Stroke parameter for modelling correlation

1. Patient
 PBI (Penerima Bantuan Iuran Jaminan Kesehatan – government subsidies):
 From APBN
 From APBD
 Non PBI (Premium paid)
 PBPU (Pekerja Bukan Penerima Upah)
 PPU (Pekerja Penerima Upah)
 BP (Bukan Pekerja)

2. Hospital Type
 Type A
 Type B
 Type C
 Type D
 Type E (special Hospital)

3. Ward Type
 Class I Ward
 Class II Ward
 Class II Ward

4. Stroke Indication Tools

 FAST - Transient Stroke Diagnosis
 ROSIER - Stroke in ER Diagnosis
 Stroke Diagnosis to treatment
 ABCD2 (Age, Blood, Clinical, Duration, Diabetes)
 NIH Stroke Score (NIHSS)
 Stroke Dignosis to intervention
 Framingham Stroke Profile (FSP)

5. Stroke Diagnostic Type

The first step in assessing a stroke patient is to determine whether the patient is experiencing an
ischemic or hemorrhagic stroke so that the correct treatment can begin. A CT scan or MRI of the head
is typically the first test performed.

 Computed tomography (CT) of the head: CT scanning combines special x-ray equipment with
sophisticated computers to produce multiple images or pictures of the inside of the body.
Physicians use CT of the head to detect a stroke from a blood clot or bleeding within the brain. To
improve the detection and characterization of stroke, CT angiography (CTA) may be performed.
In CTA, a contrast material may be injected intravenously and images are obtained of the cerebral
blood vessels. Images that detect blood flow, called CT perfusion (CTP), may be obtained at the
same time. The combination of CT, CTA and CTP can help physicians decide on the best therapy
for a patient experiencing a stroke.
 MRI (magnetic resonance imaging) of the head: MRI uses a powerful magnetic field, radio
frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and
virtually all other internal body structures. MR is also used to image the cerebral vessels, a
 procedure called MR angiography (MRA). Images of blood flow are produced with a procedure
called MR perfusion (MRP). Physicians use MRI of the head to assess brain damage from a
stroke.

To help determine the type, location, and cause of a stroke and to rule out other disorders, physicians
may use:

 Blood flow tests: These tests give information about the condition of arteries in your head and
neck that supply blood to your brain.
 Electrocardiogram (ECG, EKG): An electrocardiogram, which checks the hearts’ electrical
activity, can help determine whether heart problems caused the stroke.
 Carotid ultrasound/Doppler ultrasound: Ultrasound imaging involves exposing part of the
body to high-frequency sound waves to produce pictures of the inside of the body. Physicians use
a special ultrasound technique called Doppler ultrasound to check for narrowing and blockages in
the body's two carotid arteries, which are located on each side of the neck and carry blood from
the heart to the brain. Doppler ultrasound produces detailed pictures of these blood vessels and
information on blood flow.
 Cerebral angiography. Angiography is a medical test that is performed with one of three
imaging technologies—x-rays, CT or MRI, and in some cases a contrast material, to produce
pictures of major blood vessels in the brain. Cerebral angiography helps physicians detect or
confirm abnormalities such as a blood clot or narrowing of the arteries.

6. Stroke Type
A stroke is a disease that occurs due to a disorder in the brain caused due to disorders of the blood
vessels in the brain and can lead to death. This disorder makes the part of the brain doesn't get the
blood and oxygen so that the brain cells become dead.
There are two types of strokes which, according to the blockage, are Ischemic and Hemorrhagic
Stroke.

Ischemic Stroke
Ischemic stroke occurs when a blood vessel supplying blood to the brain is blocked. On average the
cause due to a buildup of fat that coats the walls of the blood vessels (atherosclerosis) or because of
cholesterol (homocysteine) and other substances may stick to the walls of the arteries and forms
plaque. The presence of the plaque is the longer it will lead to blood flowing properly difficult and
caused a blood clot (thrombus).

There are two types of ischemic, one of them is Thrombotic Stroke, stroke that is caused by a
thrombus that developed in the arteries of the brain and has become narrow. In additions, it is
Embolic Stroke, stroke occurs due to blockages due to thrombus, air bubbles, or fractions of a FAT
(emboli) that exist in other parts of the body of which are at the heart, vessels of the aorta in the chest
and neck however join the blood flow to the parts. In addition, there is also a heart fibrillation atrial
abnormalities, which can lead to the presence of thrombus in the heart pumped up and then flow into
the areas of the brain.

Hemorrhage Stroke
Hemorrhage stroke is a stroke due to blood vessels to leak or rupture in or around the brain that
resulted in the suspension of the blood supply to the tissues of the brain. The presence of blood can
overwhelm or even shut down the brain tissue and surrounding areas so annoying or deadly brain
function.
 There are two types of Hemorrhage stroke, one of them is intracerebral, this bleeding is bleeding
occurs in the brain because there is trauma (brain injury) or it could be there are abnormalities of the
blood vessels (aneurysm or angioma). This type of stroke experienced about 10% the highest
contributor to stroke and death caused by stroke. In addition, it is a subarachnoid hemorrhage is
bleeding in the subarachnoid space, the space between the inner layer (Pia mater) and the middle
(arachnoid mater) from the network of brain membranes (meninges). Generally, occurs because the
outbreak is a bulge (aneurysm) in the arteries. This is the trigger stroke disability is permanent even
death. Stroke is more experienced women than men.

7. Stroke Risk
Hemiplegia
Hemiplegia is if one hand or one foot or even one side of the face became paralyzed and unable to
move. Hemiparesis is if one hand or one leg or one side of the face to be weak, but not completely
paralyzed. The term physical setbacks, there is concern that weak or paralyzed in one arm, one leg or
one side of the face after the stroke. There are times when hemiplegia and hemiparesis may affect one
hand and one side of the face on the same side of the body, or one arm and one leg on the same side
of the body. Generally this condition can be improved when someone doing physical therapy and
rehabilitation.

Spasticity
Spasticity is a muscles stiff conditions due to the weakened muscles after stroke. There is indeed a
medical treatment for this, but the following physical therapy would be helpful so that your muscles
do not become rigid and suffered permanent disability.

Atrophy
Patient's atrophy occurs due to loss of muscle tone that makes the hands, legs, or face. Therefore, in
stroke patients should also prevent the occurrence of this is growing worse with the way muscles still
have to move. Through physiotherapy muscles are trained to keep moving in order to stay strong.

Aphasia
Aphasia can affect a person's language ability to speak, understand a conversation, reading, and
writing. There are 20% of stroke patients who suffered aphasia.

8. Stroke Treatment
A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Treatment
depends on the severity and type of stroke. Treatment will focus on restoring blood flow for an
ischemic stroke and on controlling bleeding and reducing pressure on the brain in a hemorrhagic
stroke.

If a stroke is caused by a blood clot, the patient may be able to receive a clot-busting drug such as
tissue plasminogen activator (t-PA) to dissolve the clot and help restore blood flow to the damaged
area of the brain. Clot-busting drugs, which can only be given within the first few hours of stroke
onset, are typically delivered intravenously by emergency medical personnel or in the hospital
emergency department.

Other stroke treatments include:

 Surgery to remove blood from around the brain and repair damaged blood vessels.
  Intracranial vascular treatments: Endovascular therapy is a minimally invasive procedure used to
improve blood flow in the brain's arteries and veins. In endovascular therapy, an image-guided
catheter is navigated through the body’s blood vessels to the brain to deliver:
 medications to dissolve blood clots.
 mechanical retrievers and aspiration systems that help remove blood clots or debris in cerebral
arteries.
 devices such as balloons, which are used to open markedly narrowed blood vessels, and stents,
small tubes used to keep blood vessels open. In this procedure, which is used to improve blood
flow in the carotid arteries that supply blood to the brain, a balloon-tipped catheter is guided to
where the artery is narrow or blocked and inflated to open the vessel. A small wire mesh tube
called a stent may be placed in the artery to help keep it open.
 tiny metal coils to repair a ruptured aneurysm in a cerebral artery

Following a stroke, many patients will receive post-stroke rehabilitation to overcome disabilities that
may occur as a result of the stroke. Post-stroke treatment may also include efforts to prevent another
stroke by controlling or eliminating risk factors such as high blood pressure, high cholesterol and
diabetes.

9. Medication Treatment
Patients may also receive blood-thinning drugs such as:
 aspirin or warfarin (also called by the brand name, Coumadin®)
 heparin or clopidogrel (also called by the brand name Plavix®).

10.Stroke Therapy (Rehabilitation)

One of the keys to success are handled more quickly, then patients will be getting better. It's called
the Golden Period with stroke patients rehabilitation must run 1-6 the first month.

Memory therapy
Much or little memory lost after a stroke depends on age, stroke severity, location of the stroke, and
the patient's health before a stroke. Memory loss in stroke patients can be recovered in several ways
such as the following:

 Stimulates the brain with brain sharpening games.

 Sticking writing in a certain place, for example "don't forget to brush your teeth" in the bathroom
as a reminder.
 Train memory with an acronym, which stands for several words or words with the same rhymes.
 Putting things in a place that you will definitely see. For example, put clothes that will be used for
tomorrow on the bed.
 Repeating information obtained repeatedly, or using a recording device.
 Move as often as possible.
 Eating foods that are beneficial to the brain such as omega-3 fatty acids.
 Talk to family and friends.
 Meet other people with the same suffering.
 Write down what things should be done.

Movement therapy
It is an important form of standard stroke physiotherapy. Research reveals that motion therapy such as
treadmills, balance exercise, and lifting weights have been shown to improve the walking ability of
stroke patients after one year of training. Quality of life is increasing regardless of how severe the
stroke is.
In addition, movement therapy can also be done by:
 Always change sleeping or sitting position to improve posture and balance assisted by a therapist,
so that the muscles and joints are not stiff.
 If it has shown improvement, the therapist can ask the post-stroke therapy patient to move in bed,
move from bed to chair, repeat sitting and standing positions.
 Practicing moving hands and feet (with or without the help of objects), of course accompanied by
a therapist or doctor.

Speech therapy
After a stroke, speech disorders are one of the effects that can occur. Speech therapy is one part of
post-stroke therapy that can be done to help stroke patients practice speech, as well as train the
muscles of swallowing and talking to function again. Some ways that can be done to practice speech
skills after stroke are:
 First, the therapist will help patients swallow. For example, by asking the patient to swallow 50
ml of water.
 Then the therapist will assess the patient's general ability to communicate. For example, by
assessing how well the patient understands the word or sentence, how difficult the patient
expresses himself, and others.
 The technique that therapists use to help communicate the difficulties of stroke patients depends
on how much the problem is experienced.
 If the patient is difficult to understand the meaning of words, the therapist can ask the patient to
match the word with the picture, sort the words according to the meaning, and determine words
that have the same meaning.
 If it is difficult to find the word you want to say, the patient is asked to practice naming objects,
practicing rhyming words, or repeating the words the therapist speaks.
 Train the strength of the mouth muscles, give direction to say a word or letter.
 Practice the ability to string words.
 Practice the ability to read and write.

The duration of therapy after stroke is very dependent on the severity and complications of stroke,
and the patient's response to therapy. Therefore, it is important for patients and their families to
discuss with doctors and therapists, related to determining the right type of post-stroke therapy.