Stroke Rehabilitation Program and Policies by the UK Government - Assignment Example

A stroke is a brain attack .When there is obstruction or limited supply of the blood to the brain which will result to loss of brain functions due to no blood or limited supply of blood this is what is called stroke .Blood transport important nutritional component and oxygen to the brain .Without this brain cells are damaged and one my die. The brain controls all aspects of the body function and when damaged it affects, body functions and mental functions. Stroke can be classified into two major categories a) Ischemic b) Hemorrhagic Ischemic is caused by due to disruption of blood supply. Hemorrhagic is caused due breaking and tearing of blood vessels or unusual vascular composition. a) Ischemic Blood supply is reduced, resulting to dysfunctional of the brain tissue. This is attributed mainly by i. Obstruction of blood vessel by clot forming locally. ii. Idem due to an embolus from elsewhere in the body or iii. General disease in the blood supply e.g. shock b) Hemorrhagic stroke Intracranial haemorrhage is the increase of blood clot over long period of time in the skull vault. Signs and symptoms Stroke symptoms normally start abruptly. Over seconds to minutes and most causes don’t proceed further. Early Recognition Unexpected onset face weakness, arm drift or unusual speech is the discoveries that probably will lead to accurate recognition of stroke. Diagnosis Several techniques can be used to diagnose stroke they include CT scans Doppler Ultrasound Arteriography Subtypes In sections of brain that influences three prominent, that houses Central nervous system pathway Spin thalamic tract Corticospinal tract Dorsal column Some of the symptoms include: Hemiplegia Numbness Reduction in sensor or vibratory sensation Some of this symptoms unilateral .Blemishes in the brain is mainly on opposite side of the body. (Depending on which side of the body is exaggerated) Twelve cranial nerves are integrated to form what is called the brain stem. A stroke that disturbs brain stone results to deficits in cranial nerve. The following symptoms Distorted smell, hearing, image view Ptosis and weakness in ocular muscles. Reduction in impulses Distorted heat rate and breathing Associated symptoms Headache, unconsciousness, vomiting Thrombotic stroke This kind of stroke occurs as result of blood clot forming rounding atherosclerotic plaques. Thrombotic stroke can be grouped into two groups depending on the type of vessel the thrombus is formed on a. Huge vessel disease involves common interior catorids, circles of Willis and vertebral b. Tiny vessel disease involves tiny arteries inside the brain Sickle cell anaemia They produce blood cells to clump up and bar blood vessels which can result to stroke. Embolic stroke This results to obstruction of arteries by embolus, a particle in motion. Since origin of embolus arises from nowhere, local therapy solves the problem in short term. Emboli mostly originate from the heat or elsewhere in the arteries. Systemic Hypo perfusion This is the reduction of blood flow in whole body due to defective cardiac pump which results to bleeding or pericardial effusion , because decrease in blood is gradual all parts of brain composition are affected. Venous thrombosis Occurs as a result of increase in venous pressure which by passes’ pressure generated by arteries. Blood leaks in damaged areas. Intracerebral hemorrhage Occurs in tiny arteries attributed to hypertension, drug abuse or bleeding disorders. Hematoma becomes large till pressure from other tissues reduces its development RECOVERY AND REHABILITATION Recovery commences as patients begin to feel better after impacts of stroke. Most or majority of people who have experienced stroke are left with disabilities. There fore rehabilitation becomes a major component geared toward helping patients be trained to deal with the negative effects of stroke. Thus helping overcome challenges of adapting to normal life and achieving best level of autonomy and this is done by a) Being taught b) Learning new innovative skills c) Change of behaviour to adjust to a new one after effects of stroke d) Seeking mentorship especially from people who have undergone similar experience The stroke team This is a composition of specialised doctors’ nurses and therapist Physiotherapy Physiotherapy integrates physical exercise to help maintain proper working of joints and muscles .Stroke causes paralysis and imbalance of the body and coordination’s .Physiotherapy helps attain muscle control and mobility. To alleviate weakness of paralysed limbs one must start with small guided movement and repeating simple tasks. As the patients starts to attain or build strength they shall be shown greater and more different movement and complicated exercise to facilitate both sides of the body to work in harmony. This will aid them have a balanced effect thus stopping overusing the side of their body that is unaltered by the stroke. Occupational therapy Intended purpose of an occupational therapist is to discover practical solutions that helps aides a person adjust easily to a normal productive life. Synchronization and acuity makes it difficult to perform routine duties. Occupational therapist aides a person do essential tasks such as cooking, shopping. Also helps return an individual return to their normal hobbies and leisure activity or adapt to knew once, learn skills that deal with memory and concentration. An occupation therapist uses a range of methods depending on current needs of a patient .This include memory aids such as diaries or exercising physical or mental skills through art works and simulators. They start with simple to complex tasks. Speech and language Stroke significantly affects communication skills. Speech and language therapist evaluate an individuals difficulties and develop and appropriate techniques depending on the needs of the patient. Aphasia This is difficulty in understanding and using spoken language and written language .In this case you find a person knows what to say but finds it difficult to express it in words. Therapy helps people identify other ways to communicate like using signs, gesture or pictures. Dysarthria, dyspraxia and dysphonia Dysarthria – this is a kind of stroke that affects muscle of face making it hard to control words Dyspraxia – In this kind of stroke person experiences difficulties in speech and understanding in dialogue. Dysphonia – this stroke affects muscles in the speech box Vision and eyesight A stroke can cause double vision, blurred vision or partial blindness Hemianopia – it’s a scenario were one cannot see anything on the right or left, thus resulting in complication of coordination and balancing. A specialist group of professions include physiotherapist, Clinical psychologist, Ophthalmologist, Othopist will help in patients with this type of conditions. Sensation Disturbances in sensation such as unpleasant feeling of hot or cold tingling like pins and needles can be experienced. Common types of continents They include Urgency Frequency Incontinence Continence Common problems experience after stroke in controlling bladder and bowels. This may be caused by nerve damage loss of muscle control or change of diet. Help is normally available from a) Continence adviser – this is a well trained and skilled professional who will advise and create a rehabilitation plan e.g. bladder retraining, exercise to strengthen muscles and continence aids. b) Physiotherapist – can teach exercises to improve walking and using the toilet c) Occupation therapist – advise on how a person`s house can be custom made to adapt to prevailing substances or what instrument would make it easier to use the wash room. Psychological changes Changes are sometimes creates temporary discomfort like aggravation, antagonism. Normally mode of life can be disrupted this sometimes can lead to depression. Rehabilitation helps people came to terms and have confidence by being optimistic about life and changes experienced. Mental process Thinking, concentrating, memory reasoning and learning are some of major factors attributed to stroke. A clinical psychologist can aid a patient and find solutions to over come them. Helping rehabilitation It’s natural to feel helpless and sometimes self esteem becomes low. However here are some helpful guidelines that will help or guide patience be on the optimistic path. a) Practise make perfect. Do not give up on exercises section aided by a therapist b) Each task should be viewed as a support in helping in gradual recovery. c) Eat a well balanced diet, exercise regularly and have plenty of rest d) Be positive and make use of your abilities and enjoy life to the fullest Support at home People around you will help in various ways Give emotional support Encourage you especially in physical and therapy section Rehabilitation in community It helps to participate in forums especially with people who have gone through what you have experienced. It helps to talk about it and make new friends’ .In the long run people will have confidence knowing that they are not alone. STROKE POLICY AND SERVICE GUIDANCE IN UK Stroke disease is a leading course of death in UK and Scotland. The underlying cause of this trends are cause by poor eating habits ,high consumption of alcohol and lack of exercise However statistics have reviled that coronary heart disease are falling both for men and women by 40% over the last decade. Occurrence of heat ailment is still alarming to appoint it’s has been regarded as irreversible and inevitable. Until recently coronary heat disease is curable and risk management offers drastic benefits in prevention. For stroke cases there is need for accurate diagnosis and improves rehabilitation .An estimate of about half a million people have coronary heart disease in Scotland. Wealth of research evidence exhibits relationship between socio – economic deprivation and high levels of high coronary heart disease. Death rate of male under 65 in most deprived communities is still more than doubled EFFECTS OF AGE An observation reviled in the medical literature which exhibits ageism exist in reaction to access diagnostic and rapeutic cardiac intervention. Older people seam to be less likely to receive a number of interventions from surgical and medical treatment EFFECTS ON GENDER Studies have examined of access to investigation and treatment in context of gender. A publication of Glasgow study published in 1999 death from CHD is three times higher in male aged 35-64 than in female of the same age. This equates a rate of 12.4 per 1000 foe men and 4.0 per 1000 for women. This shows that women seem to be more investigated than men EFFECTS OF GEOGRAPHY Coronary angiograph is high in areas with cardiac centres. Non island boarders with lowest coronary angiography rates are Argishire and Arran, Dufries and Gallow way. RECOMENTATIONS Health board should be sensitive enough to give particular attention to deprived and more geographically remote communities. Innovative ways to educate and inform patients who have symptoms that suggest heart disease to seek professional opinion early Managed Clinical Network It’s the process of initiating stroke prevention program in line with local for health improvement. To assist meat this object the Heat Health National Learning Network published a frame work that illustrated how local primary prevention would be integrated into local heath planning structures .Quality assurance system that would account for primary and secondary prevention for stroke. THE NATIONAL OUTLOOK Involving combined action from regional to local centres to encourage participation with emphasis on physical activity, campaign against smoking and promoting health eating habits are key ingredients in combating this looming crisis. HEALTH IMPROVENT CHALLANGE Mainly focuses on smoking, physical activity and healthy eating Smoking Smoking is one of major contributors to coronary heat disease and stroke in Scotland of which can be avoided. Approximately one in four people in Scotland smokes. In January 2004 a regulatory plan was executed by Scottish Executive branded “A breath of Fresh Air for Scotland” aimed at reducing smoking and tobacco related ill health and banning public smoking. Physical Activity There is a positive impact of physical activity on coronary heat disease and stroke. They include improving insulin sensitivity, reducing hypertension and related ailment. Workforce Issues An increase in the number of training posts from 8 Spr to !0 Spr .Employment of additional 30 cardiologists specialist nurses, technicians, Allied health professional and cardiac surgeons. RECRUITMENT AND RETENTION CHALLANGES Due to the fact that there was a vacuum before Working for health was instituted .Planning is essential in the development and support of national team dedicated to support. Working for health is directed by National Workforce committee whose major objectives is to evaluate a) Model of supply and demand b) Work force planning c) Plans for educators d) Work force design and work load e) Careers recruitment and retention f) Work performance and effectiveness g) Work force observers Strategy Recommendation The NHS Board shall have Local cardiac service Administered by Clinical Network Operation with guide lines stipulated on Quality Standards for Health. Improving access to treatment and care Waiting Times for examination and Treatment Efficiency will go alone why in providing service rendered by public hospitals; patients should not wait for long hours for service. Well planned organised services will go alone way in ensuring patient`s needs are catered for. Rapid Access Chest Pain Services Rapid pain Chest Pain clinics should be equipped to handle all aspect of CHD. Revascularisation Rates Task force report of 2001planned an intension of one thousand four hundred revascularation procedure per one million populations. As foreseen rate for PCI have gradually increased while rates for CABG have remained constant. The CHD and Stroke Strategy recommended that rates be increased progressively with aim of reducing and ultimately eliminating waiting lists. This is consistent with all the evidence about the benefits of early intervention and the approach taken by the National Waiting Times Unit. Figures from Scottish Revascularisation Register for 2003-04 show the current rate of revascularisation to be 1,318 per million of population. If the rate of PCI in Scotland continues to increase at the present rate, we will exceed our target of 1,400 interventions per million of population in 2004-05. Adults with Congenital Heart Disease A national programme for the surveillance and treatment of adults who have ongoing health problems attributable to congenital heart disease has been proposed and is being considered by the National Services Advisory Group. The proposal is sponsored by NHS Greater Glasgow and NHS Lothian and strongly supported by the Scottish cardiology community. The ongoing clinical needs of this group of patients are well recognised and there have been significant advances in trans-catheter and surgical interventions for patients with congenital heart defects. Certain operations are life saving in infancy or childhood but have the potential to lead to later complications requiring further surgery in adulthood. The number of patients in this group is increasing as a consequence of the success of paediatric intervention in recent times. Several individual elements of the service are already in place but work is still needed on the co-ordination of the supervision and care of the patient population by a core multi-disciplinary specialist team. The National Services Advisory Group is on track to agree a recommendation by April 2005. CASE EVALUATION Revascularisation Capacity Review In December 2003, the Scottish Executive and the Chairs of the three Regional Planning Groups commissioned a short piece of work around capacity planning for revascularisation services in Scotland. The work arose from a lack of clarity surrounding available capacity within NHSScotland and the likely future requirements, given the anticipated reductions in waiting time guarantees. The group reported in April 2004; its recommendations included: Percutaneous Coronary Intervention PCI has demonstrated considerable growth over the last four years and this continued growth is unlikely to change in the near future there was wide variation in the efficiency (patient through-put) of catheter laboratories additional capacity will be required to cope with the projected growth in PCI additional catheter laboratories may need to be commissioned at some sites laboratory equipment at several sites will need to be replaced in the next three years Consideration should be given to a networked approach to attract consultant staff to regional centres consideration should be given to using the Regional Planning Groups to develop and sustain referral patterns for cardiac investigation and intervention Cardiac Surgery the number of bypass grafts has fallen or become stable over recent years theatre capacity does not need to increase but neither should it decrease at this time if waiting times are to be decreased further current theatre capacity needs to be supported by increased ICU capacity to accommodate the more complex needs of patients and longer lengths of stay consideration should be given to an agreed substantive short-term workload for the Golden Jubilee National Hospital to support the achievement of waiting times guarantees The recommendations are now being translated into a costed implementation plan. Heart Failure Improvements in heart failure management mean patients live longer and have a better health related quality of life. Heart failure is a complex condition in which the heart can no longer pump blood around the body adequately. There are a number of causes of heart failure, the most common of which is CHD. The risk of heart failure increases with age and with an aging population, the management of heart failure is an important element of the CHD and Stroke Strategy. The Strategy suggested that each MCN should work with its NHS Board to establish a local Heart Failure Group and develop an implementation strategy. In terms of diagnosis, echocardiography remains the gold standard investigation. It is relatively expensive, but costs and practicalities of carrying out the test in primary care have become an option as equipment has become smaller and cheaper. Other advances in heart failure diagnosis include a blood test for elevated brain nature tic peptide, a marker for heart failure. Together, these advances have made it possible to develop nurse-led heart failure initiatives in primary care. The role of the nurse specialist is now well established in the management of this group of patients, their interventions focusing upon: early diagnosis, optimisation of medical therapy; symptom control; psychological support and patient education. To date over 1m has been invested in heart failure services from Strategy funds and seven MCNs have nurse-led heart failure programmes in place. The remainder are in the advanced stages of planning the service. 5.18 In July 2004, the Minister for Health and Community Care announced an additional 450,000 to support the development of a National Centre for the Treatment of Advanced Heart Failure. The case mix of the National Centre is expected to be as follows: specialist assessment and advice on management cardiac resynchronisation therapy advanced complex heart surgery liaison with cardiac transplantation service Read More