Stroke Warning Signs

Do South Asians stand a higher risk of Stroke?

Stroke or Brain Attack is caused by blockage of arteries or veins in the brain or by bleeding in the brain. It is essential for everyone to remember FASTER to be able to identify stroke and seek treatment immediately. The term FASTER stands for

F - Facial droop
A - Arm or Leg weakness
S - Speech disturbance
T - Time - Call 108 immediately
E - Early - Seek immediate treatment
R - Restore blood supply to the brain

Studies have shown that stroke related deaths are higher among people of South Asian descent (India, Pakistan, Sri Lanka and Bangladesh). The prevalence of high blood pressure, diabetes, cardiac disease, smoking, obesity, rheumatic heart disease, infective meningitis and postpartum stroke are higher in these countries than elsewhere. As such, it is no surprise that the incidence of stroke is also higher in these countries. Added to this is the fact that the level of awareness among people is very low.

How can I reduce the risk of stroke?

• High blood pressure does not have any symptoms so the only way to check is to have your blood pressure measured regularly. If you are over 40 you should get your blood pressure checked at least once every five years and more often if it is high or you have other health problems. This can be done by your GP, or you can check it yourself with a home testing kit.
• Diabetes is a condition caused by too much sugar (known as glucose) in the blood. Having diabetes almost doubles your risk of stroke. This is because high levels of glucose in the blood can damage your blood vessels, making them harder and narrower and more likely to become blocked. If this happens in a blood vessel leading to or within the brain it could cause a stroke. If you have diabetes, you must have regular check-ups with your GP or at a diabetes clinic to make sure your blood glucose and blood pressure stay at healthy levels.
• Atrial Fibrillation is a type of irregular heartbeat that can cause blood clots to form in the heart. If these clots block the blood supply to your brain, it can lead to a stroke. If you have Atrial Fibrillation you can be treated with blood thinning medication such as warfarin, or drugs called novel oral anticoagulants, which can reduce your risk of stroke by 50–70%
• Cholesterol is a fatty substance and is vital for your body to function properly. Most of the cholesterol in our body is made by the liver, but it can also be absorbed from some of the foods we eat.  Too much bad cholesterol in your blood can cause fatty deposits to build up in your arteries and restrict the flow of blood. It also increases the chance of a blood clot developing. High cholesterol has no noticeable symptoms, so you need to have your cholesterol level checked, especially if you are over 40 and have any of the other main risk factors for developing the condition: 
• a history of heart disease or high cholesterol in your family 
• you are overweight 
• you have high blood pressure or diabetes. 

Drugs called Statins can help to prevent fatty deposits forming and reduce your risk of stroke

• Lifestyle 
• Smoking doubles your risk of having a stroke and the more you smoke, the greater your risk. Smoking reduces the amount of good cholesterol in your blood and carbon monoxide from cigarette smoke damages artery walls and makes your blood more likely to clot
• Using gutka, qimam/kimam, paan or naswar is also harmful to your health. Studies have shown that people who use them are more likely to die from a stroke than people who do not. Other products like bidi/beedi and shisha also contain tobacco, so if you smoke these you are at risk of the same kinds of diseases as cigarette smokers, including stroke.
• Regularly drinking large amounts of alcohol greatly increases your risk of stroke.
• South Asian people carry more weight around their waist than the rest of the population. The South Asian Health Foundation suggests that South Asian men whose waist measures over 90cm and South Asian women whose waist measures over 80cm should be considered overweight.
• Eating a healthy, balanced diet can help to lower your blood pressure and the amount of cholesterol in your blood. Eat more fruits, vegetables, fibre and healthy protein and cut down on fat, sugar and salt.
• Steaming, boiling and grilling are all healthier than frying, which adds extra fat. Fried foods such as samosas, pakoras, chips or fried bread like bhaturas or puri should be enjoyed as occasional treats, rather than a regular part of your diet.
• Research shows that regular exercise can reduce your risk of stroke by 27%. You should aim to do at least 30 minutes of moderate physical activity five or more times a week.

Find out more about stroke at www.strokesupport.in 

Children and Stroke

It is a myth that stroke occurs only in elderly individuals. Although less common, infants and children can be affected with stroke.

How common are strokes in children?

Stroke occurs in about 1 in every 4000 live births across the world. Population based statistics are not available for India, however, stroke is one of the leading causes of disability and death in children as well. About 50%-80% of children with stroke are left with permanent neurological deficits such as paralysis of arm, leg, cognitive impairment, speech disturbance, etc

What are the causes of stroke in children?

The risk factors for stroke in children are different from those in adults. Common risk factors include

• Heart disease
• Dehydration
• Head and Neck infections
• Trauma
• Moyamoya disease
• Systemic conditions such as inflammatory bowel disease
• Maternal infection in the fluid around the fetus
• Premature rupture of membranes during pregnancy
• Pregnancy related high blood pressure

What are the effects of strokes in children?

• Sudden onset of severe, progressive headache 
• Eye movement problems or complete or partial loss of vision 
• Sudden numbness or weakness in the face, arm or leg (especially on one side of the body) 
• Difficulty speaking or understanding words or simple sentences
• Difficulty swallowing 
• Dizziness, loss of balance or lack of coordination 
• Loss of emotional control and changes in mood.
• loss of consciousness, seizures 
• Sudden inability to move part of the body (paralysis)
• Behavior changes or personality changes, improper language or actions.

Will my child get better?

• Prompt identification, treatment of complications and prevention of another stroke is the cornerstone of treatment of a child with stroke. The clot busting drug tPA is not generally recommended in children as its efficacy has not been studied in this population.
• Recovery from stroke is different with each child.
• In general, most young people will recover more abilities than older people will. 
• Children often recover the use of their arms and legs and their ability to speak after a stroke.

List of specialists involved in management of a child with stroke

• Pediatrician - a child health specialist, can often help coordinate multiple issues with child’s general health
• Rehabilitation Specialists -  includes doctors such as physiatrists and pediatricians with expertise in child rehabilitation
• Speech Language Therapist - for assessment and help with speech or language challenges
• Neuropsychologist - for assessment and help with learning and education needs
• Psychologist -  can assist with the psychological stresses in both child and family that are common in child stroke
• Orthopedic Surgeon - expert in the “mechanical” complications of stroke such as tightness in the arm or leg that might be helped by surgery
• Hematologist -  a blood specialist who helps with testing for blood clotting disorders or occasional rare causes of stroke in children
• Neonatologist -  a pediatrician expert in newborn care is usually involved early in the care of children diagnosed with acute neonatal strokes
• Neurosurgeon - occasionally involved when certain types of stroke can be helped with surgical procedures

Stroke Support India - Supporting Stroke Survivors and Caregivers....

Stroke Support India - Supporting Stroke Survivors and Caregivers....

What is EMRI (Emergency Management and Research Institute)?

GVK EMRI (Emergency Medical Research  Institute) is a non-profit organization providing emergency medical services in India and operating and operating under a Public Private Partnership mode (PPP).

EMRI handles medical, police and fire emergencies through the “1-0-8 Emergency Service". This is a free service delivered through well organized emergency call response centers and staffed by well trained paramedical personnel that are able to dispatch over 2600 ambulances across Andhra Pradesh, Gujarat, Uttarakhand, Himachal Pradesh, Chhattisgarh, Goa, Chennai, Rajasthan, Karnataka, Assam, Meghalaya, Madhya Pradesh, Daman & Diu and Dadra & Nagar Haveli. Beginning in 2005 in Hyderabad, EMRI has become the world's largest integrated Emergency Response Services (ERS) Provider serving 40% of India's population across 12 states and two Union Territories. EMRI has signed memorandums of understanding (MOU) with over 6800 hospitals, which have agreed to provide initial stabilization of EMRI transported patients free of cost for the first 24 hours. In some other states (Rajasthan, Bihar, Punjab, and Trivandrum), Ziqitza has been contracted by the government to operate the 1-0-8 emergency service.

Each ambulance is staffed by a trained EMT (Emergency Medical Technician) who provides pre–hospital care while transporting the patient to a hospital for stabilization. If required, the EMT is able to communicate (via cell phone) with the in house ERCP (Emergency Response Care Physician) who is a qualified medical practitioner, available 24/7 to support the EMT as and when required.

When an emergency is reported through 108, the paramedic, who answers the call, gathers the needed basic information and dispatches appropriate services. Basic information obtained includes:

• Where the call is placed from (district/taluka/city/town/exact location/landmark)
• The type of emergency
• Number of people injured and the condition of the injured
• The caller's name and contact number – for location guidance if required

Emergency help dispatched through this process is expected to reach the site of the emergency in an average of 18 minutes. Pre-hospital care will be given to patients being transported to the nearest hospital.

Ziqitza 108 Emergency Response Service operates in the following states

Apps for Stroke survivors - Apps for Aphasia

Stroke survivors might face difficulties in their day-to-day life because of deficits in speech, memory, etc. There are a number of apple/android apps that are designed to assist stroke survivors in carrying their daily activities and have proven to be very useful. In this post, we discuss some of the common apps that help patients with aphasia (speech difficulty). These apps may be downloaded on iPad/Tablet/Smartphone and help in generating speech, converting text to speech, virtual keyboards, pictures, symbols and video.

Augmentative and Alternative Communication (AAC) is the term used to describe a set of tools and strategies that an individual uses to solve everyday communication challenges. Communication can be in the form of speech, glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, speech-generating devices, etc


Free Apps

• Vox4all® - Android/Apple - is an augmentative and alternative communication (AAC) system for tablets and smartphones. Aims to give voice to those who cannot speak, bridging communication barriers. Using a system of symbols, images, synthesis and voice recording, you can create and configure an environment totally adapted to each user. Available in four languages - English, Spanish, Portuguese, Portuguese.
• Aac Talking Tabs - Android - Uses pictures & symbols-Tap and talk or build phrases. You can create tables or tales and books as well.
• Voice4u - Android/Apple - is an simple application that consists numerous of fun and memorable images that can help assist and improve language. There are over 170 icons consisting of pictures with it’s corresponding word. The icons are included with clear, easy-to-listen audios.
• JABtalk - Android - is a free speech communication application designed to help non-verbal children and adults communicate.
• TapToTalk - Android/Apple -  makes communication fun, like another “game” on on an iPad/Tablet. Just tap a picture and TapToTalk speaks. Each picture can lead to another screen of pictures 
• SmallTalk - Android/Apple - The SmallTalk™ Family of Communication apps are FREE and offer users extreme portability for practicing speech and communicating on the go
• Dragon Dictation - Android/Apple - Can be used as a therapy device for articulation (feedback on intelligibility) or for people with writing impairment (i.e speech to text)

Paid Apps

• Proloquo2Go ($190) - Apple - It provides natural sounding text-to-speech voices (American, British, and Indian English), high-resolution symbols, automatic conjugations, a default vocabulary of over 7000 items, word prediction, expandability, and accepts your own pictures.
• RocketKeys ($160) - Apple - customizable talking keyboard. This app lets you build the keyboard by choosing the exact keys, size, layout, colors, prediction, and voices you want.
• MyTalk Tools ($49.99) - Android/Apple -  helps people with communication difficulties say what they want with sequences of words, sounds and images. You choose the content (simple grids or boards with bold images) and play recorded
• TalkTablet - Android/Apple - for people who have difficulty communicating as a result of autism, aphasia, Down Syndrome, stroke, laryngectomy or any other condition that affects a persons ability to communicate effectively.TalkTablet is the only fully featured AAC speech solution that is compatible with Apple iOS, Android and Kindle handheld and tablet devices.
• Assistive Express ($25) - Apple - is designed to be simple and efficient, allowing users to express their views and thoughts at the most express manner, with natural sounding voices.

There are many more apps available depending upon the need of patients. For a complete list of apps, click on the links below

http://www.stroke.org/sites/default/files/resources/iHOPE-Aphasia-Apps-List.pdf

http://www.stroke.org/stroke-resources/resource-library/aphasia-apps

Stroke burden and prevention