Stroke is the third leading cause of death in the world wide and a major cause of disability in the elderly. Stroke remains the leading cause of serious, long-term neurologic impairment and functional disability. Stroke is often a catastrophic event affecting all aspects of an individual’s life. The impact of stroke on a patient is usually unanticipated and often devastating, requiring major adjustment in lifestyle and psychology of stroke survivors. Estimating and understanding disability following stroke should be a high priority in health care. To better characterize stroke-related disability, health care professionals should use a conceptual model of disablement and measure functions across all domains of disablement.

1. IMPACT OF CEREBROVASCULAR ACCIDENT (CVA) AND
ITS ASSOCIATED DISABILITY
Dissertation submitted by :
Kazi Mohammad Kamrul Hasan
ID :142-0049-011
Major: Epidemiology
Department of Public Health
University of South Asia

2. INTRODUCTION
Stroke is the sudden death of some brain cells due to a lack of oxygen when
blood flow to the brain is impaired by blockage or rupture of an artery. Stroke is a
more leading cause of disability in adults, resulting in much morbidity and
mortality in the world. This disease 3rd leading cause of death worldwide and the
leading causes of long term disability. WHO has mentioned that Two-thirds of
these deaths occurred in people living in developing countries and 40% of the
subjects were aged less than 70 years. Each year millions of stroke patients have
to adapt to a life with restrictions in activities of daily living as a consequence of
cerebrovascular disease.

3. INTRODUCTION…..
Stroke remains the leading cause of serious, long-term neurologic impairment
and functional disability. Stroke is often a catastrophic event affecting all
aspects of an individual’s life. The impact of stroke on a patient is usually
unanticipated and often devastating, requiring major adjustment in lifestyle
and psychology of stroke survivors. Current stroke outcome assessments are
limited to the resulting neurological impairment and functional
disability, neglecting to evaluate the total influence of the event on a patient’s
well-being .

4. RATIONALE
• Stroke is a common neurological condition, mostly seen in developing
country. Day by day there is increasing the number of stroke patient, in
different areas. As Bangladesh is a developing country and trying to develop
health care system so it is important to know the study creates and overview
about demography, Impact and associated disability of stroke patients.
Reliable good quality data collection is important for public health use – to
identify impact and trends where people are not enough concerned about
health.

5. HYPOTHESIS
• Patient of the study population have poor knowledge about cerebrovascular
accident (CVA), Its impact, risk factors and associated disability.

6. OBJECTIVES
• General objective
It is the aim of the study to explore the Impact on patient of cerebrovascular
accident (CVA) and its associated disability.
• Specific objectives
Objectives related to the patients’ demographic status, health and functional
abilities
1. Identify the demographic profile of cerebrovascular accident (CVA) patients.
2. Identify the health status and degree of physical dependence of patients.

7. Study population
200 (Sample) patient of this research project would be man and women
patient of ages 40-80. The target population of this study would be all man
and women patient in Mymensingh medical collage hospital, Community
based medical collage hospital, Insaf (Pvt) hospital and Pain and paralysis
center, Mymensingh. who has faced cerebrovascular accident (CVA) and its
associated disability conditions.

8. RESULTS

9. Gender of patient
The study was conducted on 200
participants, among them 71% were
male and 29% were female. Male are
more affected than female in
cerebrovascular accident. In this
study it was found that male and
female ratio was 2.44:1.
Male
71%
Female
29%
Gender

10. Age group No of patients Percentages
□ 40-50 22 11%
□ 51-60 41 20.5%
□ 61-70 92 46%
□ 71-80 45 22.5%
Total 200 100%
Distribution of the Age group
Age of the participants were 11%
in between 40-50 years, 20.5% in
between 51-60 years, 46% in
between 61-70 years and 22.5 % in
between 71-80 years. It was found
that the majority of the
cerebrovascular accident patients
were aged between 60-70 years.
Most vulnerable age group was
61-70 years.

11. Distribution of the Patient according to Education Level
Education
Level
No of patients Percentages
Illiterate 18 9%
Literate 16 8%
Primary 52 26%
SSC 0 0%
JSC 64 32%
HSC 10 5%
Bachelor 30 15%
Masters or
above
10 5%
Total 200 100%
In this study showed distribution of the
participants according to their education
level were 9% were illiterate (never
attended school), 8% were literate
(attended school but did not
complete), 26% were passed primary
education, 15% were complete
bachelor, and 5% were complete
masters or above. The figure shown
that the involvement of
cerebrovascular accident in the
people who are illiterate, literate and
well educated.

12. Distribution of the occupation status of the patient
4
10
2
0
20
0
18
1
2
4
23
16
0 5 10 15 20 25
Other
Unemployed
Teacher
Student
Services holder
Rickshaw puller
Housewife
Factory/garments worker
Driver
Day laborer
Businessman
Agriculture
percentages
Occupation
Among them 16% of the participants
were Agriculture, 23% were
Businessman, 4% were Day
laborer, 2% were Driver, 1% were
Factory/garments worker, 18% were
Housewife, 20% was Services
holder, 2% were Teacher, 10% were
Unemployed and 4% were other
professional status.

13. Rural
53%
Urban
47%
Living area
In this study 200 cerebrovascular
accident patients were participants.
Among them 53% were living in
rural area and 47% were living in
urban.
Living area of the participants

14. Distribution of stroke by type
Ischemic
89%
Hemorrhagic
11%
Type of stroke
A total of 200 cerebrovascular accident
patients were participants. Among them
89.5% participants were attacked by
ischemic stroke and 10.5%
participants were attacked by
hemorrhagic stroke.

15. Patients risk factors for stroke
Health condition Patients Percentages
Hypertension 110 55%
High cholesterol 15 15%
Obesity 36 18%
Nerves stress 8 4%
Cancer 0 0%
Tuberculosis 0 0%
Diabetes 46 23%
Cardiac problem 68 34%
Smoker 52 26%
Arthritis 14 7%
Lung problem 4 2%
Neurological
condition
8 4%
Others 0 0%
This figure indicates that the
majority of patients 55% have
Hypertension. The 34% participants
has Cardiac problem, 26%
participants were Smoker 23%
participants has Diabetes, 18%
participants has Obesity, 15%
participants has High cholesterol.

16. 0
10
20
30
40
50
60
Left
hemiplegic Right
hemiplegic
tr
Tetraplegia
Paraplegia
Left
hemiplegic
53% Right
hemiplegic
47%
Tetraplegia
, 0% Paraplegia
, 0%
Effected side
200 cerebrovascular accident patients
were participants. Among them 53%
participants were affected by Left sided
hemiplegic and 47% participants were
affected by Right sided hemiplegic.
What parts of body is affected

17. 0
10
20
30
40
50
60
70
32
20
25
20
10
8
16
12
12
10
10
4
26
Participants
Hypertension High cholesterol Diabetes Obesity Smoker
This figure indicates that the majority
of patient (32+10+16+12=70) has
according to Hypertension, high
cholesterol, Diabetes and obesity. In the
other patients (20+8+10=38) has according
to Hypertension, high cholesterol and
obesity. Some participant (25+12+10=47)
has according to Hypertension, Diabetes
and obesity.
Comparison study about most of the health condition (risk factors)

18. Active daily life (ADL)
Majority of patients (130) 65% did
inactive life. There job requires his to
sit at a desk most of the day, some
patient spend much of his leisure time
in sitting activities. Others patient (70)
35% did live an active life.
35%
65%
Active daily life
Yes
No

19. Impact after stroke

20. According to GMFCS 25% patients were
Level-I who walks without
limitations, 47% patients were Level-II
who walks with limitations, 19% patients
were Level-III who walks with using a hand-
held mobility device, 5% patients were Level-
IV who Walks with self-mobility with
limitations; may use powered mobility, 4%
patients were Level-V who transported in a
manual wheelchair.
25%
47%
19%
5%
4%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
LEVEL I LEVEL II LEVEL III LEVEL IV LEVEL V
Mobility Level (GMFCS)
Mobility for each level (GMFCS)

21. Impact on hand function of patient
Impact Patients Percentages
Very difficult 173 86.5 %
A little difficult 7 3.5%
Somewhat difficult 13 6.5 %
Not difficult at all 7 3.5%
Total 200 100%
Majority of patients 86.5% were
hand function Very difficult. The
6.5% participants were hand
function somewhat difficult, 3.5%
participants were hand function A
little difficult and 3.5% participants
were hand function not difficult at
all.

22. Facial palsy
Among them 63.5% (127) participants
were Abnormal response, one side of
face does not move as well as the other
side and 36.5% (73) participants were
Normal response, both sides of face move
equally.
Yes
63.5%
No
36.5%
Facial palsy
(Have the patient shows teeth or smile?)

23. Speech difficulty
Among them 65.5% participants were
Abnormal response, patient slurs words,
uses the wrong words, or is unable to
speak and 34.5% participants were Normal
response, patient uses correct words with no
slurring.
0
10
20
30
40
50
60
70
Yes No
65.5
34.5
persantages
Speech difficulty
Speech difficulty
(Have the patient uses correct words with no slurring?)

24. Distribution of the Patient according to disability
Among them 72.5% were intellectual
disability, 53% were memory and
thinking difficulty, Also 73%
participants most of the time were
emotion disability and 65.5%
participants were communication
difficulty .
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
72.5
53
73 65.5
27.5
47
27 34.5
Yes No

25. In the world, stroke is `the leading cause of death and it is becoming a major
threat of Neurological disability in population of Bangladesh. Bangladesh is
a developing country with low socio-economic condition where people are
not enough concerned about health. It is clear that, this devastating
condition not only affects the patient but also their family. The objective of
this hospital-based study was to identify the Impact of patient, associated
disability important risk factors for stroke prevalent in our society both
among the urban and rural population. This study may have not reflected the
exact situation but gives an utmost picture of the disease.
CONCLUSION

26. # Awareness needs to be created, particularly who are in risk factors to
highlight the harmful effects of cerebrovascular accident.
# Policies and programs are needed to improve disability condition before and
during stroke.
# Government, NGO, social workers and volunteers should focus on risk
factors, impact of CVA, also associated disability to the people.
# Plan to supply low cost rehabilitation tools for the disable patients.
# Risk factors of Stroke through mass media such as Television, Radio, and
Newspaper may improve present situation.
# Friends and family members may also play a vital role.