and activities of daily living (ADL)40 Delaware Stroke Initiative
  • 43. People with disabilities may also have other health problem concerns, like cardiac disease, diabetes,high blood pressure, and obesity. Whatever the cause or the outcome, people with permanent long-termdisabilities will notice three significant trends in the aging process 1) Changes due to aging start at an earlier age than in adults without disabilities 2) The aging process may progress more rapidly due to the injury and related disability 3) Aging may have a greater effect on the lives of an individual with a disability than on those of the same age who are not disabledTips for Managing Accelerated Aging and DisabilityOsteoporosis – For individuals with long-term disabilities, there are important things to watch for andconsider in planning for the future. When the legs and joints are affected, there is increased risk of bonethinning and osteoporosis, especially in women. Health checkups and tests such as bone scans mayindicate the need for increased intake of calcium or the need for prescription medications that can bestarted early before osteoporosis becomes a serious problem. Walking, swimming and other forms ofexercise are encouraged. Safety becomes paramount to prevent a fall that may cause injuries such as ahip fracture, head injury or long bone fracture.Skin Breakdown – People who are inactive—spending a lot of time in bed or sitting in a wheelchair—must take special precautions for skin care. It is important to prevent reddened areas that are prone tobreakdown or pressure ulcers. Good personal hygiene with gentle cleansing and frequent repositioningrelieves pressure on the skin. The skin becomes dry and thinner with age and loses some of the elasticity.Remaining in the same position for too long and pulling or shearing the skin getting in and out of bed arefrequent sources of skin breakdown. Daily inspection is needed with immediate attention at the earliestsigns of skin problems to prevent skin ulcers and infection. Good fluid intake and a nutritious diet alsoplay key roles in keeping the skin healthy.Exercise – Health care providers, physical therapists and exercise physiologists can recommendexercises and a routine to maintain a good cardiovascular system. Poor circulation is not healthy for theheart or the brain and may lead to feelings of sluggishness or even a mild headache. Most people withdisabilities can perform deep breathing and range of motion (ROM) exercises. It is much easier to stick toa routine exercise program if is becomes part of the daily schedule and performed for 15 to 30 minutesevery day of the week. Keeping an exercise calendar is a good way to show progress. Adding a bloodpressure measurement and pulse rate will demonstrate the positive long-term effects of exercise forcardiovascular improvement. Positive outcomes of an exercise program include improved color, increasedcirculation, feelings of warmth of the face and skin, and an improved sense of well-being.Fall Prevention – Falls can be a major problem among older adults and even more so among those with apermanent disability. A fall can lead to serious injuries or even death. Health care providers can work withthe disabled person and his or her family to develop a program of fall prevention in the home. Gait, balance, physical strength, muscle tone, and coordination are checked to determine if theindividual needs a cane, walker, or other assistive devices. Falls can occur during activities like walking, Stroke: A Guide to Information and Resources in Delaware 41
  • 44. getting in and out of bed, sitting or standing up, bending down, or going up and down steps. Goodlighting, tie shoes that fit well, and the removal of scatter rugs or other floor items make the homeenvironment safer for moving around independently. Before getting out of bed, disabled individuals shouldsit on the edge of the bed or a chair and wait a few minutes before standing up. This prevents dizzinessthat may lead to a fall. Some medications may also cause dizziness and light-headedness when movingtoo quickly from a flat to a sitting or standing position. Less active older adults tend to have more falls.It is vital to maintain a regular exercise program to work on balance, strength and reaction time. Gettingout of bed during the night, or at inappropriate times, is usually related to hunger, thirst, going to thebathroom, and pain. Tips for fall prevention include: g Keep a light on in the bathroom g Never store frequently-used items on shelves that are too high or too low g Wear comfortable walking shoes that fit well and have non-skid soles g Check around the home for areas to install “grab bars” for safety (e.g., bathroom, shower area and stair wells) g Never place scatter or throw rugs in the path where older adults with disabilities will walk g Keep clutter to a minimum g Choose tile or wood flooring, which are easier for use with a walker, cane or wheelchairWandering – After a stroke or brain injury, some older adults may wander. Wandering can take on manydifferent behavior patterns: using the hands to touch and feel objects in their environment that mightbe exhibited by aimlessly going through cabinet drawers; using existing areas in the environment thattrigger the need to wander (e.g., hallways, walkways and other usual traffic patterns in the home); seekinglocations from the past (e.g., trying to return to a former home, church, or community site); trying toexercise restless legs or reduce high energy levels through wandering; and a highly agitated state whereinterference may result in combativeness or hostility. Safety measures must be taken to allow appropriatelevels of wandering and also to protect the wanderer from harm. Create a hazardous-free environmentwith safeguards to allow supervised wandering. In some instances, alarms may be necessary. Consult witha health care provider to help balance the need for wandering with safety concerns.Nocturia (Going to the Bathroom at Night) – Leaving a bathroom light on at night or the use of a bedsidecommode is helpful for those who need to use the bathroom at night. If the bed is too high or difficult toget in and out of, a hospital bed should be considered for safety and ease of transfer. Family membersmay consider setting the alarm for 4–6 hour intervals at night to help the disabled person use thetoilet. The need to empty the bladder is often the reason older adults wake up during the night. Olderadults and those with disabilities may have nocturia, or the need to urinate at night. If bed wetting, orincontinence, becomes a problem, talk to a health care provider to investigate the cause. In many cases,simple steps can be taken to stop nocturia by eliminating caffeine, alcoholic beverages and fluid intakeafter 6:00 p.m. Spicy foods may also contribute to nocturia for some people.42 Delaware Stroke Initiative
  • 45. Diet – Healthy diets are essential for older adults to maintain good health. There is an abundance ofliterature and information about healthy diets, which most Americans ignore. Individuals with a disabilityare urged to check with their health care provider and request recommendations for a diet that is basedon their age, health needs, gender, degree of activity, exercise level, and physical energy needs. Thekey is to shop and purchase only the foods that are allowed on your diet. A good routine is to cookhealthy foods, reduce sugar and salt whenever possible, eat three meals per day (or divide meals intosix small servings), and drink 6–8 glasses of fluids daily. A healthy diet also helps prevent constipation, acommon condition of older adults with disability. It is recommended that older adults stop eating snackfoods such as potato chips, cookies, and candy/sweets. Keep fresh seasonal fruits and vegetablesavailable to substitute for “junk food” snacks. Orange, grape and cranberry juice, or fruit combinationsare recommended to help meet the 5–6 daily servings of fruits and vegetables. For those with problemsof serious constipation, the addition of prunes, apricots, strawberries, and other fruits and whole graincereals and natural foods help to increase bowel elimination and avoid the need for laxatives.Family or Caregiver Support With a strong support team of professional caregivers and family, many aging individuals with adisability can be managed in the home setting for many years. Before the physical, emotional, or financialneeds become overwhelming and assistance can no longer be provided, however, everyone involvedshould evaluate alternatives of care and agree on future options based on the needs of the disabledfamily member. There may come a time for the family when their loved one can no longer remain at homeor skilled nursing care is needed 24 hours per day. A positive and supportive outlook is critical in living with a loved one who is aging with a disability.Well-informed and well-educated family members who are strong advocates for quality care with accessto community resources and services will be better able to offer more effective health, recreational, socialand wellness activities to improve the quality of life for the older adult with a disability. Physical Therapy Occupational Therapy Aquatic Therapy Speech Therapy 60 years Free Transportation s e rv i n g t h e c o m m u n i t y s i n c e 1 9 4 5 North Wilmington • 302.529.7750 Wilmington • 302.656.2521 Newark • 302.738.3110 Bear • 302.836.5670 Middletown • 302.376.7670 Dover • 302.744.9691 Stroke: A Guide to Information and Resources in Delaware 43
  • 46. CAREGIVERS NEED CARE, TOO!by Leah JonesCARE DelawareDelaware Division of Services for Aging and Adults with Physical DisabilitiesDelaware Health and Social ServicesThe AARP recently released a study showing that nearly 130,000 Delawareans are providing unpaid careto another adult. For 67 percent of these people, caregiving is a second job. While juggling the demandsof their “day jobs” with the tasks of caring for a loved one—including victims of stroke—caregivers oftenforget to take care of themselves. So focused on the physical and emotional needs of the person in theircare, they can face “burnout” that may threaten their own health.What is caregiver burnout? Caregivers can experience burnout when their responsibilities prevent them from participating inactivities that support their own mental and physical health, such as regular doctor visits, exercise, socialand recreational activities, and participation in support groups. Signs of caregiver burnout include: g Nervous habits, such as overeating or chain smoking g Frequent crying and heightened emotional reactions to every-day situations g Anger, depression, irritability and anxiety g Lack of Concentration g Social withdrawal g Exhaustion g Sleeplessness g Medical Problems Caregivers are often isolated and under a great deal of stress. They’re juggling full-time jobs with theresponsibilities of caring for an elderly person. Many people find themselves in this situation somewhatsuddenly, when a family member falls ill or becomes disabled. In Delaware, there is a program to help caregivers deal with the challenges of caregiving, includingemotional and physical stress as well as the skills needed to care for someone at home. CARE Delawareis a program of the Division of Services for Aging and Adults with Physical Disabilities.This program offers respite care, caregiver skills training, resource centers, one-on-one assistance andaccess to national resources. For more information about CARE Delaware resources and information, call the DelawareHelpline at 1-800-464-HELP, contact the DHSS’ Division of Services for Aging and Adults with PhysicalDisabilities (DSAAPD) at 1-800-223-9074, or visit their website at www.DSAAPD.com. For those who are caring for a loved one from a distance and need to find the agency on aging intheir elder’s local area, assistance is also available through the Elder Care Locator, a service of the U.S.Administration on Aging, by calling 1-800-677-1166 or online at www.eldercare.gov.44 Delaware Stroke Initiative
  • 47. Delaware’s number one health system has climbed to the top in America. The people of Christiana Care have earned the 2004 , Distinguished Hospital Award for Clinical Excellence™ ranking us among America’s top 5% for Overall Clinical Performance. Trust your health to experience.The 2004 Distinguished Hospital Award for Clinical Excellence is awarded byHealthGrades, a nationally recognized expert in evaluating the quality of hospital services. ® www.christianacare.org
  • 48. STROKE INFORMATION RESOURCESGlossary of Terms ARTERIOGRAM: an x-ray procedure that is performed for a radiologic visual view of theACTIVITIES OF DAILY LIVING: abbreviated as ADL, arteries or vessels in the brain using a special dyeinclude daily hygiene, such as bathing, showering, that is injected by way of a small catheter or tubeor washing; grooming, shaving, combing one’s hair to learn if the arteries have a block, damage oror dressing; eating and drinking; and walking or rupture.standing for mobility. ATHEROSCLEROSIS: a common abnormalACUTE: a disease or condition that begins abruptly. condition that refers to the plaques or “hardened areas” along the inner walls of the arteries causingAFO (ANKLE-FOOT ORTHOSIS): a variety of the blood vessel to become narrowed withprotective braces that are applied to the ankle reduced blood flow to the different regions of thearea to support a weak or paralyzed ankle and brain. This condition is seen with aging and buildfoot muscles. AFOs help to support the ankle and up of lipids, cholesterol, proteins and calcium thatprevent injury. may create a risk for thrombosis. It is associated with use of tobacco, high blood pressure, obesityAGNOSIA: the total or partial loss in the ability for and other conditions that are risk factors for stroke.an individual to recognize familiar objects throughsensory mechanisms, e.g., vision, hearing, touch, ATROPHY: a wasting or reduction in size, e.g.,smell. smaller muscles as a result of “disuse” or not using the muscles, diseases, or lack of physical exercise,AMBULATION: the act of walking or moving with or or a reduction in the size of the brain due to thewithout assistive devices. aging process or reduced blood flow over a long period of time.APHASIA: a complete or partial loss of orimpairment of the individual’s ability to use or BRAIN ATTACK: a more accurate description thanunderstand language. It may be temporary or “stroke” or a newer term to use when the brainpermanent: Expressive aphasia in which words does not have enough blood flow to give oxygencannot be formed or expressed, or Receptive and nourishment to the brain or when there is aaphasia in which language is not understood. bleed in the brain and the brain is covered with bleeding from a vessel that has ruptured. It isAPRAXIA: a loss of the individual’s ability to carry medical emergency.out purposeful, voluntary movements or acts,without the presence of paralysis or muscular BRAIN DAMAGE: injury to the brain that may resultweakness. Apraxia may be seen as the inability to from a stroke or brain attack, brain trauma, birthuse an object correctly or to produce speech. injuries, or infections of the brain.46 Delaware Stroke Initiative
  • 49. BRAIN SCAN: a painless diagnostic test in CEREBRAL THROMBOSIS: a clotting of blood inthe nuclear medicine department that uses any cerebral vessel that block blood flow to partsradioisotopes that are injected in the view (IV) for of the brain.imaging to locate an abnormality in the brain. Ascanner is used to photograph for any abnormal CEREBROVASCULAR ACCIDENT (CVA): the olderaccumulation of the isotopes in the brain tissue. term used when damage to the brain is caused by the vascular system from a clot or hemorrhage.BRUIT: an abnormal blowing or “swishing” sound The newer term is “brain attack.”or murmur heard while placing a stethoscope overthe carotid artery. When the artery is approximately CEREBROVASCULAR DISEASE: pertains to the70% blocked, a bruit may be heard by the vascular system with chronic or progressiveexperienced examiner. If the artery is almost totally changes in the circulation of the brain that canblocked, there is usually no audible sound. lead to a brain attack.CANINE PARTNER OR SERVICE DOG: a special CHOLESTEROL: a waxy lipid or fat-like substancedog that has been trained by professionals to that is produced by the body and found almostassist individuals with a disability, like a brain exclusively in foods of animal origin. Increasedattack, to pull a wheelchair, open doorways and levels of low-density lipoprotein cholesterol mayfor companionship, security, lowering of blood be associated with atherosclerosis, whereas higherpressure, reduction of stress and anxiety and levels of high-density lipoprotein cholesterolimproved quality of life. appear to lower the person’s risk for heart disease and stroke.CAROTID ARTERY: the major arteries on eachside of the neck that are responsible for carrying CHOLESTEROLEMIA: excessive amounts ofa large amount of blood supply to the head and cholesterol in the blood.neck. A carotid “bruit” or murmur may be heard by Chronic: a disease or condition that developsusing a stethoscope placed gently over the carotid slowly and persists for a long time.artery that suggests an arterial narrowing. COGNITIVE THERAPY OR RETRAINING: the processCEREBRAL: pertaining to the brain or to the of treating mental and emotional disorders thatcerebrum of the brain which is the largest and help an individual change patterns of thinking,uppermost section. problem solving, memory, math, language and recovery over time through various methods, toCEREBRAL EMBOLISM: a blood clot, or embolism include a self-paced computer-assisted program,that blocks a vessel in the brain and prevents to enhance re-learning.oxygen and circulation to the areas beyond theclot. COMA: a state of profound unconsciousness when an in individual has lost the ability to interact withCEREBRAL HEMORRHAGE: bleeding from a blood the environment. The individual cannot be aroused.vessel in the brain that can lead to displacementor destruction of brain tissue. Stroke: A Guide to Information and Resources in Delaware 47
  • 50. COMMUNICATION BOARD: devices that can usually ELECTROENCEPHALOGRAM (EEG): a graphic chartbe acquired through a rehabilitation department that records the electrical impulses produced bythat use pictures, letters or numbers to assist in the brain cells detected by placing electrodescommunication when an individual is unable to on the scalp that provide information aboutspeak. New technology offers electronic devices. neurological conditions, e.g., seizures.CONTRACTURE: an abnormal shortening of EMBOLISM: an abnormal condition of themuscles or other soft tissue around a joint that circulation when a sudden blockage occurs frommay result in pain and discomfort and loss of a clot wandering from one part of the body to thefunction brain where it cuts off blood supply and can cause a brain attack.CT SCAN OR COMPUTED TOMOGRAPHY: aradiographic diagnostic test that produces a EMOTIONAL LIABILITY: a condition of excessivefilm representing a detailed cross section of the emotional reactions and frequent mood swingshead and brain (or other parts of the body). The that may include excessive or inappropriateprocedure is a quick, safe, painless test that can laughing or crying with greater magnitude than thebe performed with or without contrast dye. situation demands.DEMENTIA: a progressive organic mental state ENDARTERECTOMY: the surgical removal of anthat may be characterized by personality changes, abnormal plaque formation or deposit in the liningconfusion and decreased intellectual capacity, of an artery that has contributed to the narrowingmemory, judgment and impulses. of the artery and causing decreased blood flow to the brain, e.g., a carotid Endarterectomy.DIASTOLIC BLOOD PRESSURE (DBP): the bloodpressure in the arteries when the heart muscle is FLACCID: weak, soft and flabby, e.g., an arm or legrelaxed. that has no muscle tone that can occur following a brain attack.DYSARTHRIA: difficulty with speech output dueto muscle weakness or in coordination causing FUNCTIONAL: the ability to carry out a purposefulslurred speech, or drooling with facial weakness or activity, e.g., activities of daily living (ADL)difficulty swallowing. GAIT: the manner or style of walking. The normalDYSLEXIA: an impairment in the ability to read or gait has a swing phase and a stance phase fordetermine the difference between right and left. each lower limb that includes rhythm, cadence and speed.DYSPHAGIA: difficulty with swallowing. HEMIPARESIS: muscular weakness on one-halfEDEMA: the abnormal collection of fluid or swelling of the body. When caused by a brain attack, thein the tissue spaces. weakness is on the opposite side of the body from the brain damage or brain attack.ELECTROCARDIOGRAM (ECG OR EKG): a graphicrecording of the electrical heart activity.48 Delaware Stroke Initiative
  • 51. HEMORRHAGE: loss of a large amount of blood medication. It has advantages over other tests, e.g.,when a vessel in the brain, for example, ruptures or CT with superior soft tissue contrast.bleeds. NEGLECT: a condition that occurs when theHEMIPLEGIA: paralysis on one-half of the body on individual ignores the paralyzed side of the bodythe opposite side of the brain damage or brain or in visual neglect fails to see a particular field ofattack. vision. Neglect can occur after a brain attack. OBESITY: an abnormal increase in the numberHYPERTENSION: the number one cause of a brain of fat cells that results in an individual beingattack is an elevated blood pressure that exceeds significantly overweight. This puts a strain on thethe normal limits for an individual’s blood pressure. heart and increases the chance of developing high blood pressure and diabetes which are risk factorsINCONTINENCE: the inability to control the bowel for stroke.or bladder from emptying. The individual withincontinence may need to have a prescribed OCCUPATIONAL THERAPY (OT): therapy providesbower and bladder program. training to regain lost function or skills following a brain attack to be able to carry out activities ofISCHEMIA: a decreased supply of oxygenated daily living (ADL), e.g., dressing, bathing, eating,blood to an organ, e.g., the brain that can cause an using assistive devices and adaptive equipment,“ischemic brain attack.” when indicated. The focus is often on the upper extremities to regain range of motion (ROM) andLANGUAGE: words or symbols that are used ADLs or other functions, e.g., impaired driving andto communicate: written, spoken, reading or writing skills.gesturing. ORTHOTIC: a device that corrects orMEMORY: the mental power that allows individuals accommodates for muscular deformities.to retain or recall past information, e.g., short-termor long-term memory recall. PARESIS: weakness of a muscle group or groups of muscles that can occur following a brain attack.MOBILITY: the ability to get about independently or The partial loss of muscle power or sensation.with assistance. PARAPLEGIA: paralysis that is characterized byMOTOR: refers to the movement generated by motor and sensory loss in the legs and trunk onmessages from the brain that result in smooth both sides of the body.interaction of nerves and muscles. PHYSICAL THERAPY (PT): the treatment forMRI (MAGNETIC RESONANCE IMAGING): a non- disorders that includes massage, manipulation,invasive diagnostic study that uses radiofrequency exercises, heat or cold and other modalities forradiation as it source to image areas of the body, individuals with pain, muscle weakness and othere.g., the brain in an external magnet field. The conditions following a brain attack. PT includesprocedure is pain-free but may cause claustro- instructions for walking, balance and posture,phobia that can be relieved with appropriate transfer and restoring function. Stroke: A Guide to Information and Resources in Delaware 49
  • 52. PHYSIATRIST: a physician who specializes in SPEECH AND LANGUAGE THERAPY: the rehab-physical medicine and rehabilitation who deals ilitation provided by a speech pathologist to retrainwith problems following a brain attack: directs the speaking, reading, writing and swallowing skills.rehabilitation team for long-term follow-up and Alternative communication systems may be offeredhome care for individuals with disabilities. with the goal to increase functional language skills.RANGE OF MOTION (ROM): the extent or degree SPONTANEOUS RECOVERY: refers to the gradualof movement in a joint that can be moved by the recovery that occurs without any professionalindividual (active) or when the joint is moved by assistance that may be related to the reduction inanother person (passive) ROM: maximum extension edema, reabsorption of blood in the brain, reducedto maximum flexion. inflammation and the influence of the environment and the individual’s own immune responses.RECREATIONAL THERAPY (RT): a service thatprovides a variety of activities for individuals with SYSTOLIC BLOOD PRESSURE (SBP): the pressuredisabilities, to include aquatic or water therapy, inside the arteries when the heart contracts withgames or other group activities to improve each beat.independence and learn appropriate leisurefunctions. TRANSIENT ISCHEMIC ATTACH (TIA): described as a mini-stroke it causes symptoms just like a brainREHABILITATION: the restoration of an individual attack but is transient lasting only a few minutesusing therapies with the goal of maximizing and completely reverses when the cerebral bloodindependence or restoring the individual to their vessel that was temporarily blocked or was in ahighest level of functioning after an illness, e.g., a spasm resolves spontaneously. A TIA could be abrain attack. warning sign of a serious cerebrovascular event and should be taken seriously.SENSORY: refers to the function of the 5 senses:smell, touch, hearing, vision and taste. VENTRICLES (CEREBRAL): a small, fluid-filled cavities within the brain that are filled withSEIZURE: abnormal brain wave activity that can cerebrospinal fluid (CSF) that is continuously beingcause changes in behavior. A seizure may be produced and circulating in the brain, to cushionclonic, tonic, focal or generalized and is usually and protect the brain.diagnosed following a test, e.g., an EEG by aneurologist. VISUAL FIELD DEFECT (VFD): refers to impaired vision affecting the outer half of one eye and theSPASTICITY: increased tension or tightness in a inner half of the other eye and is similar to a “blindmuscle that resists efforts to stretch. This condition spot.” The loss is generally on the side that iscan result in pain and discomfort, weakness, loss paralyzed after a brain attack.of function and independence that can requiremedications, therapy, or a surgical implantation of VOCATIONAL REHABILITATION: the process ofan intrathecal baclofen device for relief. retraining an individual to perform job-related activities after they have experienced a disability, such as a brain attack.50 Delaware Stroke Initiative
  • 53. Suggested Reading List Web SitesStroke Survivors by William H. Bergquist, Rod Delaware Stroke InitiativeMclean, and Barbara A. Kobylinski; Jossey-Bass www.destroke.orgPublishers, San Francisco, 1994. $22.50. Stroke Information Directory www.stroke-info.comA Stroke Manual for Families: Actions andReactions by Tampa General Rehabilitation Center; American Stroke Association (ASA)HDI Publishers, Houston, TX. www.strokeassociation.orgAmerican Heart Association Family Guide to Internet Stroke CenterStroke Treatment, Recovery, Prevention by Louis R. www.strokecenter.orgCaplan, MD, Mark L. Dyken, MD, and National Stroke Association (NSA)J. Donald Easton, MD; Times Books, Random www.stroke.orgHouse, NY, 1994. $14. Brain Attack Coalition www.stroke-site.orgWhen Someone You Loves Has a Stroke, ANational Stroke Association Book by Marilynn National Institute of Neurology Disorders andLarkin; Lunn Sonberg Book Associates, NY, 1995. Stroke (NINDS) www.ninds.nih.govLearning and Living After Your Stroke byHarmerville Rehabilitation Center, Pittsburgh, PA. Rehabtrials www.rehabtrials.org1983. Available from Harmerville RehabilitationCenter, P.O. Box 11460, Pittsburgh, PA 15238, $17. Stroke Connection Magazine www.strokeassociation.org“Stroke,” by Lawrence M. Brass, MD; chapter inYale University School of Medicine Heart Book, Doctors Guide to Stroke Information andedited by Barry L. Saret, MD, Marvin Moser, MD, Resourcesand Lawrence S. Cohen, MD; William Morrow and www.pslgroup.com/Strokes.htm#NewsCompany, Inc., NY, 1992. Health and Medicine in the News www.biomed.lib.umn.edu/hmedMy Year Off by Robert McCrum Speaking the Language of StrokeStrokes: What Families Should Know by Elaine www.stroke.org/pages/about.cfmFantle Shimberg; Ballantine Books, NY, 1990. $4.95. Heart and Stroke Encyclopedia A-Z GuideRecovering at Home After a Stroke: A Practical for You and Your Family (The Howard J. 56Rusk Institute of Rehabilitation Medicine) by Healthology VideoFlorence Weiner; Berkley Publishing Group, 1994. www.healthology.com/focus-index.asp?f=stroke&b =healthologyLiving with Stroke: A Guide for Families byRichard C. Senelick, MD and Peter W. Rossi, MD; AphasiaContemporary Books Inc., Chicago, 1994. $14.95. www.Memorytalk.com/aphasia.thml Stroke: A Guide to Information and Resources in Delaware 51
  • 54. Lifespan: Preventing Falls Spinal Cord Injury, Stroke, Paralysis Guide towww.lifespan.org/services/rehab/articles/falls.htm Support Organizations http://neurosurgery.mgh.harvard.edu/paral-r.htmOn Being Struck by Strokewww.strokesurvivor.org Stanford Stroke Center www.stanford.edu/group/neurology/strokeMail ListSTROKE-L@LSV.UKY.EDU Stroke & Aphasia Information www.strokesupport.comAmerican Heart Associationwww.americanheart.org Stroke-L ( stroke discussion mail-list): To subscribe, send an e-mail message toAmerican Speech-Language-Hearing Association LISTSERV@LSV.UKY.EDU (Enter as message:(ASHA) www.asha.org "Subscribe Stroke-L Digest")Aphasia Hope Foundation The Stroke Networkwww.aphasiahope.com _ www.strokesupport.org.Disability Resources Virtual Hospitalwww.geocities.com/~drm www.vh.org/Providers/ClinGuide/Stroke/Index.htmlDoctors Guide to Stroke Info and Resources VNA Stroke Survivors Connectionwww.pslgroup.com/STROKES.htm www.vna-pgh.org/stroke.htmlMayo Clinic Other Stroke-related Websiteswww.mayo.edu/cerebro/education/stroke.html http://dna2Z.com/projects/stroke http://neuro-www.mgh.harvard.edu/forumMedicare www.asel.udel.edu/at-online:www.medicare.gov www.closingthegap.com www.communicationdisorders.netMed Help www.dysphagiatherapy.comMedhlp.netusa.net/ www.independentliving.com www.jeffersonhealth.org/diseases/neuro/stroke.htmMel Health Information Resourceswww.mel.lib.mi.us/health/health-disease-stroke. Disclaimer: Please let us know if any resources listed here are incorrect or undesirable. Also let us know about any otherNational Aphasia Association Internet resources that you would recommend to stroke andwww.aphasia.org head injury survivors and family members.National Family Caregivers Associationwww.nfcacares.org National Organizations Alliance for Aging ResearchNational Stroke Associationwww.stroke.org 202-293-2856. Independent, non-profit organization founded toN.I.N.D.S. (National Institute of Neurological promote medical research into conditions affectingDisorders & Stroke) human aging, such as stroke, hypertension (highwww.ninds.nih.gov blood pressure), and congestive heart failure.52 Delaware Stroke Initiative
  • 55. American Association of Homes & Services Augmentative and Alternativefor the Aging Communication – Rehabilitation202-783-2242, www.AAHSA.org Engineering Research Center on Communication Enhancement (AAC-RERC)American Association of Retired Persons Duke University Medical Center(AARP) Box 3888202-434-2277 or 1-800-424-3410 Durham, NC 27710www.aarp.org (919) 681-9983Membership required (eligible at age 50). Provides http://www.aac-rerc.com/health information brochures, supplementalmedical insurance, financial investment program. Agency for Health Care Policy andOffers discounts on medications, lodging, and car Researchrentals. P.O. Box 8547 Silver Spring, MD 20907-8547American Stroke Association 1-800-358-92959707 East Easter Lane http://www.ahcpr.gov/Englewood, CO 80112-37471-800-787-6537 Centers for Medicare and Medicaidhttp://www.stroke.org Services (CMS) A bimonthly publication called “Stroke Smart” Medicare Hotline: 1-800-MEDICAREis available for an annual subscription of $12. www.medicare.govA pamphlet called “Steps to Recovery” is also Federal agency that administers Medicareavailable. (for elderly or disabled individuals) and Medicaid (for individuals with low income). Offers freeAmerican Heart Association (AHA) publications and operates a telephone hotline/Stroke Connection information service.7272 Greenville Ave.Dallas, TX 75211-4596 Gerontological Society of America (GSA)1-800-553-6321 202-842-1275. E-mail: geron@geron.orghttp://www.americanheart.org/ www.geron.org The American Stroke Association is the division Multidisciplinary association that deals withof the American Heart Association that’s solely research, practice, and education in aging.focused on reducing disability and death fromstroke through research, education, fundraising National Association of Professionaland advocacy. Geriatric Care Managers (520) 881-8008. www.caremanager.orgAmerican Speech, Language and Referral source for geriatric care managersHearing Association nationwide by Internet or purchase of brochure.10801 Rockville PikeRockville, MD 20852 National Citizens’ Coalition for Nursing1-800-638-8255 Home Reform 202-797-0657 Stroke: A Guide to Information and Resources in Delaware 53
  • 56. National Committee to Preserve Social National Easter Seal SocietySecurity and Medicare 70 East Lake Street1-800-966-1935 or (202) 216-0420 Chicago, IL 60601E-mail: grassroots@ncpssm.org 1-312-726-6200National Council on the Aging National Health Information Center ( NHIC)(202) 479-1200 U.S. Department of Health and Human ServicesMembership benefits include newsletter, (301) 565-4167 or 1-800-336-4797information, and telephone referrals. Health information referral service.National Institute on Aging National Rehabilitation Information CenterU.S. Department of Health & Human Services, 8455 Colesville Road., Suite #915Public Health Service, National Institutes of Health, Silver Spring, MD 20910-1119(301) 496-1752 or 1-800-222-2225 1-800-346-2742NIA conducts and supports research to increaseknowledge of the aging process and associated National Institute of Neurological Disordersphysical, psychological, and social factors. Call for and Stroke (NINDS)a list of publications. National Institute of Health Bethesda, MD 20892National Library of Medicine A pamphlet (NIH pub No. 99-2222, June 1999)301-594-5983 or 1-888-FINDNLM is available called “Hope through Research.” Itwww.nlm.nih.gov contains many resources and basic information.National Stroke Association Smoke-Enders1-800-STROKES (787-6537) 1-800-828-4357www.stroke.org, E-mail: info@stroke.org Seminars and a learn-how-to-quit-smoking kit.NSA publishes educational materials forprofessionals and consumers, including audio and Social Security Teleservicevideo tapes, slide presentations, stroke prevention 1-800-772-1213 (Spanish and English)profiles and guides, promotional items, journals,and a newsletter entitled “Be Stroke Smart.” State and Local OrganizationsNational Aphasia Association Alzheimer’s AssociationMurray Hill Station 2306 Kirkwood Hwy., Wilmington, DE 19805P.O. Box 1887 (302) 633-4420, Kent/Sussex: (800) 219-7666New York, NY 10156-0611http://www.aphasia.org/ American Heart Association The National Aphasia Association is an Delaware Affiliate, Inc.organization dedicated to promoting the care, 1196 Old Churchmans Road, Newark, DE 19711welfare, and rehabilitation of those with aphasia (302) 633-1211through public education and support of research.54 Delaware Stroke Initiative
  • 57. Architectural Accessibility Board past 1.5 years, are encouraged to participate.(302) 739-5644 Contact John P. Scholz, Phd., P.T., Associate Professor: jpscholz@udel.eduDelaware Assistive Technology InitiativeDuPont Hospital, PO Box 269 AARP DelawareWilmington, DE 19899 One Rodney Square North, 1100 N. Market Street,(302) 651-6790 or 1-800-870-DATI Ste. 1201, Wilmington, DE 19801 Publishes “The AT Messenger” that focuses (302) 571-8791, deaarp@aarp.orgon technologies and organizations that supportassistive technologies. Academy of Lifelong Learning 2700 Pennsylvania Ave., Wilmington, DE 19806-1169Delaware Division of Services for Aging and (302) 573-4417Adults with Physical DisabilitiesDept. of Health & Social Services Freedom Center for Independent Living1901 North DuPont Highway, New Castle, DE 19720 The Freedom Center is a consumer-driven1-800-223-9074 organization committed to promoting independent DSAAPD sponsors programs that improve the living options for individuals with disabilities.quality of life for Delawareans through community- 3 East Main Street, Middletown, DE 19709based services, advocacy and partnerships. (302) 376.4399 or 866.OUR-RIGHTSDelaware Health and Social Services offers a Freedomcil@yahoo.com“Guide to Services for Older Delawareans” that isfull of references with a convenient index. Adult Day Care Adult day care centers offer a safe and caringDelaware Helpline environment for adults who need supervision1-800-464-4357 (in Delaware) or assistance and might not be safe or actively(302) 573-2433 (outside Delaware) engaged if left at home. Trained staff members The Delaware Helpline is a toll-free service may provide food services, nursing care orwhich provides information on state government monitoring, with a variety of recreational activities,agencies and referrals to community resources. medication supervision, support groups and socialThe Delaware Helpline has Spanish speaking staff services. Rehabilitation services (OT, PT, SLP) areand services for the hearing impaired. The service sometimes available. Most adult day care centersis free. Hours from 7:30 a.m.–6:00 p.m. provide transportation. Some offer extended daytime and weekend hours. Adult day careUniversity of Delaware programs serve functionally-impaired individualsPhysical Therapy Department who do not require 24-hour institutional care but307 McKinly Laboratory, Newark, DE 19716 are unable to manage independently withoutPhone (302) 831-6281 assistance or supervision.www.udel.edu/PT/scholz/main.html Studies problems in movement coordination in Delaware Elwynindividuals who have had a stroke and to identify 321 E. 11th Street, Wilmington, DE 19801more effective treatment approaches. Individuals (302) 657-5607 or (302) 658-8860, www.elwyn.orgwho have had a stroke, particularly within the Stroke: A Guide to Information and Resources in Delaware 55
  • 58. Gilpin Hall Adult Day Program CHEER Adult Day Center and1101 Gilpin Avenue, Wilmington, DE 19806 Alzheimer Day Treatment(302) 654-4486 5 Sandhill Road, Georgetown, DE 19947 (302) 854-9500Riverside Health Care Center700 Lea Blvd., Wilmington, DE 19802 Evergreen Center II Alzheimer Day Treatment(302) 765-4175 Christiana Care Visiting Nurse Association 611 duPont Hwy., Milford, DE 19963Southpark Terrace (302) 422-15751605 N. Broom Street, Wilmington, DE 19806(302) 655-2908 Laurel Senior Center - Adult Day Care Program 113 N. Central Ave., P.O. Box 64, Laurel, DE 19956Deerfield Senior Day Care3704 Kennett Pike Care or Case ManagementGreenville, DE 19807 Care Management involves the services of care(800) 987-3646 or (302) 888-1190 managers (also called “case managers”) who assist clients by assessing physical and mentalEaster Seals Adult Day Care well-being; providing information and referral24 Reads Way, New Castle, DE 19729 regarding appropriate resources; and coordinating social, medical, and housing services. GeriatricEvergreen Center I - Alzheimer Day Treatment care managers are experienced in assistingChristiana Care, Visiting Nurses Association older people and their families/caregivers withBuilding F, 3000 Newport Gap Pike issues relating to long term care options andWilmington, DE 19808 arrangements. Many care managers offer crisis(302) 955-8448 intervention, counseling, and support services. To locate a qualified, experienced geriatric careFoulk Manor South Adult Day Care manager in your area, call the National Association407 Foulk Road, Wilmington, DE 19803 of Professional Geriatric Care Managers at (520)(302) 655-6249 881-8088, or visit their Mid-Atlantic chapter website for online information at www.gcmonline.org.Masonic Home of Delaware, Inc.4800 Lancaster Pike, Wilmington, DE 19807 Elder Options Planners, LLC(302) 004-4434 113 N. Rodney Street, Wilmington, DE 19806 (302) 777-3900University of Delaware - Active Day Center200 White Chapel Drive, Newark, DE 19713 IKOR Quality Care(302) 831-6774 724 Yorklyn Road, Hockessin, DE 19707 (302) 489-3100 or 877IKORUSADaybreak Mature Day CareDelaware Hospital for the Chronically Ill (DHSS), 100 Life SolutionsSunnyside Road, Smyrna, DE 1997 504 West 9th Street, Wilmington, DE 19801(302) 653-8556 ext. 348 or 346 (302) 622-829256 Delaware Stroke Initiative
  • 59. Neuroscience Nursing Consultants needs, and work with the client to resolve theEllen Barker, MSN, APN, 3600 Centerville Road, situation. Referrals can be anonymous with strictGreenville, DE 19807, (302) 888.1461 confidentiality by calling:Senior Partners, Inc. DHSS Division of Services for Aging and AdultsBox 1908, Wilmington, DE 19899, (302) 764-7880 with Physical Disabilities. NCC: (302) 453-3820 Kent/Sussex County: (302) 422-1386Senior Social Services Statewide Toll Free: 1-800-223-9074203 Wooddale Ave., New Castle, DE 19720(302) 328-4485 Division of Securities, Fraud Unit: (302) 577-8424 Department of Justice Consumer Protection Unit:Supportive Care Services (302) 577-8600 or 1-800-220-5424507 West 9th Street, Wilmington, DE 19801(302) 655-518 Office of Pubic Advocate Carvel State Office Building - 4th Floor, 820 FrenchThe Family and Workplace Connection Street, Wilmington, DE (302) 577-50773511 Silverside Road, Wilson Building, Wilmington,DE 19810, (302) 479-1679 Elder Law Program Wilmington/New Castle CountyCompanion Programs 100 West 10th Street, Wilmington, DE 19801,First State Community Action Agency (302) 575-0666P.O. Box 877, Georgetown, DE 19947(302) 856-7761 Kent County 640 Walker Road, Dover, DE 19904,Modern Maturity Center, Inc. (302) 674-85001121 Forrest Ave., Dover, DE 19904, (302) 734-1200 Sussex CountyNew Castle County Senior Services 144 E. Market Street, Georgetown, DE 19947Senior RolCall Lifeline Office, (302) 239-5151 (302) 856-4112Visiting Friends CHEER EmploymentSussex County Senior Services, Inc. Division of Employment and Training5 Sandhill Road, Georgetown, DE 19947 4425 North Market Street, Wilmington, DE 19802,(302) 854-9500 (302) 761-8085Counseling/Mental Health Wilmington Senior CenterServices 1901 N. Market Street, Wilmington, DE 19802Delaware Health and Social Services’ Adult (302) 651-3440Protective Services Program receives andinvestigates reports of abuse, neglect or Senior Employment Servicesexploitation of physically and/or mentally impaired Wilmington Senior Center, Inc., 1901 N. Marketadults, age 18 and older. In such a case, a social Street, Wilmington, DE 19802, (302) 651-3440worker will contact the individual, assess his/her Stroke: A Guide to Information and Resources in Delaware 57
  • 60. Division of Employment and Training Assisted Living Facilities: Offer housing plusPencader Corporate Center, 225 Pencader services to assist residents, such as aides toCorporate Center, Suite 211, Newark, DE 19702, provide personal care (assistance with bathing,(302) 368-6622 dressing, taking medications, etc.), on-site nursing or medical care, etc., for additional fees.Division of Employment and TrainingPO Box 616, 1114 S. DuPont Highway, Suite 104, Continuing Care Retirement Communities: Offer(302) 739-5473 a variety of living options (such as apartment buildings/condos and single family dwellings/Modern Maturity Center cottages), as well as nursing and medical services.1121 Forrest Ave, Dover, DE 19904, (302) 734-1200 Also offer conveniences such as dining, shopping,Division of Employment and Training banking, and recreational facilities.PO Box 548, Rt. 113, Georgetown, DE 19947-0548,(302) 856-5230 Independent Living Facilities/Retirement Communities: Offer housing for independentFirst State Community Action Agency seniors, plus organized social and recreationalPO Box 877, 856-7761 programs. Health/medical services may or may not be provided.Home Health Care Agencies Residential/Domiciliary Care Facilities–AdultMedicare-Certified Home Health Agencies: Care Residencies: Offer a type of long-term careHHA’s offer skilled, medically-necessary services housing for adults/seniors with mental or physicalordered by a physician and provided by licensed challenges. Facilities have at least four beds andprofessionals such as registered nurses, physical provide room and board for either ambulatory ortherapists, occupational therapists, speech- non-ambulatory residents. Also provide supervisionlanguage pathologists, respiratory therapists,medical social workers, dieticians, and licensed and assistance with bathing, dressing, and otherpractical nurses. “Skilled” services must be related activities of daily life.to appropriate medical conditions, needed on The Division of Services for Aging and Adultsan intermittent basis for homebound clients, with Physical Disabilities (DSAAPD) has very limitedand provided with a reasonable expectation state funding for modifications to permanentof achieving significantly positive outcomes in residences, and will not pay for modifications toa generally predictable period of time. Home rental properties. There is a $10,000 lifetime cap forhealth agencies must be certified by Medicare or modifications. Contact DSAAPD at 800.223.9075Medicaid in order to bill Medicare or Medicaid, The Delaware Division of Vocationalrespectively. Home health agency orders cover Rehabilitation’s Independent Living Program hasa maximum of 60 days at a time. Note: While funds to pay for home modifications. As in the casereceiving skilled nursing or rehabilitation services, of DSAAPD, DVR has a waiting list. DVR will payhome care clients may also qualify for some “non- for rental properties under some circumstances.skilled” personal care or support services, which Individuals must meet the eligibility criteria. Contactare described and listed in the “Nursing and DVR at 302.378.5779Personal Care” section of this Stroke ResourceGuide. Several government agencies and local governments operate low interest loan programs58 Delaware Stroke Initiative
  • 61. that make funds available for renovations and Central Branchhome modifications. Contact the USDA Rural 501 W. 11th St., Wilmington, DE 19801Development at 302.697.4353 (302) 571-6900 The Delaware State Housing Authorityadministers Community Development Block Grants Walnut Street Branchunder its Housing Rehabilitation Loan Program 1000 A North Walnut St., Wilmington, DE 19801 (302) 571-6935with low interest (3 percent) loans to low incomeDelawareans who own their home or landlords who Western Branchrent to low income tenants. Call 302.577.5001. 2600 Kirkwood Highway, Newark, DE 19711 The City of Wilmington administers the (302) 453-1482Community Development NeighborhoodRehabilitation Program which provides home Sussex Family Branchimprovement loans for low to moderate income 105 Church, Rehoboth, DE 19971homeowners with disabilities. Call 302.576.3000. (302) 227-8018 New Castle County Department of CommunityAffairs administers a Housing Rehabilitation TransportationProgram that includes grants for emergencyrepairs and low interest loan programs for Driving Instruction andhomeowners to make major renovations. Call Handicap Permit Information302.395.5614. If physical impairment occurs following a stroke, a patient’s doctor or the hospital is required to report the name of the stroke survivor to theExercise Programs Department of Motor Vehicle. Therefore, to haveThe following is a brief list of local YMCA the license renewed, stroke survivors may haveorganizations offering accessible exercise to obtain a referral from their physician to a driverprograms. Please consult your doctor or rehabilitation program (i.e., Moss Rehab, Brynrehabilitation therapist before participating in such Mawr Rehab, or Health South Chesapeake). Theseactivities and for more information on exercise- rehabilitation programs must be certified throughrelated services in your area. the Department of Motor Vehicle in training individuals how to drive modified vehicles. PleaseCentral Delaware Branch consult your physician or local Department of1137 S. State St., Dover, DE 19901 Motor Vehicle for more information.(302) 674-3000 Delaware Department of Motor VehicleBear-Glasgow Branch Handicap license plates and cards are630 Peoples Plaza, Newark, DE 19702 available to qualified persons and applications(302) 832-7980 which require a physician’s signature may be obtained from any Delaware Motor VehicleBrandywine Branch location. Hours of operation for all offices:3 Mt. Lebanon Rd., Wilmington, DE 8 a.m.–4:30 p.m. on Mon., Tues., Thurs., and Fri.;(302) 478-8303 12–8:00 p.m. on Weds. Stroke: A Guide to Information and Resources in Delaware 59
  • 62. Dover Office Delaware State Council of Senior Citizens Inc.Rt. 113-303, Transportation Circle 181 N. Thistle Way, Newark, DE 19702P.O. Box 698, Dover, DE 19903 (302) 738-5646(302) 739-2500 Middletown Odessa Townsend Senior CenterGeorgetown Office 300 S. Scott St., Middletown, DE 19709Rt. 113, South Bedford Extension (302) 378-4758Georgetown, DE 19947, (302) 856-2500 Newark Senior CenterNew Castle Office 200 White Chapel Dr., Newark, DE 19713Airport Road, New Castle, DE 19720 (302) 737-2336(302) 323-4434 Supportive Care ServicesWilmington Office 507 W. 9th St., Wilmington, DE 198018th St. & Bancroft Pkwy., Wilmington, DE 19805 (302) 655-5518(302) 577-2586 Wilmington Senior CenterVans, Scooters, Wheelchairs 1901 N. Market St., Wilmington, DE 19801Accessible Vans of America, LLC (302) 651-34001-800-862-7475http://www.accessiblevans.com Cape Henlopen Senior Center Inc.Senior Services and 11 Christian St., Rehoboth, DE 19971Health Organizations (302) 227-2055Delaware Senior Olympics Inc. CHEER Transportation ProgramBlue Hen Corp. Center, Rt. 113, Dover, DE 19901 (302) 856-4909(302) 736-5698 Cheer Centers Sussex County Senior ServicesFrederica Adult Center Community Action Building201 S. Market St., Frederica, DE 19946 Milton, DE 19968, (302) 684-4819(302) 335-4555 Community Church ofHarrington Senior Center Inc. Oak Orchard, Angola, DE, (302) 945-3551102 Fleming St., Harrington, DE 19952(302) 398-4224 Indian River Senior Center Inc. 322 Mitchell St., Millsboro, DE 19966Milford Senior Center (302) 934-8839501 N. Walnut St., Milford, DE 19963(302) 422-5420 Lewes Senior Center Inc. 310 Nassau Park Rd., Lewes, DE 19958Senior Citizens Center (302) 645-92931121 Forrest Ave., Dover, DE 19904, (302) 734-120060 Delaware Stroke Initiative
  • 63. Stroke Support Groups Baratt’s ChapelThe following support groups are designed for the 636 Bay Rd.,Frederica, DE 19946 (302) 335-5544stroke survivor and/or their family and caregivers.Such groups offer the individual a chance to Biggs Museum of American Artmeet with others who are learning to adapt to 401 Federal Street, Dover, DE 19901, (302) 674-2111life following a stroke, and provide them withcommunity involvement and useful informational Harrington Historical Society Museumsessions regarding stroke. 110 Fleming St., Harrington, DE 19952 (302) 398-3696New Castle CountyStroke Club (Easter Seals) Kent County Theatre GuildMeets at the Jewish Community Center 140 Roosevelt Ave., Dover, DE 19901(302) 324-4444 (302) 674-3565“Thumbs Up” Stroke Support Group Smyrna MuseumSponsored by the Delaware Stroke Initiative 11 S. Main St., Smyrna, DE 19977, (302) 653-1320Meets at the New Ark United Church of Christ300 East Main Street, Newark, Delaware New Castle County Ashland Nature CenterCo-Facilitators, Dick and Mary Ellen Green Brackenville & Barley Mills Rds., Hockessin, DE(302) 292-1793 (302) 239-2334Sussex County Brandywine ZooSussex County Stroke Club (Easter Seals) N. Park Drive, Brandywine Park, Wilmington, DEMillsboro, (302) 934-9801 or (302) 856-7164 (302) 571-7788Milford Stroke Club Delaware Art MuseumMilford Memorial Hospital/Rehab Therapy Gym 2301 Kentmere Pkwy., Wilmington, DE 19806(302) 424-5964 (302) 571-9590Accessible Activities Delaware Center for the Contemporary ArtsDelaware offers many accessible museums, per- 200 South Madison St., Wilmington, DE 19801forming arts venues, recreational activities and (302) 656-6466other attractions to help stroke survivors and theirfamilies and/or caretakers remain socially active in Delaware History Museumtheir communities. 504 Market Street Mall, Wilmington, DE 19801 (302) 656-0637Kent CountyAir Mobility Command Museum Delaware Museum of Natural History1301 Heritage Rd., Dover Airforce Base, Dover, DE Rt. 52 between Greenville & Centerville, Del.(302) 677-5938 (302) 652-7600 Delaware Division of Parks and Recreation (11 state parks), (302) 739-4702 Stroke: A Guide to Information and Resources in Delaware 61
  • 64. Delaware Symphony Orchestra Winterthur Museum, Garden & Library818 N. Market Street, Wilmington, DE 19801 Rt.52, Kennett Pike, Wilmington, DE 19807(302) 652-5577 or 1-800-37-GRAND (302) 888-4600Delaware Theatre Company Sussex County200 Water St., Wilmington, DE 19801 Anna Hazard Museum(302) 594-1100 17 Christian St., Rehoboth Beach, DE 19971 (302) 226-1119Delaware Toy and Miniature Train MuseumOff Rt. 141, Wilmington, DE, (302) 427-8694 Georgetown Historical Society 510 S. Bedford St., Georgetown, DE 19947The Grand Opera House (302) 855-9660818 Market St. Mall, Wilmington, DE 19801(302) 658-7897 Lewes Historical Society 110 Shipcarpenter St., Lewes, DE 19958Hagley Museum (302) 645-7670Rt. 141 & Brandywine River, Wilmington, DE(302) 658-2400 Nanticoke Indian Museum Oak Orchard Intersection, Millsboro, DE 19966Opera Delaware (302) 945-70224 South Poplar St., Wilmington, DE 19805(302) 658-8063 Sea Shell CityPlayhouse Theatre 708 Ocean Highway, Fenwick Island, DE 1994410th & Market Sts. Wilmington, DE 19801 (302) 539-9366(302) 656-4401 Milford 2nd St. PlayersRockwood Museum 2 S Walnut St., Milford, DE 19963610 Shipley Rd., Wilmington, DE 19809 (302) 422-0220(302) 761-4340 Possum Point PlayersUniversity of Delaware Center for Black Culture Old Laurel Highway, Georgetown, DE 19947192 S. College Ave., Newark, DE 19716 (302) 856-3460(302) 831-2991Wilmington Drama League TechnologyCommunity Theatre, 10 W. Lea Blvd., Wilmington, DE Delaware Assistive Technology & Initiative Center19802, (302) 764-1172 for Applied Science & Engineering, University of Delaware/Alfred I. DuPont Hospital for Children, POWilmington & Western Railroad Box 268, Wilmington, DE 19899-0269. The DATI isGreenbank Station, Rt. 41, Wilmington, DE 19808 a joint project of the Center for Applied Science(302) 998-1930 and Engineering at the University of Delaware and the Alfred I. DuPont Hospital for Children. DATI isWilmington Blue Rocks funded by the National Institute on Disability and801 S. Madison St., Wilmington, DE 19801 Rehabilitation.(302) 888-2015, www.bluerocks.com62 Delaware Stroke Initiative
  • 65. Delaware Recycles Assistive Technology Other Resources and Products(302) 645-4358 or visit their website: http://www.asel.udel.edu/dati/recycle/index.html AbilityHub: Adaptive equipment and methods for accessing computers: www.abilityhub.comAssistive Technology Equipment Loan ResourceCenter: Call 1.800.870.DATI ABLEDATA: National database for adaptive equipment: 800.227.0216, www.able-data.comDATI Mailing List: For $20 you can receive anannual subscription. Make checks payable to the: Accessible Journeys: Arranges vacations acrossDE Assistive Technology Initiative, University of the world that are accessible and comfortable:Delaware/Alfred I. duPont Hospital for Childrens, 800.846.4537, www.disabilitytravel.comPO Box 269, 1600 Rockland Road, Wilmington, DE19899-0268 or call 800.870.DATI or 302.651.6790 Accessible Van Rentals: Call 888.282.8267TRAVELIN’ TALK: This is a network of 1,600 people Adaptive Equipment and Device Aids: Sammonsand organizations world-wide willing to provide Preston catalog, call toll free 1-800-323-5547 or visitassistance to travelers with disabilities. For www.sammonspreston.cominformation, write to Travelin Talk, P.O. Box 3534,Clarksville, TN 37043-3534. Aids to Daily Living: http://www.bentonmedical. com/aids.htmlTelephone Reassurance Program Amtrak: 800.523.6590, www.amtrack.com (searchCONTACT Delaware, Inc. under “accessibility”)P.O. Box 9525, Wilmington, DE 19809(302) 761-9100, 1-800-262-9800 Association of Foot and Mouth Painting Artists: An international organization that helps developInterfaith Volunteer Caregivers, Delaware the talents of painters that are accepted into theEcumenical Council for Children and Families group: (770) 986-7764, www.amfpa.com240 N. James Street, B-2, Wilmington, DE 19804(302) 225-1040 Arts and Healing Network: An internet site that has information on considering the connectionModern Maturity Center between art and healing. www.artheals.org1121 Forrest Ave., Dover, DE 19904, (302) 734-1200 AT508.com: This is an internet site for informationCHEER - Sussex County Senior Services, Inc. on assistive technology and how it pertains to5 Sandhill Road, Georgetown, DE 19947 Section 508 and the Federal Law: www.at508.com(302) 854-9500 Buddy Safety Roller: This walking aide is designedGenerations Home Care, Inc. for stroke survivors and covered by medical205 East Market Street, Georgetown, DE 19947, insurance and Medicare: 60-15 Safety Roller EO 147.(302) 856-7774 High front cross brace for over the toilet use, which is part of the triple reinforced steel. http://www. safetyroller.com/stroke.htm Stroke: A Guide to Information and Resources in Delaware 63
  • 66. CANINE COMPANIONS FOR INDEPENDENCE: Offers Paralympics: Provides services to disabledcanine companions for individuals with a disability athletes. (719) 471-8772, www.paralympic.orgat virtually no cost: (707) 577-1700, www.caninecom-panions.org RehabMart.com: Online discount medical equipment and supply company. http://www.Coalition for Disabled Musicians, Inc.: Assists rehabmart.com/disabled musicians, offers accessible rehearsaland recording studio with adaptive techniques for Service Monkeys: Helping Hands providespain, endurance and other limitations: (631) 586- capuchin monkeys to individuals with disabilities:0366, www.disabled-musicians.org (617) 787-4419, www.helpinghandsmonkeys.orgElderCorner: Provides information on health-related Quarter Technology Incorporated (QTI): Offers unitsissues. http://www.eldercorner.com/ that are voice activated with switches or computer mouse: (978) 649-4ECU, www.qtiusa.comGreyhound: Buses for individuals as an alternativeto other travel: (800)231-2222 ScootAround: Offers scooter and/or wheelchair rentals: (888) 441-7575, www.scootaround.comHome Health Care Products & Adaptive EquipmentFor Independence: The Center for Assistive Technology: Link tohttp://www.thewright-stuff.com Assistive Products, 800-627-2281, www.cat.buffalo.eduNational Mobility Equipment Dealers Association: U.S. Disabled Athletes Fund (USDAF): BuildingTrade group of companies that sell adaptive programs for adaptive sports in every community,driving equipment: 800-833-0427, www.nmeda.org (770) 850-8199, www.blazesports.comNational Highway and Transportation Safety U.S. DOT Hotline: A toll-free number for air travelersAdministration: Offer advice and information with disabilities: 800.778.4838on driving training, vehicle selection and/ormodification: www.nhtsa.gov/cars/rules/adaptive Very Special Arts (VSA): Affiliates in 39 states and other countries create learning opportunities forThe National Arts and Disability Center (NADC): creative writing, dance, music and drama and theInformation, technical assistance and referrals visual arts for individuals with disabilities: 800-933-for the performing, visual, media and literary arts: 8721 or www.vsarts.orgNADC, Tarjan Center for Developmental Disabilities,(310) 794-1141, www.nadc.ucal.edu. Wheelchair Getaways: Call 800.536.5518 or Wheelers: 800.456.1371The National Center on Physical Activity andDisability (NCPAD): Helps supply databases and X-10 Technology: This is information about a remoteinformation on recreation and sports programs switching system that uses existing wiring in aand equipment vendors from across the U.S.: (800) resident or worksite: X10Wireless Technology, Inc.,900.8086, www.ncpad.com 800-675-3044, www.x10.com64 Delaware Stroke Initiative
  • 67. Visit Our Web Site: www.destroke.org STROKE RISK SCREENINGThis screening tool includes a lists of potential risk factors for stroke. Complete the “yes” or “no” questions and take this formto your health care provider (doctor, nurse, nurse practitioner, clinic or any DSI free stroke risk screening). The form can becompleted under the supervision of a qualified professional who can check your blood pressure and pulse and help youevaluate your risk for stroke and discuss stroke prevention and steps to take if you suddenly develop signs of having a stroke.Site and address of screening: Date:PART I - STROKE RISK SCREENING TOOL YES NO1. Have you ever been told that you have high blood pressure? (if not, skip to question #3)2. If you take medication for high blood pressure, do you frequently miss doses?3. Do you have a history of irregular heart beat, also called atrial fibrillation?4. Have you ever been told that you have a narrowing of the arteries (carotid) in the neck?5. Have you had a heart attack, heart by-pass surgery, angioplasty or other heart disease?6. Have you had a previous stroke or mini-stroke (TIA)?7. Do you have diabetes?8. Do you smoke cigarettes regularly, or have you smoked cigarettes in the past 5 years?9. Has a family member had a stroke, heart attack or hemorrhage (rupture) of a blood vessel in the brain?10. Do you drink more than 2 ounces of alcohol daily (e.g., 2 drinks of liquor, 2 glasses of wine, or 2 beers)?11. Have you ever been told that you have abnormal lipids or cholesterol levels?12. Do you exercise less than 30 minutes daily or have any type of physical activity less than 3 times a week?13. Do you or immediate members of your family have Sickle Cell disease?14. Do you use any of the following drugs: Cocaine, Crack, Heroin, Speed, Amphetamines, diet pills or Ecstasy?15. Are you more than 20 pounds over your target weight?16. If you are a woman, do you smoke cigarettes and take birth control pills? Add the number of “yes” responses in questions 1-16 to find your Health History Risk Score = YES NO17. Measure blood pressure (BP) in arm in sitting position: (systolic)/ (diastolic) Is the highest systolic BP >130 OR is the highest diastolic BP >85?18. Check radial pulse x 60 seconds: beats per minute. Is radial pulls irregular? Add the number of “yes” responses in questions 17-18 to find your Clinical Risk Score = Add your Health History Risk Score to Clinical Risk Score to equal the Brain Attack/Stroke Risk Score = and your Brain Attack/ Risk for Brain Attack/ If your age is: Stroke Risk Score is: Stroke is: <55 years 0 LOW >55 years 0 LOW >55 years 2 MODERATE >55 years >3 HIGH >65 years 1 MODERATE >65 years >2 HIGH Any age 3 MODERATE Any age >3 HIGHFOLLOW-UP:If risk for brain attack/stroke is LOW, this assessment should be shared with your health care provider/doctor during the next visit. If riskfor brain attack/stroke is MODERATE, notify health care provider/doctor within one week of the results of this screening and request anappointment for evaluation and care to prevent stoke. If risk for brain attack/ stroke is HIGH, call health care provider/doctor TODAY with theresults of this screening and request an appointment for evaluation and care to prevent stroke. Stroke: A Guide to Information and Resources in Delaware 65
  • 68. ALL PERSONS SCREENED FOR RISK FACTORS SHOULD BE EDUCATED ABOUT WARNING SIGNS OF BRAIN ATTACK/STROKE.IF ANY OF THESE WARNING SIGNS OCCUR, CALL “911” IMMEDIATELY AND SEEK TREATMENT AS SOON AS POSSIBLE.SIGNS OF BRAIN ATTACK/STROKE: • Sudden weakness or numbness • Sudden change in vision • Sudden difficulty speaking • Sudden unusual headache • Sudden dizzinessPART II – DEMOGRAPHICSName: (last) (first) (middle initial)Gender: c Male c FemaleHighest level of education: c Elementary c College c High School c Post Graduate TrainingAddressCity State Zip CountyTelephone (home): (work):Best time to call: am/pmDate of Birth: Age TodayDo you have a health care provider/doctor? c yes c noHave you seen your health care provider/doctor within the past year? c yes c noDo you have health care insurance? c yes c noEthnicity/Race: c African-American/Black c Caucasian/White c Hispanic/White c Hispanic/Non-white c Asian/Pacific Islander c Native Indian/Alaskan c OtherTo help educate people about the risk of Brain Attack/Stroke, it is important for DSI to understand what participantsthink and learn about the information they receive. Can we contact you by phone in the next 3 to 6 months for thispurpose? c yes c noDid you view our stroke video today? c yes c noI have received a screening for the risk of Brain Attack/Stroke and agree to follow up with the recommendations. I understand this is only a screening.I agree that this data can be entered into a database for research without identifying me by name. DSI agrees to abide by all federal and state laws andregulations, including but not limited to, The Health Insurance Portability and Accountability Act of 1996 (HIPPA), as amended, to protect confidential anyand all private health information obtained by DSI in the course of this stroke risk screening.(Signature of Participant) (Signature of Health care Provider)Note: This Stroke Risk Screening tool has been modified 11/27/01 by Ellen Barker, MSN, APN, Neuroscience Nursing Consultants, Greenville, Del. Forcomplete information, visit our web site: www.destroke.org. There is no copyright. Permission is not needed for copying this form.66 Delaware Stroke Initiative
  • 69. DSI STROKE RESOURCE GUIDE Stroke Guide Order Form & Free ListingsORDER FORM: To order additional copies of the Delaware Stroke Guide, complete the followinginformation and return this form with check made payable to "Delaware Stroke Initiative."Name:Address:Phone:c Please send me copies of the latest edition of the Stroke Resource Guide at a cost of $10 percopy plus $3 shipping and handling charges.Total number of Stroke Resources Guides: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total Amount of check including Shipping and Handling: . . . . . . . . . . . . . . . . . . . . . .$FREE LISTING: If your organization provides medical care services, programs, products or activities forindividuals who have experienced a stroke or “Brain Attack,” or for their families or caregivers, pleasecomplete this form and return it to the DSI office:Organization or Name of Program, Service or Product:Contact Person:Address:Phone: Fax:Email:Briefly describe the program, services, products, including cost:c Please send me information about purchasing a Display ad in the next edition of the DSI StrokeResource Guide.Return this form to: Delaware Stroke Initiative Metroform Medical Complex 620 Stanton-Christiana Road, Suite 302, Newark, DE 19713 Phone: 302.633.9313 Web site: www.destroke.org Email: destrokeinititive@earthlink.net Stroke: A Guide to Information and Resources in Delaware 67
  • 70. GET INVOLVED! Delaware Stroke Initiative Membership & Volunteer FormDSI needs your support! Membership is open to any individual, family, corporation, group, physician, nurse or healthcare provider who supports our mission and goals. Our success depends on your support. Please join DSI to helpexpand our programs and activities in Delaware. Annual membership from January through December is:c Free to any individual recovering from a strokec $25 Individual General Membership: Benefits include email notice of all activities and listing in our database as a member.c $500 Corporate Membership: Benefits include mailings of all DSI activities, invitation to attend all DSI meetings, listing on our website as a Corporate Member and invitation for one individual to attend all professional conferences during the year.c $1,000 Gold Membership: Benefits include mailings of all DSI activities, including Board of Directors meetings, listing on our website as a Gold Member, listing on all fundraising and publications as a Gold Member and invitation for two individuals to attend all professional conferences during the year.c $5,000 Platinum Membership: Benefits include mailings to all DSI activities, including all Board of Directors meetings, listing on our website as a Platinum Member, listing on all fundraising and publications as a Platinum Member and invitation for four individuals to attend all professional conferences during the year.c I would like to VOLUNTEER to help with DSI’’s activities and programs and would like to be contacted.Name:Company:Address:Phone:Fax:Email:DONATIONSIn addition, DSI accepts all donations. Check to see if your place of employment has matching donation programs thatwill double your contribution! You may call the DSI office at (302) 633-9313 if you need a Tax Identification number.UNITED WAY: DSI meets the United Way of Delawares requirements as a Designation Write-in Agency. To make a UnitedWay donation, follow these two simple steps:1) Write-in: Delaware Stroke Initiative (DSI), Metroform Medical Complex, 620 Stanton-Christiana Road, Suite 302, Newark, DE 197132) Enter: Code 9430 on your United Way of Delaware Pledge Form in the Specific Care AreaMail this form, along with membership dues or donations to the following address. Make checks payable to DelawareStroke Initiative. Delaware Stroke Initiative Metroform Medical Complex 620 Stanton-Christiana Road, Suite 302 Newark, DE 1971368 Delaware Stroke Initiative
  • 71. ‘it changed my life. ’ for me, it’s been a miracle. These are the words that inspire us at AstraZeneca – the knowledge that many of our “ideas” have ultimately brought relief to millions of people. Our more than 11,000 scientists worldwide are continually creating new sources of hope for patients with cancer, heart disease, gastrointestinal disorders, respiratory disease, neurological disorders, and infectious diseases. Everyone deserves a life without discomfort; a life that’s not controlled by the effects of illness, injury or aging. At AstraZeneca, a world leading pharmaceutical company, we’re working toward that goal everyday. Our best ideas are yet to come. www.astrazeneca-us.com © 2004. AstraZeneca Pharmaceuticals LP
  • 72. Since you may not have time toevaluate 4,644 hospitalsagainst 500 criticalstandards in 45 keyperformance areas,allow us to show you whatwould happen if you did.In the nation’s most thorough performance evaluation,St. Francis scores inthe top 5% nationally. With scores like these, you can have confidence in care from St. Francis. Recently St. Francis Hospital took part in an evaluation by the Joint Commission on Accreditation of Healthcare Organizations. 4,644 500 standards of performance hospitals in the nation are evaluated across more were measured, including: than 500 performance standards. After days of • Patient rights observations, interviews, poking, and prodding, • Medication use the Joint Commission announced St. Francis’ • Plant, technology, and safety management overall score of 98, which has been achieved by • Management of information only the top 5% of like hospitals across the U.S. • Operative and other invasive St. Francis Home Health Care received a perfect procedures score of 100. • Infection control • Orientation, training, and The quality of St. Francis Hospital continues to education of staff soar every day with advanced procedures like • Medical staff qualifications innovative spine surgery techniques, high-tech joint replacements, and the area’s most sophisti- cated beating heart bypass surgery. So if you ever have to choose a hospital, you don’t have to remember much; just 5%. 7th & Clayton Streets Wilmington, DE 19805 302.421.4141 www.stfrancishealthcare.org