Are there more stroke patients?

Are there more stroke patients than there were? Are they increasing in your rehab center?

Stroke patients are a very large group and are increasing worldwide. In the Czech Republic, as many as 40,000 people have had a stroke. We are also accepting more and more stroke patients in our rehabilitation centre. 150 to 200 a year. For example, in the last 3 years we have hospitalized 518 patients, almost half of them with moderate neurological impairment and almost a third with severe impairment. These patients were largely uninvolved and needed assistance, at least initially, with most routine activities.

What are the risk factors for stroke?

Strokes occur as a result of a combination of medical causes and risk factors arising from poor lifestyle choices. Medical causes include: high blood pressure and cholesterol, atherosclerosis (hardening of the arteries), heart disorders, diabetes, cerebral arterial aneurysms, family history of stroke and other genetic factors, and migraines. Risk factors resulting from poor lifestyle include smoking, unhealthy diet, obesity, sedentary lifestyle and lack of exercise, stressful situations. Most of these can be influenced or eliminated completely. These are the so-called controllable risk factors. But some things cannot be influenced - like racial origin or hereditary disposition.

How do stroke patients get to your center and how long do they stay?

Our centre provides what is known as early medical rehabilitation, so we should generally admit patients following the completion of their stay in other acute care departments. This is also why we most often admit patients after vascular events straight from neurology or other acute wards once their condition has stabilised. We have a well-functioning cooperation in this respect, not only with large university neurology clinics. They already start rehabilitation after a stroke here, and we follow up on this treatment in our centre. Stays with us are most often three weeks, but in some cases the stay is considerably longer, especially if we see that the patient has the "potential" to improve, is positively motivated and well cooperating, and if it is clear that rehabilitation is effective in their case. Occasionally, we also accept applications for admission for patients who are more than one year after a stroke and have severe disabilities that are unfortunately not significantly affected by rehabilitation.

What treatment methods and procedures do you provide to patients after strokes at your centre?

Patients after a stroke usually have motor disabilities, impaired mobility of their limbs, walking, balance, sensitivity, impaired self-care, sometimes poor speech, and various psychological disorders. The basis of the rehabilitation programme for all stroke patients is physiotherapy and occupational therapy. Physiotherapy mainly includes various methods of improving the strength, mobility and coordination of the affected limbs, and includes training in standing and walking. Occupational therapists then focus on improving the patient's self-sufficiency, practicing the management of everyday activities such as dressing, eating, hygiene, and often include procedures to improve so-called "cognitive" functions (such as memory, attention, concentration), which are often impaired after a stroke. For many patients, a speech and language therapist, a specialist in speech disorders (and communication disorders in general), is also an indispensable member of the treatment team, as some patients have impaired communication in various ways after a stroke.

What else is important for patients after a stroke?

Often a psychologist's intervention is needed; patients used to have depression or emotional disorders. Prosthetists work with patients, as special, individually made splints or braces are often needed for rehabilitation. The care of middle and lower medical staff, i.e. nurses, orderlies and nursing staff, is very important. Without their work, which is physically and mentally demanding, it is impossible to provide quality care to patients, especially after major vascular events. The social worker is also indispensable, as she finds out about the patient's background, communicates with the family and helps to arrange follow-up stays or assistance in the home environment. The work of all these staff is, of course, interlinked, and they must continuously exchange information about the patient's health and current needs.

In your opinion, what should be improved in the care of patients after a stroke? Is the care of these patients financially and materially challenging?

There are some reserves in the speed of initiation of treatment. It is important that the patient after a stroke gets into the care of a specialist centre as soon as possible, where the correct diagnosis can be made quickly and the necessary treatment provided. Unfortunately, some people arrive there too late. There is also a need for more sophistication in the medically correct continuity and continuity of patient progression from one facility to the next. Caring for more severe patients after vascular events is physically, mentally and financially demanding. The patient needs various aids, splints, dressing material, diapers, sometimes expensive drugs, which puts a considerable strain on the department's budget. However, the difficulty of the patient's functional disability is not yet adequately reflected in the reimbursement provided by health insurance companies for these patients. However, an adequate system of reimbursement for more difficult patients is being worked on, and I can confirm that this is currently being sought by the committee of the Society of Rehabilitation and Physical Medicine of the Czech Republic in cooperation with other institutions.

Editor Hana Vítková, Blesk pro ženy