3 steps for younger patients to regain life after stroke

Symptom recognition, recovery, and rehabilitation are three key steps to optimize stroke recovery among patients aged below 60, say experts.

The most common signs and symptoms of stroke include facial drooping, arm weakness, and speech difficulties. Consultant neurologist and internal medicine physician Dr Kok Chin Yong said that the signs and symptoms of stroke are rather similar across the board; it’s best to remember the acronym BE FAST (Figure 1). For further assessment, doctors can use a defined stroke scale such as the National Institutes of Health Stroke Scale (NIHSS) to determine the severity of the stroke. [Available at https://www.ninds.nih.gov/health-information/public-education/know-stroke/health-professionals. Accessed on 16 May 2023]

BE FAST in detecting signs and symptoms of stroke.
B balance issues/ dizziness
E eye/ visual problems
F facial drooping
A arm/ leg weakness or numbness
S speech disturbance
T time to call 999

Time is of the essence when it comes to stroke treatment, hence patients at high risk of stroke and their family members should be advised to look out for symptoms. If they notice any stroke-related symptoms or abnormalities, they should immediately rush the patient to the nearest hospital for timely assessment and treatment. Early treatment can improve patients’ outcome.

The process of recovery and rehabilitation
Although treatment and rehabilitation are crucial in the journey to recovery for poststroke patients, many factors should be considered before and during the rehabilitation process. Consultant rehabilitation medicine specialist Dr Foong Chee Choong said rehabilitation is an important part of the recovery process, thus it is important to choose a facility that is well equipped with the expertise and tools to aid the process.

Foong also noted that the recovery process and types of treatment will vary according to the patient’s condition, so patients usually have varying progress. An individualized treatment plan, which is tailored to their needs, is proposed following an assessment of the patient.

Further, age is an important factor in stroke recovery. “Younger stroke survivors have a better outcome, regaining mobility and recovering much faster. However, older stroke survivors will also benefit well from a proper stroke rehabilitation programme,” said Foong.

Dr Foong explains that the rehabilitation technology in Malaysia has improved and one of the widely investigated and adopted approaches in the past decade is the use of an exoskeleton gait trainer in improving the mobility of stroke survivors. The robotics device is versatile and benefits not only stroke patients but also those with other conditions such as spinal cord injury, paraplegia, traumatic brain injury, joint replacement, osteoarthritis, Parkinson’s disease, and cerebral palsy among others.

The benefit of using robotics in stroke rehabilitation is that it provides intensive training with highly accurate feedback, which is vital to improve patients’ movement and function. Additionally, the robotic device can provide various levels of assistance required so that patients with different levels of severity can benefit from this machine.

With the help of robotic technology, it generally takes 1 to 3 months to see any improvement in walking among stroke patients. “It is important for the patient and their family to have a functional goal, be motivated and be patient, as any rehabilitation process takes time and effort and will result in recovery for them,” said Foong.

The contributing factors of young stroke
Stroke is a leading cause of death and serious long-term disability worldwide and can be either ischaemic or haemorrhagic. The National Stroke Association of Malaysia stated that stroke cases have been increasing among younger adults, with 15 percent of ischaemic strokes occurring in young adults and adolescents. In 2016, 40 percent of patients with stroke admitted to hospitals were aged below 60. [Malays J Med Sci 2021;28(4):14–23] Healthcare professionals also recognize an increasing trend of ischaemic stroke in the younger working group. “However, the earlier the recognition of the stroke, the better, as there are more treatments available,” said Kok.

There are many risk factors for stroke including smoking, not exercising regularly, eating unhealthy foods, and drinking alcohol. Young adults are more susceptible to these risk factors. “Vascular risk factors such as hypertension and diabetes, and environmental factors such as air pollution is one of the recognised risk factors as well. One frequently missed risk factor is obstructive sleep apnoea, and of course, illicit drug usage such as amphetamine and heroin that can cause blood vessels disturbances and lead to [ischaemic and haemorrhagic] strokes,” explained Kok.

Kok strongly discouraged the use of recreational drugs, as misuse and overdosing of such drugs may lead to severe constriction of blood vessels and stroke. He added that stress is common now and it can directly lead to unhealthy behaviour. “It is important to learn to recognize these stressors and address them accordingly. For instance, if stress leads to poor sleep, then it is a concern and needs to be addressed. This is because poor sleep itself has an impact on the immune system and causes abnormalities in blood and heart issues, which may potentially lead to stroke,” he said.

Rare, acquired risk factors may also present in the younger population including Moyamoya syndrome (a rare progressive cerebrovascular disorder caused by blocked arteries), anti-phospholipid syndrome (leading to an abnormal blood clotting) as well as heart abnormalities.

Overall, it is essential for young adults to prioritize their lifestyle habits and take proactive measures to safeguard their health. By identifying risks, recognizing symptoms, and pursuing recovery, young adults can prevent stroke and improve their overall health and wellbeing.