What to do stroke?

What should you do if someone has a stroke?

Share on PinterestUnderstanding what to do when someone suffers a stroke can make a significant difference to their chances of survival or recovery.

After calling 911:

  • Remain calm.
  • Ensure the surrounding area is safe and that there is no imminent danger, such as from moving vehicles.
  • Talk to the person. Ask them their name and other questions. If the individual is unable to speak, ask them to squeeze your hand in response to questions. If the person does not respond, they are likely unconscious.

If the person is conscious:

  • Gently place them into a comfortable position. Ideally, they should be lying on their side with their head and shoulders slightly raised and supported with a pillow or item of clothing. After this, try not to move them.
  • Loosen any tight clothing, such as buttoned-up shirt collars or scarves.
  • If they are cold, use a blanket or coat to keep them warm.
  • Check that their airway is clear. If there are objects or substances, such as vomit, in the mouth that may be hindering breathing, place the person on their side in the recovery position (see below).
  • Reassure the person. Tell them that help is on the way.
  • Do not give them any food or liquids.
  • Note the person’s symptoms and look for any changes in condition. It is important to give the emergency personnel as much information as possible about the situation.
  • Try to remember the time that the symptoms started, look at a clock if possible. It is hard to estimate the passage of time when you are in a stressful situation.

If the person is unconscious:

  • Move them into the recovery position (see below).
  • Monitor their airway and breathing. To do this:
    • lift the person’s chin and tilt their head slightly backward
    • look to see if their chest is moving
    • listen for breathing sounds
    • place a cheek over their mouth and try to feel their breath
  • If there are no signs of breathing, begin CPR (cardiopulmonary resuscitation)

Current practice for CPR is chest compressions only. 911 can instruct you how to do this if you do not know how.

The recovery position

Share on PinterestThe recovery position should be used if someone is unconscious, or if their airways may not be clear.

If someone is unconscious, or if their airway is not completely clear, place them in the recovery position. To do this:

  1. Kneel beside them.
  2. Take the arm that is farthest away and place it at a right angle to their body.
  3. Place the other arm across their chest.
  4. The leg that is farthest away should remain straight. Bend their other knee.
  5. Support their head and neck and roll the person onto their side, so that their bottom leg is straight and their top leg is bent at the knee, with that knee touching the ground.
  6. Tilt their head slightly forward and down so that vomit in the airway can drain out.
  7. Manually clear out the person’s mouth, if necessary.

Performing cardiopulmonary resuscitation (CPR)

CPR is a lifesaving technique which can be performed to help people whose breathing and heartbeat have stopped. If someone who has had a stroke is not breathing, performing CPR until the emergency services arrive, may save their life.

The American Heart Association (AHA) recommend that those who have not received formal CPR training initiate hands-only CPR on teenagers and adults.

This type of CPR involves using the hands without giving mouth-to-mouth resuscitation. It consists of two steps:

  1. Calling 911.
  2. Pushing hard and fast in the center of the chest.

If an automated external defibrillator device (AED) is available, it can be used to check heart rhythm and deliver an electric shock to the chest, if necessary.



Recognising the signs of a stroke

The signs and symptoms of a stroke vary from person to person, but usually begin suddenly.

As different parts of your brain control different parts of your body, your symptoms will depend on the part of your brain affected and the extent of the damage.

The main stroke symptoms can be remembered with the word FAST:

  • Face – the face may have dropped on 1 side, the person may not be able to smile, or their mouth or eye may have drooped.
  • Arms – the person may not be able to lift both arms and keep them there because of weakness or numbness in 1 arm.
  • Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake; they may also have problems understanding what you’re saying to them.
  • Time – it’s time to dial 999 immediately if you notice any of these signs or symptoms.

It’s important for everyone to be aware of these signs and symptoms, particularly if you live with or care for a person who is in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure.

Other possible symptoms

Symptoms in the FAST test identify most strokes, but occasionally a stroke can cause different symptoms.

Other signs and symptoms may include:

  • complete paralysis of 1 side of the body
  • sudden loss or blurring of vision
  • dizziness
  • confusion
  • difficulty understanding what others are saying
  • problems with balance and co-ordination
  • difficulty swallowing (dysphagia)
  • a sudden and very severe headache resulting in a blinding pain unlike anything experienced before
  • loss of consciousness

But there may be other causes of these symptoms.

When someone suffers a stroke, time is essential.

You have a very limited period of time to restore blood flow to the brain before the injury is irreversible.

You must know what a stroke looks like and get to a hospital.

The sudden occurrence of one or more of the following may be symptoms of a stroke:

  • Numbness, weakness or tingling in the face, arm or leg (especially on one side of the body).
  • Changes in vision, double vision, blurriness, loss of vision in one or both eyes.
  • Confusion or problems with judgment, memory, spatial orientation or perception.
  • Difficulty with or inability to walk, dizziness and loss of balance.
  • Difficulty with or inability to speak or understand.
  • Difficulty with swallowing.
  • Loss of coordination or consciousness.
  • Drowsiness or lethargy.
  • Mood changes (sudden depression or apathy).
  • Severe, sudden headache, possibly along with pain between the eyes, in the face or a stiff neck, and vomiting or altered consciousness.

Note that the key words for all symptoms are sudden onset. Slowly developing problems in any of these areas are probably not symptoms of a stroke. Furthermore, a condition called a transient ischemic attack or TIA creates symptoms that mimic a stroke, but they usually last for less than 24 hours (possibly as short as a few minutes). A TIA is a temporary loss of or disturbance in brain function. In itself it may not be serious, but it is a warning sign that you could have a stroke in the future.

A number of tests can be used to decide the type and cause of a stroke, and the specific areas of the brain that have been affected. Most of these tests create images of the brain and the arteries that feed it. They could also be used before a stroke to look for blockages in the carotid arteries. Among the imaging techniques used are arteriography, computerized tomographic angiography (a form of CT scanning with a dye injected into the vein), MRI and ultrasound.

One of the most effective ways to limit the effects of a stroke is to begin treatment as quickly as possible. A stroke is the interruption of the flow of blood to any part of the brain, which damages brain tissue. The longer the delay before treatment begins, the more damage to the brain tissue. The interruption in blood flow is caused either by a blood clot or other particles blocking the arteries that carry blood to the brain (an ischemic stroke) or by bleeding in the brain, caused by a ruptured blood vessel or an injury (a hemorrhagic stroke). So the goal of emergency treatment is to find out what kind of stroke the person is having then take appropriate measures to stop it by dissolving the blood clot or stopping the bleeding.

Ischemic strokes can be stopped by using a class of drugs known as thrombolytics or clot busting medicines. Injected directly into a vein, they can break up or dissolve blood clots, thus removing the blockage and restoring blood flow to the brain. The most widely used is called TPA (for tissue plasminogen activator). But TPA must be given within three hours of the start of symptoms. After three hours, the benefits of dissolving the clot no longer outweigh the risk of hemorrhage (N.B. There really is no debate about IV TPA after three hours — it is contraindicated. )

Further, because of potential side effects and risks, some people who have had an ischemic stroke are not ideal candidates for thrombolytics even within three hours. Doctors must understand the details of each individual case before giving the drugs. For example, if your blood pressure is uncontrollable when they’re being considered, your doctor may not use them. Finally, before any thrombolytics can be given, it must be certain that the person is having an ischemic stroke. If the stroke is caused by bleeding, the drugs could make things worse.

Other possible drugs to treat ischemic strokes include blood thinners, like heparin and coumadin, and aspirin and other anti-platelet agents.

Hemorrhagic strokes are caused by bleeding. One of the most common types of hemorrhagic stroke is due to high blood pressure. Tiny blood vessels deep in the brain can rupture, causing bleeding into the brain tissue. This type of bleeding is often called “intracerebral hemorrhage.” Another type of bleeding may be caused by a ruptured (broken), badly formed blood vessel. This type of blood vessel is called an AVM, for “arteriovenous malformation.” Some AVMs can be removed by surgery, and that may be a way of preventing a possible stroke. But if an AVM is too large or found deep within the brain, surgery may not be possible. There are other possible treatments for AVMs, including procedures that shrink them by blocking the arteries that supply them with blood.

Another possible cause of a hemorrhagic stroke is an aneurysm, a localized, blood-filled dilatation (swelling) of a blood vessel caused by a disease or the weakening of the vessel’s wall. Again, there are a number of surgical treatments for aneurysms, including aneurysm clipping (the aneurysm is clamped shut, preventing it from getting blood from the artery it’s attached to) and aneurysm embolization (a tiny coil is put into the aneurysm which makes it clot, preventing blood from nearby arteries getting into it).

A hemorrhagic stroke may also require surgery to remove blood that has pooled in the brain during the stroke.

After a stroke, the emphasis should be on preventing a second stroke (about 25 percent of people who recover from a first stroke will have a second within five years) and rehabilitation. Rehabilitation depends on the type of disability the person has, and can include speech, occupational, and physical therapy. About 10 percent of those who have had a stroke recover most or all of their abilities; 50 percent can remain at home with medical assistance; 40 percent move to long-term care facilities. Unquestionably, 
a supportive family, friends and environment can help stroke patients with recovery.

Minimize Brain Damage From a Stroke

Treatment of an ischemic stroke is the restoration of blood flow to the brain to prevent and minimize damage.

A blockage is usually caused by atherosclerosis, an accumulation of “plaque” (deposits of fat) in the arteries that narrows them, reducing blood flow, or by blood clots in the arteries. The plaque not only blocks the blood flow itself, it can also help create a clot because it forces the blood to flow abnormally. A clot that stays in one place (usually the place it was formed) is called a thrombus. A clot that breaks loose, travels to another spot, and wedges itself into a narrower blood vessel, is called an embolism.

The first indication that an artery may be blocked can be an abnormally loud, harsh noise coming from it, heard through a stethoscope during a physical examination. This noise is called a bruit (pronounced “bru-we”). The next step can be one or more tests to look at the arteries that feed the brain and measure the amount and type of blockage in them. They’re the same type of diagnostic imaging tests now used to diagnose a wide range of conditions, including heart problems.

They include:

  • Carotid arteriogram (also called carotid angiogram): This is an X-ray of the carotid arteries to look for blockages. A catheter (a small tube) is inserted through a small incision into a blood vessel and threaded up into the carotid arteries. A contrast dye is then injected into the catheter to make blockages more visible on the X-ray.
  • Carotid ultrasound: Many people are familiar with ultrasound imaging used with pregnant women to produce images of fetuses. Similarly, carotid ultrasound produces pictures of the carotid arteries. High-frequency sound waves are sent into the neck, pass through the tissue then bounce back. The results are images that show any narrowing or clotting in the carotid arteries.
  • Computerized tomography angiography (CTA): Many people are also familiar with CT scanning (often called “CAT scanning”) which produces detailed images of organs and tissues. CTA is a form of CT scanning that uses dyes injected into the bloodstream to make blockages and other problems more visible.
  • Magnetic resonance imaging (MRI): This technique uses a strong magnetic field to create a three-dimensional view of the brain to look for the areas damaged by a stroke.
  • Magnetic resonance angiography (MRA) combines an MRI with an injected dye to better see the arteries in the neck and brain. It is used to determine if the stroke was caused by bleeding (hemorrhage) or other lesions and to define the location and extent of the stroke.

If these tests show that either of the two carotid arteries are narrowed, a physical intervention to remove the blockage may be needed. When an individual has symptoms of a stroke or TIA from a carotid artery that is over 70 percent blocked, evidence suggests that those individuals should strongly consider undergoing an operation to remove the blockage. If the individual has not had any symptoms from the severe blockage, or if the amount of blockage is less severe (50 to 70 percent), decisions about surgery should be individualized, depending on unique patient characteristics and preferences.

The process of removing the blockage is called carotid revascularization. Currently, one of two approaches is generally followed.

One approach is an operation called a carotid endarterectomy (CEA). The surgeon opens the affected artery and physically removes the blockage — the plaque, clot, etc. Studies show that this procedure reduces the risk of stroke and is especially helpful to people with severe blockages, even if they have no symptoms at all. Although all surgery has general and specific risks (the specific risks for carotid endarterectomy is that the surgery itself might cause a stroke or heart attack), the risks for CEA are not great.

The second approach is known as carotid artery stenting or carotid angioplasty-stent (CAS) and may be more appropriate than surgery in some patients. Angioplasty is the process of opening or widening a narrowed blood vessel. The procedure was first used in the 1970s to treat coronary artery disease; now it has been extended to other arteries, including the carotid artery. A catheter is threaded up into the arteries. A tiny balloon at the end of the catheter is inflated to open the narrowed blood vessel. The process may also involve using a tiny umbrella-like filter (called a “distal protection device”) at the end of the catheter to catch any particles that break free from the artery and prevent them from traveling to and blocking some other blood vessel.

A stent is an object put inside a blood vessel to keep it open and unblocked. Today a stent is usually a tiny tube made of a metallic mesh that looks something like a wire cage or spring. After a blocked blood vessel has been opened, a stent can be slid along the catheter and put in place to keep the vessel open. Some stents are coated with medicines to help prevent further blockages.

While carotid stenting is a newer technique and still under investigation, current research has shown it to be as effective as carotid endarterectomy in some cases and a less invasive form of surgery. Meanwhile, other new techniques to remove clots, such as catheter embolectomy (using a catheter threaded into one of the carotid arteries to remove clots) are being explored.
You Can Prevent a Stroke From Happening

You may not have to have a stroke. You’ve heard it before — control your blood pressure, control your cholesterol, stop smoking and keep your body to a healthy weight. You can dramatically reduce the risk of having a stroke, along with preventing a heart attack, Type 2 diabetes and many other diseases.

In general, to prevent stroke you should:

  • Know your risk factors and develop a plan, with your doctor, to reduce them.
  • Control high blood pressure, high cholesterol, diabetes and heart disease with lifestyle changes and medicines prescribed by your doctor.

High blood pressure is the leading risk factor for stroke. But you can reduce your blood pressure by making some simple lifestyle changes.

  • Stop smoking.
  • Don’t abuse alcohol (no more than one to two drinks per day).
  • Eat a low-fat diet.
  • Minimize the amount of sodium in your diet. Sodium is found in table salt (chemical name, sodium chloride), so minimize the amount of salt you eat; avoid salty snacks.
  • Exercise often, on a regular schedule.
  • Lose weight if you’re overweight.
  • Reduce and manage stress by changing your lifestyle and simplifying your life, exercising and using relaxation techniques.

There are also prescription medicines that help reduce blood pressure, like:

  • Diuretics.
  • ACE (angiotensin-converting enzyme) inhibitors.
  • Angiotensin receptor blockers.
  • Beta-blockers.
  • Calcium channel blockers.

You should discuss these medicines with your doctor, who will prescribe what’s appropriate for you. You can get more information about them at Medline Plus, an online service of the National Library of Medicine, the National Institutes of Health and other government agencies and health-related organizations.

Most strokes are caused by a blood clot or atherosclerosis (fatty build-up) blocking the flow of blood through arteries leading to the brain. Atherosclerosis is the same condition that can also cause a heart attack. High levels of LDL-cholesterol (commonly called “bad cholesterol”) are a major cause of atherosclerosis. Therefore, two other types of stroke preventing medicines are those that:

  • Reduce blood clotting.
  • Reduce LDL-cholesterol, plaque and atherosclerosis.

The first type, prescription anti-clotting medicines, include anticoagulants, antiplatelet agents and thrombolytics. Like all prescription medicines, they must be used properly, following all of your doctor’s recommendations and precautions.

  • Anticoagulants decrease the blood’s ability to form clots. They’re often called “blood thinners,” though they don’t actually thin the blood, nor do they dissolve clots already present.
  • Antiplatelets stop blood platelets (substances in blood that promote clotting) from clumping together to form clots.
  • Thrombolytics are often called “clot busters” because they break up or dissolve already existing blood clots.

Aspirin is a non-prescription antiplatelet medicine. But even though it is available over the counter, it may not be appropriate because it increases the risk of bleeding. Do not “self-medicate” yourself with aspirin. Instead, talk to your doctor about its risks and benefits.

The second type of medicine, prescription LDL-cholesterol reducing drugs, include statins, bile acid sequestrants and fibrates.

  • Statins are currently considered the most important and effective group of LDL-cholesterol reducing medicines. They slow cholesterol production and increase the liver’s ability to remove the LDL-cholesterol already there. Because the body makes more cholesterol at night, these drugs are usually taken in the evening, at dinner or before bed. Side effects appear to be minimal and studies show that people using statins have reported 20 to 60 percent lower LDL-cholesterol levels.

As of this writing, five statin drugs are available in the United States:

  • Lovastatin.
  • Simvastatin.
  • Pravastatin.
  • Fluvastatin.
  • Atorvastatin.

Bile acid sequestrants bind with bile acids in the intestines that contain cholesterol. Then they are eliminated during defecation, reducing the amount of cholesterol in the blood. Often, these drugs are prescribed in combination with statins.

As of this writing, three main bile acid sequestrants are available in the United States:

  • Cholestyramine.
  • Colestipol.
  • Colesevelam.

Fibrates lower the level of triglycerides (the main component of fat and therefore another major cause of atherosclerosis) in the blood.

Nicotinic acid is a non-prescription cholesterol lowering substance. It’s a form of niacin, the water-soluble B vitamin. When taken in high doses, well above the suggested daily amount, it can be effective in lowering LDL-cholesterol and triglyceride levels. Note that there’s another form of niacin, nicotinamide, that doesn’t lower cholesterol and shouldn’t be used instead of nicotinic acid. Further, high doses of nicotinic acid can have side effects. Do not “self-medicate” yourself with Vitamin B. Instead, talk to your doctor about its risks and benefits.

In addition to all these preventative measures, there are also physical ways to unblock an artery, including surgery and a procedure called “stenting.”

This article reprinted with permission from Second Opinion, a public television health program hosted by Dr. Peter Salgo and produced by WXXI (Rochester, N.Y.), West 175 and the University of Rochester Medical Center.

Next Avenue Editors Also Recommend:

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Learn first aid for someone who may be having a stroke

Common questions about first aid for someone who may be having a stroke

How can I help the person if they are frightened or anxious?

Are there other signs and symptoms that someone may be having a stroke?

What causes someone having a stroke to have a drooping face, a weak arm and slurred speech?

Stay calm and let them know that help is on the way. Help them sit or lie down and reassure them while you wait for the ambulance.

Back to questions

Yes, other signs and symptoms include:

  • dribbling from the mouth
  • numbness
  • blurred vision
  • a sudden severe headache
  • difficulty maintaining balance
  • dizziness or feeling light-headed
  • difficulty expressing themselves or understanding other people.

Back to questions

Strokes are caused by problems in the blood supply to the brain. Brain cells become damaged and begin to die. This brain damage affects the body’s functions, resulting in facial or limb weakness. Sometimes only one limb or one side of the body is affected.

Back to questions

Email us if you have any other questions about first aid for someone who may be having a stroke.

How to Help Someone Having a Stroke

Nobody wants to see a loved one become a stroke victim. But if you need to offer stroke help, fast action is important.

“After an acute stroke, time is of the essence,” says Matthew D. Vibbert, MD, assistant professor of neurology and neurological surgery at Thomas Jefferson University in Philadelphia. “The sooner a person suffering a stroke gets to an emergency room, the more likely doctors will be able to restore blood flow to the affected area, saving brain cells. The more brain cells we save, the better the chances for a good recovery.”

Here’s what you should do in order to act fast and assist a stroke victim:

  • Know all stroke symptoms. There are certain stroke symptoms you should be able to recognize. Any sudden onset of trouble with vision, speech — either slurring words or talking nonsense — or weakness on one side of the face or body are signs of stroke, says Dr. Vibbert. “Confusion, inattention, and headache can also accompany stroke. If in doubt, get it checked out. Don’t wait to see if it ‘passes.’”
  • Call 911. “Don’t waste time by calling a family member, a friend, or the person’s doctor,” urges Daniel Labovitz, MD, an assistant professor of neurology at the Albert Einstein University College of Medicine/Montefiore Medical Center in New York. It’s important to get stroke help immediately to increase the chances of a full recovery. “Call 911. It’s okay if it turns out that the symptoms are not from stroke,” he says.
  • Stay with your loved one. When offering stroke help, you need to make sure that no additional harm comes to the stroke victim. “Stay with the patient to prevent them from falling or further injuring themselves,” says Vibbert.
  • Take a few notes. Make note of the time when the stroke took place. “This is critically important information later,” says Vibbert. If the patient takes any medication, make a list of which ones (including dosage if you know it), and bring it to the hospital, he adds. If possible, bring the actual medications to the hospital with you.
  • Do not offer the person food or medicine. “Although most strokes are caused by blockage in an artery, some strokes are caused by bleeding from an artery that burst,” says Dr. Labovitz. “Giving aspirin to someone with this condition could make it worse.”
  • Stay calm. Although it can be difficult, it’s important to compose yourself and assure the stroke victim that everything is going to be all right. “Try to concentrate on the situation and remind yourself that you are doing everything you can to help,” says Danielle Haskins, MD, medical director of the Stroke Center at Saint Barnabas Medical Center in Livingston, N.J. “Reassure your loved one that you aren’t going anywhere and that help is on the way.”
  • Keep a positive outlook. “When they get the help they need, most patients improve enough to return home and function independently, even if they have some permanent symptoms,” says Labovitz.

“It is helpful to know that a stroke usually starts out at its most severe and then improves, sometimes very quickly,” says Labovitz. “There is a lot of room for hope. Staying calm and thinking clearly can really help.”

How to Help Someone Who Had a Stroke

It’s always a great idea to know how to help someone who had a stroke.

Whether you’re a friend or family member, your support during stroke recovery is vital for your loved one’s success.

To help someone who had a stroke, use these 5 tips to provide extra support:

1. Know That Every Stroke Is Different

If you don’t know what a stroke is, then education is the first step.

A stroke occurs when an artery supplying blood to the brain becomes completely blocked by a clot (ischemic stroke) or bursts (hemorrhagic stroke), resulting in damaged or destroyed brain cells.

Every stroke is different depending on the size, duration, and area of the brain that was affected. This means that everyone will recover differently, too.

If possible, it’s a great idea to contact your loved one’s doctor to ask about the size and location of the stroke. It will help you determine the best treatments during right side stroke recovery vs left side stroke recovery.

2. Don’t Do Too Much for Them

During stroke recovery, it’s common for caregivers to want to baby their survivor every step of the way. Try to avoid this if you really want to help someone who had a stroke.

The brain heals by performing difficult tasks in a repetitious manner. For example, to relearn how to use their hands, they need to perform activities using their hands.

If you’re constantly doing things for them, then their brain won’t have the optimal chance to relearn movement.

You can, and should, still help them where they need help, but being overbearing can hinder their recovery.

3. Overcome Communication Barriers (Aphasia) Together

Sometimes a disorder known as aphasia occurs post-stroke, where speech becomes impaired. Depending on the severity level of aphasia, it may be difficult for a stroke survivor to find the right words to say or understand what you’re trying to communicate.

If your survivor has trouble speaking, you may want to recommend singing therapy – it’s an overlooked, yet highly effective, form of speech therapy.

Please note that aphasia does not mean that a stroke survivor has lost his or her intelligence. It simply means that he/she has lost the ability to find the right words. If you can remember that, then you can interact with grace.

When your survivor has trouble understanding you, you don’t need to shout. They aren’t having trouble hearing you, they’re just having trouble processing your words as quickly as before.

Just repeat what you said normally, and both parties will feel respected.

4. Make Room for the Grieving Process

After experiencing a stroke, many survivors face devastating losses that can compromise their sense of freedom.

As a result, many stroke survivors will go through the 5 stages of grief. To provide them with the support they need, understand that anger, frustration, and depression are a necessary part of the process. Help them heal by simply being there and lending a listening ear.

Only attempt to solve their problems if they ask. Wouldn’t you prefer that if you were going through extremely difficult times?

5. Maintain Social Connections

Stroke survivors are often faced with isolation, either from immobility or post-stroke depression. Whenever someone is going through tough times, things are always much more bearable with the presence of friends and family.

Support your loved one with your true value: your relationship. There’s power in your presence. If you don’t know what to say, just don’t say anything.

Sometimes all you need to do is simply be there.

Post-Stroke Rehabilitation Fact Sheet

Rehabilitation nurses

Nurses specializing in rehabilitation help survivors relearn how to carry out the basic activities of daily living. They also educate survivors about routine health care, such as how to follow a medication schedule, how to care for the skin, how to move out of a bed and into a wheelchair, and special needs for people with diabetes. Rehabilitation nurses also work with survivors to reduce risk factors that may lead to a second stroke, and provide training for caregivers.

Nurses are closely involved in helping stroke survivors manage personal care issues, such as bathing and controlling incontinence. Most stroke survivors regain their ability to maintain continence, often with the help of strategies learned during rehabilitation. These strategies include strengthening pelvic muscles through special exercises and following a timed voiding schedule. If problems with incontinence continue, nurses can help caregivers learn to insert and manage catheters and to take special hygienic measures to prevent other incontinence-related health problems from developing.

Physical therapists

Physical therapists specialize in treating disabilities related to motor and sensory impairments. They are trained in all aspects of anatomy and physiology related to normal function, with an emphasis on movement. They assess the stroke survivor’s strength, endurance, range of motion, gait abnormalities, and sensory deficits to design individualized rehabilitation programs aimed at regaining control over motor functions.

Physical therapists help survivors regain the use of stroke-impaired limbs, teach compensatory strategies to reduce the effect of remaining deficits, and establish ongoing exercise programs to help people retain their newly learned skills. Disabled people tend to avoid using impaired limbs, a behavior called learned non-use. However, the repetitive use of impaired limbs encourages brain plasticity and helps reduce disabilities.

Strategies used by physical therapists to encourage the use of impaired limbs include selective sensory stimulation such as tapping or stroking, active and passive range-of-motion exercises, and temporary restraint of healthy limbs while practicing motor tasks.

In general, physical therapy emphasizes practicing isolated movements, repeatedly changing from one kind of movement to another, and rehearsing complex movements that require a great deal of coordination and balance, such as walking up or down stairs or moving safely between obstacles. People too weak to bear their own weight can still practice repetitive movements during hydrotherapy (in which water provides sensory stimulation as well as weight support) or while being partially supported by a harness. A recent trend in physical therapy emphasizes the effectiveness of engaging in goal-directed activities, such as playing games, to promote coordination. Physical therapists frequently employ selective sensory stimulation to encourage use of impaired limbs and to help survivors with neglect regain awareness of stimuli on the neglected side of the body.

Occupational and recreational therapists

Like physical therapists, occupational therapists are concerned with improving motor and sensory abilities, and ensuring patient safety in the post-stroke period. They help survivors relearn skills needed for performing self-directed activities (also called occupations) such as personal grooming, preparing meals, and housecleaning. Therapists can teach some survivors how to adapt to driving and provide on-road training. They often teach people to divide a complex activity into its component parts, practice each part, and then perform the whole sequence of actions. This strategy can improve coordination and may help people with apraxia relearn how to carry out planned actions.

Occupational therapists also teach people how to develop compensatory strategies and change elements of their environment that limit activities of daily living. For example, people with the use of only one hand can substitute hook and loop fasteners (such as Velcro) for buttons on clothing. Occupational therapists also help people make changes in their homes to increase safety, remove barriers, and facilitate physical functioning, such as installing grab bars in bathrooms.

Recreational therapists help people with a variety of disabilities to develop and use their leisure time to enhance their health, independence, and quality of life.

Speech-language pathologists

Speech-language pathologists help stroke survivors with aphasia relearn how to use language or develop alternative means of communication. They also help people improve their ability to swallow, and they work with patients to develop problem-solving and social skills needed to cope with the after-effects of a stroke.

Many specialized therapeutic techniques have been developed to assist people with aphasia. Some forms of short-term therapy can improve comprehension rapidly. Intensive exercises such as repeating the therapist’s words, practicing following directions, and doing reading or writing exercises form the cornerstone of language rehabilitation. Conversational coaching and rehearsal, as well as the development of prompts or cues to help people remember specific words, are sometimes beneficial. Speech-language pathologists also help stroke survivors develop strategies for circumventing language disabilities. These strategies can include the use of symbol boards or sign language. Recent advances in computer technology have spurred the development of new types of equipment to enhance communication.

Speech-language pathologists use special types of imaging techniques to study swallowing patterns of stroke survivors and identify the exact source of their impairment. Difficulties with swallowing have many possible causes, including a delayed swallowing reflex, an inability to manipulate food with the tongue, or an inability to detect food remaining lodged in the cheeks after swallowing. When the cause has been pinpointed, speech-language pathologists work with the individual to devise strategies to overcome or minimize the deficit. Sometimes, simply changing body position and improving posture during eating can bring about improvement. The texture of foods can be modified to make swallowing easier; for example, thin liquids, which often cause choking, can be thickened. Changing eating habits by taking small bites and chewing slowly can also help alleviate dysphagia.

Vocational therapists

Approximately one-fourth of all strokes occur in people between the ages of 45 and 65. For most people in this age group, returning to work is a major concern. Vocational therapists perform many of the same functions that ordinary career counselors do. They can help people with residual disabilities identify vocational strengths and develop résumés that highlight those strengths. They also can help identify potential employers, assist in specific job searches, and provide referrals to stroke vocational rehabilitation agencies.

Most important, vocational therapists educate disabled individuals about their rights and protections as defined by the Americans with Disabilities Act of 1990. This law requires employers to make “reasonable accommodations” for disabled employees. Vocational therapists frequently act as mediators between employers and employees to negotiate the provision of reasonable accommodations in the workplace.


When can a stroke patient begin rehabilitation?

Rehabilitation should begin as soon as a stroke patient is stable, sometimes within 24 to 48 hours after a stroke. This first stage of rehabilitation can occur within an acute-care hospital; however, it is very dependent on the unique circumstances of the individual patient.

Recently, in the largest stroke rehabilitation study in the United States, researchers compared two common techniques to help stroke patients improve their walking. Both methods—training on a body-weight supported treadmill or working on strength and balance exercises at home with a physical therapist—resulted in equal improvements in the individual’s ability to walk by the end of one year. Researchers found that functional improvements could be seen as late as one year after the stroke, which goes against the conventional wisdom that most recovery is complete by 6 months. The trial showed that 52 percent of the participants made significant improvements in walking, everyday function and quality of life, regardless of how severe their impairment was, or whether they started the training at 2 or 6 months after the stroke.


Where can a stroke patient get rehabilitation?

At the time of discharge from the hospital, the stroke patient and family coordinate with hospital social workers to locate a suitable living arrangement. Many stroke survivors return home, but some move into some type of medical facility.

Inpatient rehabilitation units

Inpatient facilities may be freestanding or part of larger hospital complexes. Patients stay in the facility, usually for 2 to 3 weeks, and engage in a coordinated, intensive program of rehabilitation. Such programs often involve at least 3 hours of active therapy a day, 5 or 6 days a week. Inpatient facilities offer a comprehensive range of medical services, including full-time physician supervision and access to the full range of therapists specializing in post-stroke rehabilitation.

Outpatient units

Outpatient facilities are often part of a larger hospital complex and provide access to physicians and the full range of therapists specializing in stroke rehabilitation. Patients typically spend several hours, often 3 days each week, at the facility taking part in coordinated therapy sessions and return home at night. Comprehensive outpatient facilities frequently offer treatment programs as intense as those of inpatient facilities, but they also can offer less demanding regimens, depending on the patient’s physical capacity.

Nursing facilities

Rehabilitative services available at nursing facilities are more variable than are those at inpatient and outpatient units. Skilled nursing facilities usually place a greater emphasis on rehabilitation, whereas traditional nursing homes emphasize residential care. In addition, fewer hours of therapy are offered compared to outpatient and inpatient rehabilitation units.

Home-based rehabilitation programs

Home rehabilitation allows for great flexibility so that patients can tailor their program of rehabilitation and follow individual schedules. Stroke survivors may participate in an intensive level of therapy several hours per week or follow a less demanding regimen. These arrangements are often best suited for people who require treatment by only one type of rehabilitation therapist. Patients dependent on Medicare coverage for their rehabilitation must meet Medicare’s “homebound” requirements to qualify for such services; at this time lack of transportation is not a valid reason for home therapy. The major disadvantage of home-based rehabilitation programs is the lack of specialized equipment. However, undergoing treatment at home gives people the advantage of practicing skills and developing compensatory strategies in the context of their own living environment. In the recent stroke rehabilitation trial, intensive balance and strength rehabilitation in the home was equivalent to treadmill training at a rehabilitation facility in improving walking.


What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS), a component of the U.S. National Institutes of Health (NIH), has primary responsibility for sponsoring research on disorders of the brain and nervous system, including the acute phase of stroke and the restoration of function after stroke. The NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, through its National Center for Medical Rehabilitation Research, funds work on mechanisms of restoration and repair after stroke, as well as development of new approaches to rehabilitation and evaluation of outcomes. Most of the NIH-funded work on diagnosis and treatment of dysphagia is through the National Institute on Deafness and Other Communication Disorders. The National Institute of Biomedical Imaging and Bioengineering collaborates with NINDS and NICHD in developing new instrumentation for stroke treatment and rehabilitation. The National Eye Institute funds work directed at restoration of vision and rehabilitation for individuals with impaired or low vision that may be due to vascular disease or stroke.

The NINDS supports research on ways to enhance repair and regeneration of the central nervous system. Scientists funded by the NINDS are studying how the brain responds to experience or adapts to injury by reorganizing its functions (plasticity)—using noninvasive imaging technologies to map patterns of biological activity inside the brain. Other NINDS-sponsored scientists are looking at brain reorganization after stroke and determining whether specific rehabilitative techniques, such as constraint-induced movement therapy and transcranial magnetic stimulation, can stimulate brain plasticity, thereby improving motor function and decreasing disability. Other scientists are experimenting with implantation of neural stem cells, to see if these cells may be able to replace the cells that died as a result of a stroke.

*An ischemic stroke or “brain attack” occurs when brain cells die because of inadequate blood flow. When blood flow is interrupted, brain cells are robbed of vital supplies of oxygen and nutrients. About 80 percent of strokes are caused by the blockage of an artery in the neck or brain. A hemorrhagic stroke is caused by a burst blood vessel in the brain that causes bleeding into or around the brain.

**Functions compromised when a specific region of the brain is damaged by stroke can sometimes be taken over by other parts of the brain. This ability to adapt and change is known as neuroplasticity.


Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

P.O. Box 5801
Bethesda, MD 20824

Information also is available from the following organizations:

American Stroke Association: A Division of American Heart Association 7272 Greenville Avenue Dallas, TX 75231-4596 Tel: 888-4STROKE (478-7653) Brain Aneurysm Foundation 269 Hanover Street, Building 3 Hanover, MA 02339 Tel: 781-826-5556; 888-BRAIN02 (272-4602) Brain Attack Coalition 31 Center Drive Room 8A07 Bethesda, MD 20892-2540 Tel: 301-496-5751 Children’s Hemiplegia and Stroke Assocn. (CHASA) 4101 West Green Oaks Blvd., Ste. 305 PMB 149 Arlington, TX 76016 Tel: 817-492-4325 Fibromuscular Dysplasia Society of America (FMDSA) 20325 Center Ridge Road Suite 620 Rocky River, OH 44116 Tel: 216-834-2410; 888-709-7089 Hazel K. Goddess Fund for Stroke Research in Women 785 Park Road, #3E New York, NY 10021 Heart Rhythm Society 1325 G Street, N.W. Suite 400 Washington, DC 20005 Tel: 202-464-3454 Joe Niekro Foundation PO Box 2876 Scottsdale, AZ 85252 Tel: 602-318-1013 National Aphasia Association P.O. Box 87 Scarsdale, NY 10583 Tel: 212-267-2814; 800-922-4NAA (4622) National Stroke Association 9707 East Easter Lane Suite B Centennial, CO 80112-3747 Tel: 303-649-9299; 800-STROKES (787-6537) YoungStroke, Inc. P.O. Box 692 Conway, SC 29528 Tel: 843-248-9019; 843-655-2835

“Post-Stroke Fact Sheet”, NINDS, Publication date September 2014.

NIH Publication No. 14-1846

Stroke fact sheet available in multiple languages through MedlinePlus

Back to Stroke Information

See a list of all NINDS disorders

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Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.


First, if you’re Googling this now because you think you or someone you are with might be having a stroke, CALL 911 RIGHT NOW AND TELL THE OPERATOR TO SEND AN AMBULANCE. TELL THE OPERATOR YOU THINK YOU ARE HAVING A STROKE. Do it now. Do not wait. Do not read on.

For those of you who are just curious, though, or spend all your pre-sleep hours thinking about all the things that could possibly kill you in the future, note that every year, nearly 800,000 Americans suffer strokes. If left untreated, strokes can cause permanent brain damage or death, and in fact, strokes are the fifth leading cause of death in adults nationwide, according to the Centers for Disease Control and Prevention.

Those are scary stats, but the good news is, doctors can treat strokes if they catch them early, minimizing damage. “Early” is the key word here—studies show that every minute your brain tissue is deprived of oxygen, you lose 1.9 million neurons and 4 billion synapses, so time is of the essence.

What is a stroke?

A stroke is, essentially, a “brain attack.” When a blood vessel is obstructed, the brain tissue on the far side of the obstruction is deprived of oxygen and glucose, and brain cells start to die off. If this happens to your heart, you have a heart attack. When it happens in your brain, that’s a stroke.

There are two different types of strokes: ischemic and hemorrhagic. Ischemic strokes are the most common, accounting for about 85 percent of all strokes, according to Joshua Stillman, M.D., an associate professor at Columbia University and the Emergency Medical Director for the NYP Stroke Center at Columbia University. They behave like heart attacks, in that a clot in blood vessel in the brain or leading to the brain will block blood flow to brain tissue. A hemorrhagic stroke occurs when a broken blood vessel or burst aneurysm seeps into your brain tissue, and accounts for about 15 percent of all strokes.


How do I know I’m having a stroke?

There are a number of stroke-related symptoms, but two things are key: their onset is sudden, and generally, they only affect one side of the body. “The single most important symptom presentation is that it’s a sudden onset,” Stillman said. “You’re fine one minute and the next you’re not. It’s a fairly dramatic, sudden onset change in neurologic symptoms.”

Dr. Sara Rostanski, neurologist at NYU Langone’s Center for Stroke and Neurovascular Diseases, said common symptoms include “numbness, vision loss, vision loss in one eye or in a vision field, especially the left side of your vision.”

“Symptoms that aren’t as unilateral are slurred speech, difficulty swallowing, double vision, trouble with language, using the wrong words or you can’t get out any words out at all,” she said. You may also be using words that don’t make any sense, you may have trouble understanding words, or a person may have trouble understanding you.

Other symptoms, according to Stillman, can include a sudden loss of facial symmetry, weakness, a sensory change in one arm or one leg, one side of the face or body. “It could be a change in balance, suddenly you’re unable to balance the way you have before. It could be a change in gaits,” he said.

And, again, it’s important to remember these changes are sudden.

“Sudden neurologic symptoms really should bring up the idea that this is a stroke,” Rostanski said.


Headaches are not common stroke symptoms, but they do sometimes accompany hemorrhagic strokes. In that case, “it’s sudden onset headache. It goes from onset to peak within, say 20 or 30 minutes. And it reaches a high peak, like a 10 out of 10 severity,” Stillman says.

A good mnemonic to keep in mind is F.A.S.T.: Face, Arms, Speech, Time. If one side of someone’s face droops, or they can’t raise one of their arms, or their speech is slurred, call 911 immediately.

What do I do if I think I’m having one?

If you think you or someone you are with is having a stroke, call 911 immediately. There are a number of interventions doctors can undertake to minimize stroke damage, but those must be done within 4.5 hours (some studies even say three), and the sooner the better.

“If you’re with someone who has a sudden change in speech or weakness on one side of their body, call an ambulance and get to an emergency room,” Stillman said. “Don’t call your best friend. Don’t call your doctor. Call an ambulance.” Ambulances might be expensive, but you need their speed, and you need paramedics, who know where to take you and can let doctors know to be ready for you.

“When you call 911, identifying that you think this is a stroke is important,” Rostanski said. “That sets off a whole chain of stroke treatment. If a stroke is in the forefront of EMT’s mind when they reach you, they can pre-notify hospital.”


It’s also important to tell doctors when you first started experiencing symptoms. “Emergency doctors will be prepared immediately, since time is of the essence.” Stillman said. “It’s similar to a gunshot injury to the brain.”

In short, do not go to a clinic, do not try to sleep the symptoms off, do not ignore them. Call 911.

What happens at the hospital?

Once doctors have determined you are suffering an ischemic stroke, they’ll likely give you an intravenous injection of a tissue plasminogen activator, or tPA, which can unblock the artery. That must be done within 4.5 hours, or it won’t be successful.

In the 4.5-hour to 24-hour timeframe, Doctors can insert a catheter through an artery in your groin and into your brain, which would unblock the blood vessel directly. If you have a large clot, after tPA doctors might perform something called a mechanical thrombectomy, which would pull out that blood clot. Occasionally, once the tPA has been administered, you may be transferred to a specialized stroke center, since those procedures take place in an urgent, but less cataclysmic timeframe, and not all hospitals are equipped to handle strokes. “It’s not atypical for complicated stroke patient to have to be transferred,” Rostanski said.

Could I mistake something else for a stroke?

Stillman says there are a few afflictions you might mistake for a stroke, like a nerve impingement, though unlike strokes, those usually present with pain. Still, if you even suspect a stroke, “Get to a hospital immediately,” he said. “The earlier within 4.5 hours the better. If you can get in within 30 minutes, you’re better off than within 1 hour.”


Who gets strokes?

People at risk for strokes include those with high blood pressure, cardiac rhythm abnormalities (like atrial fibrillation), in addition to smoking and diabetes. Older people are more likely to suffer strokes, since “increasing age is substantial risk factor,” Stillman said.

Still, young people do have strokes, especially smokers, heavy drug users, and, occasionally, women on birth control pills, since those can cause blood clots. “Stroke is rare in young people, but I see young people with strokes all the time,” Rostanski said. “And the effect of stroke in a young person, given the potential of many, many years of disability, does necessitate getting treated as quickly as possible.”

So, again, if you present with sudden stroke-seeming symptoms: “Don’t sleep it off, don’t ignore the symptoms. Call 911,” Rostanski said. “It’s OK if you’re wrong. We don’t catch strokes unless we suspect them.”

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