Different Strokes, Different Outcomes-What to do Post Stroke.
Summary
After having a stroke and being released from the
hospital, many people return home without the
proper transition back into their: homes,
communities, careers if capable, or lives. After
having a stroke, you are a person that has a
diminished or changed ability level, and that can be
a lot to deal with emotionally, intellectually,
spiritually and physically. When rehabilitating from
stroke there is optimal therapist exposure, because
stroke is the fifth leading cause of death in the U.S.
This is high due to high blood pressure, cholesterol,
heart, disease, obesity, diabetes, and people whom
have had a stroke prior.
The stakeholders in stroke policy are "academics,
public health advocates, AHA/ASA representatives,
emergency department physicians and nurses, EMS
staff and administrators, hospital administrators,
insurance payers, neurologists and other medical
specialists, hospital stroke coordinators, state health
department managers and regulatory
representatives, and stroke survivors. Interviewees
spoke specifically about their professional
interaction in the PSC system of care” (CDC).
Issue at Hand
Stroke cost the nation $34 billion annually, but after
care for stroke is not being implemented properly.
People are being transitioned out of the hospitals
without training on how to resume life after stroke.
Medicaid is paying for: a wheelchair, a shower seat,
canes, Botox if necessary, along with a doctor’s
visit that includes physical therapy once a month,
they also provide you with rides to and from the
facility. Those are all great service covered for the
body, and covering huge barrier in the way we
make health accessible, but what about the person.
How can we go about informing the person on how
to deal with life as a person whom now has a
disability? The health care delivery system needs to
implement a post stroke policy worldwide for all
stroke types. The policy should deal with
disadvantaged neighborhood's and hospitals so
there's no gap in services. Persons in neighbors
without the best care are not given information,
counseling, or grief management meanwhile they
are given to much medication pay stroke. The
policy should also deal with the finding and the
delivery in services that cover outpatient care post
stroke for recovery. Dealing with education is a
crucial issue and barrier when it comes to recovery
for the patient and their family. They should be
informed about: what this means, the benefits,
barriers, accommodations that will need to be made,
and making accessibility easier in their lives. People
who just had a stroke when returning home are at
very high risk for falls and depression.
“As post stroke psychosocial issues are studied,
greater understanding of the complexity of the
problem is obtained. For example, Vickery et al214
analyzed how the stability of self-esteem plays a
role in the rate of depressive symptoms. The
depression and emotionalism section of the 2005
stroke rehabilitation clinical practice guidelines
does an excellent job of describing the incidence of
post stroke depression and pseudo-bulbar affect.
What is clear from the literature is that these issues
are real and warrant assessment and treatment as
early as possible and on an ongoing basis”
For falls, there can be an education seminar
implemented that deals with lighting, stairs, proper
foot placement, and proper body maneuvering.
Depression and falls can be avoided with proper and
early intervention. Other barriers to monitor are: the
accreditation of the facility, the reliability of the
facility, the emergency response challenges they
face, the amount of people they can serve compared
to the amount of beds available, person to staff
ratio, and financial matters.

Figure 1. The Decline Spotlight on Stroke for 2017.
Green - continued, Purple- reversed, Orange- slowed.
Recommendations for Care
To ensure best practice of stroke units are being
created be sure to have models that cover the
following.
1) Integrated
2) Acute care
3) Rehabilitation
Facilities should make sure that people are
receiving the interdisciplinary team they need if
physical therapy is required. Ensure that different
sets of staff do not have tension between
themselves, and that they are maintaining
professionalism at all times. “Stakeholders indicated
that tension sometimes exists between emergency
physicians, neurologists, and stroke neurologists”
(CDC). Tension can affect the quality of care given,
making the after stroke affects worse, and the
patients and their families uncomfortable. Post
stroke doctors should involve people and their
caregivers in the plan for future stroke care. People
should also receive contact information to local
stroke group, and be offered balance training
programs. “After six months, and twelve months
persons who had a stroke should be reviewed”
(Canadian Stoke Strategy). To monitor the quality
of services and staff, a stroke committee should be
established along with opportunities for feedback of
services in all facilities. “A state task force or
advisory committee may be one such forum,
especially if it is charged with making periodic
recommendations” (CDC). The Barriers that play
apart in the delivery of care need to be addressed.
Emergency room reliability and accreditation need
to be revaluated for the metropolitan area. We need
to hold them to a higher standard, even in low
income neighborhoods. The emergency response
time plays apart in the recovery outcomes. The
faster you respond, and the level of care
implemented with patients depends on bettering
their likely hood of recovery. Analyze and change
the financial and regulatory disincentives that play a
role in the way services are being distributed and
delivered. For example, different hospitals having
different technology, systems, funding, and grants.
References
Center for Disease Control. Division for Heart Disease and Stroke
Prevention. (2017, September 01). From
https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_stroke.htm
https://www.cdc.gov/stroke/images/vs-stroke-map.jpg
Center for Disease Control. a study of recommendations for policy
implementation primary stroke center policy implementation. (2012).
From,
https://www.cdc.gov/dhdsp/docs/primary_stroke_center_policies_rec
ommendations.pdf
The Canadian Stroke Strategy. A Guide to the Implementation of
Stroke Unit Care. (December 2009). From,
http://strokebestpractices.ca/wp-content/uploads/2010/11/CSS-
Stroke-Unit-Resource_EN-Final2-for-print.pdf