Stroke Prevention in Chinese Medicine – Because Knowing is Half the Battle!!

Did you know??

For every minute of delay in treating a stroke, the average patient loses 1.9 million brain cells, 13.8 billion synapses, and 12 km of axonal fibres?And
For Each hour in which treatment does not occur, the brain loses as many neurons as it does in almost 3.6 years of normal aging?

This is why it’s so important to know and recognize the right signs and symptoms of stroke. It’s ESPECIALLY important because stroke can be difficult to detect, and getting to the hospital within a three-hour time frame is crucial to avoid long-term irreversible damage.

According to the Heart and Stroke Foundation, the 5 signs of stroke include:

1. Weakness, sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary.
2. Trouble speaking – Sudden difficulty speaking or understanding or sudden confusion, even if temporary.
3. Headache  – Sudden severe and unusual headache
4. Vision problems. – Sudden trouble with vision, even if temporary
5. Dizziness – Sudden loss of balance, especially with any of the above signs

In Traditional Chinese Medicine, there is one more VERY important symptom that can indicate Stroke – and that is the sign of a deviated tongue. For thousands of years, Traditional Chinese doctors have been using the tongue to diagnose patterns of illness.  The tongue can give us an idea of what is going on inside the body- how energy is flowing, how blood is circulating, and if there are any imbalances in temperature and body fluids that need to be corrected. In stroke, a deviated tongue can indicate that there is an imbalance of blood and energy circulation in the body.

When I first learned about this, I was a little skeptical, and wasn’t sure how reliable tongue deviation in detecting stroke could actually be.  It wasn’t until I encountered it myself in my own practice that I knew for sure that this TCM observation was legit! The story goes like this.

I was only a couple of months into starting my Acupuncture and Chinese medicine practice, when a patient came to me to treat his shoulder and rotator cuff. He said it was caused by consistent injury to his shoulder from playing volleyball.  After asking him a series of questions I discovered he was going through a recent divorce, stressed from studying for his MCATs, and had a history of chronic headaches.  Aside from that he was a fairly healthy individual who worked out 4-5x a week and ate very healthy and well-balanced meals.  When I felt his pulse (another major diagnostic tool in Chinese Medicine), his hand was shaking and the pulse was very fast, and very strong- as if there was a drum beating from inside his artery.  When I saw his tongue I saw that his tongue was slanted towards the left side of his mouth and was quivering. He asked me what I was seeing and I explained that he was showing signs of someone predisposed to a stroke, or in Chinese medicine diagnosis, we call it Liver-Yang Rising causing Liver-wind.

He thought I was crazy. I thought I was being crazy too, as it seemed to be a ridiculous assumption. He was a 30 year old, perfectly healthy young man.   I saw him a couple of times but his headache and shoulder pain didn’t’ go away (which is what he came in for). He eventually stopped coming in to see me. 😦

A little over a month later, I found out he had a stroke. It was caused by a cerebral hemorrhage, otherwise known as a brain bleed.  He had admitted himself to emergency because he had started feeling numbness in his face and tingling in his arm.  As soon as he felt that, he remembered my TCM diagnosis and knew right away he was having a stroke. The doctor was shocked that he was even walking and talking in his office. He predicted his brain had leaking for at least 2 months. It turns out he had a concussion possibly from playing volleyball or from working out.
They performed an emergency surgery to remove the blood in his brain and he is back to being a healthy 30 year old. Zero complications and currently studying Medicine in Australia.

After this experience, I knew for sure that Chinese medicine prevailed in preventative medicine. It saved his life! This experience taught me a great lesson and I hope you too, and that is “Knowing REALLY is half the Battle!” Knowing the right signs and symptoms and catching it at the right time can SIGNIFICANTLY reduce, or PREVENT the amount of damage and the amount of time it’ll take to recover from a stroke. That being said, to prevent stroke from happening or recurring, it’s important to know that tongue deviation can be an early warning sign that can show up far before the other signs and symptoms of stroke.

So remember, important warning signs to look out for if you suspect a stroke:

1. Tongue deviation
2. Weakness, sudden loss of strength
3. Trouble speaking,
4. Headache,
5. Dizziness and
6. Vision problems.

And for our fighters and stroke survivors, my next blog is for you:

How Acupuncture and Traditional Chinese Medicine can Aid in the Recovery and Rehabilitation of Stroke.

Till next time.
Regine Gorospe

**Disclaimer: If you experience any signs and symptoms of stroke, see your doctor immediately**

Technology Talk: Introducing the Amadeo!

Introducing the Amadeo!

At Aim2Walk we are always striving to integrate the latest technology into our rehabilitation protocols.  The newest piece of equipment to arrive at the clinic is the Amadeo Hand Rehabilitation Device.  The Amadeo website promotes “The Perfect Team: The Therapist and their Assistant the Amadeo”.  Here at the clinic we are rapidly learning how our new ‘assistant’ can help us to maximize the quality of our hand rehabilitation and reduce our patients’ time to recovery.

The design of the Amadeo creates a natural gripping movement for the patient’s hand.  As the hand and fingers are moved, the brain is stimulated to organize and reorganize itself to these movements.  The more practice you can get, the better this works!  The robotic assistance from the Amadeo allows a patient to achieve more repetitions of practice at a higher intensity than with conventional therapy.  This may help to reduce spasticity, improve the quality of therapy and reduce therapy duration.

Features of the Amadeo

1. Adjusts Individually:  The therapist adjusts the Amadeo to custom fit for each patient.

2. Passive and Active Therapy: The Amadeo allows the therapist to choose from a number of different modules according to the patient’s progress during therapy.  This device is ideal for all phases of rehabilitation, from passive range-of-motion exercises in the early stages through assistive therapy and onto active and interactive games for more advanced stages of recovery.

Amadeo_Patient-1-e1347324155983-324x180

3. Specialized in Hands: Each individual finger is attached to the Amadeo separately, allowing for for the fingers and thumb to move into flexion and extension either individually, one after the other or all together.  This allows the therapist to set the limit of movement for each individual finger and monitor what each individual finger does in therapy.

Individual Finger

4. Measure Progress:  Biofeedback allows the patient to follow their own movements in real time through visual and sound cues.  Sensors in the device allow for recording of Range of Motion and Force.  Therapy progress is measured and can be explained to the patient using assessments and progress reports.

Monitoring Progress

I have been excited to see how well our patients are responding to this new piece of robotic technology! If you are interested in learning more about the Amadeo you can read about it here.

-Tara

Protein Post Stroke – What You Should Know

Our third and final student blog submission for our current crop of students comes from Holly.  As you will see from her entry below, Holly is very thorough and she will make an excellent health care practitioner someday. Enjoy her entry on the benefits of proper nutrition post stroke.

The building blocks: Importance of Protein Post-Ischemic Stroke

By: Holly Durham

In Canada, a stroke occurs every 10 minutes. That results in 50,000 strokes every single year! Of these, 80% are ischemic, which means the blood flow to the brain was somehow interrupted (www.heartandstroke.com, 2013).  As you might imagine, there is a lot of research happening to find cures and treatments for these incidents. Would you believe that this can be prevented and/or treated (alongside other modalities) with something as simple as nutrition? It seems simple but nutrition is actually quite complex and how it can assist in the rehabilitation of stroke patients is complicated, and still being researched but extremely interesting!

Individuals who have suffered a stroke will find themselves malnourished soon afterwards. This occurs for a few reasons:

1) Function of the arm and hand is typically compromised making food preparation difficult

2) Prolonged hospital stays lead to atrophy of the muscles leading to worse infections and disorders (Ha, Hauge, Bente Spenning & Iversen, 2010)

3) Dysphagia – the difficulty or inability to swallow resulting in minimal caloric intake – occurs in 80% of the stroke population (www.heartandstroke.com, 2013). The time immediately following a stroke is critical for protein, vitamin and mineral intake either through foods or through supplementation (http://www.nlm.nih.gov/medlineplus, 2013).

Protein is one of the most important nutrients to ingest post stroke, especially in ischemic stroke cases. When the blood flow is interrupted to the brain it disrupts homeostasis – or the body’s comfortable balance and state in which it is most efficient – which creates dysfunction in the glucose metabolism (Bouziana & Tziomalos, 2011). The fuel used to create energy for the body shifts from glucose – which is the primary fuel in healthy individuals – to protein. Protein is not a typical fuel that is used because it is not efficient to make energy and it is also the building blocks of the body. All of the protein stores then are emptied to produce energy, which inhibits protein synthesis (Bouziana & Tziomalos, 2011). When there is little to no protein synthesis occurring cell death is around the corner. Proteins are also important in assisting the transmission of signals through the central nervous system (CNS) to the rest of the body (Bouziana & Tziomalos, 2011). Rehabilitation clinics such as Aim2Walk are working to retrain the CNS and rest of the body to work together again. If patients are able to consume more amino acids, it will replenish some of the stores to help maximize the rehabilitation process and push the body’s capabilities to the limit (Ha, Iversen & Hauge, 2008).

To drive this point home here is a scenario. When Sally was 35 she had a stroke, which affected the entire right side of her body. Of course, being the average Canadian she was right hand dominant. Not only did Sally have to learn how to use her left hand for everything she only had that hand to rely on. Due to the minimal function and coordination, it was difficult for Sally to prepare healthy meals the way she used to. Instead she now went to the grocery store to pick out premade and processed meals that were easy to put into the microwave or oven, with very little preparation. Typically these premade foods are high in carbohydrates and low in protein. However, the body needs the protein in order to continue rehabilitating the pathways through the body and transmitting the signals through the CNS. Unfortunately Sally’s body is unable to use carbohydrates as fuel now so any protein that she does intake is used as fuel instead, which leaves minimal protein to continue building and rehabilitating the pathways through the CNS.

Carbohydrate stores do not get used up as fuel, and instead turn to fat (Ha, Iversen & Hauge, 2008).

Protein can be found amongst many different sources. The most common are meats, fish and poultry. However, there are alternatives that are healthy options, and are very important if a patient is vegetarian or vegan. Both of these lifestyles it is important to find sources that will supply the same nutrients found in meats, fish and poultry. Foods such as, beans, lentils, and eggs contain forms of protein as well as many leafy greens and dairy products. Dairy products all contain some form of whey protein, which is also beneficial. Ultimately, it is important to eat a balanced diet that will best suit your individual needs. Each body is unique and may have special requirements. Seeing a dietician, natural path or other health care professionals are recommended to ensure you are giving your body everything it needs to maintain a high quality of life.

– Holly

References

Bouziana, S. B., & Tziomalos, K. (2011). Malnutrition in patients with acute stroke. Journal of Nutrition and Metabolism.

Ha, L., Hauge, T., Bente Spenning, A., & Iversen, P. O. (2010). Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: A randomized, controlled trial. Elsevier Clinical Nutrition, 29(5), 567-573.

Ha, L., Iversen, P. O., & Hauge, T. (2008). Nutrition for elderly stroke patients. Elsevier Scopus, 128(17), 1946-1950.

Stroke. (2013). Retrieved March 27, 2013, from Heart and Stroke Foundation of Canada website: http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483933/k.CD67/Stroke.htm

Swallowing disorders. (2013, February 14). Retrieved March 27, 2013, from MedlinePlus website: http://www.nlm.nih.gov/medlineplus/swallowingdisorders.html