Improved stroke outcomes must be a common goal

Hope for better quality of life with fast multi-disciplinary care

Wednesday, November 8 2023

Playing down serious symptoms in the hope that they will subside is one of the gravest mistakes a person can make. Not only does this lessen the potential to save the life of a patient in the case of a stroke, but also reduces their chance to retain their independence thereafter.

Dr Themba Tshabalala, a neurologist practising at Netcare Pretoria East Hospital, notes that prompt multi-disciplinary intervention in the case of a stroke can dramatically improve a person’s quality of life. He stresses the need for greater awareness around this in South Africa, where 10 people suffer a stroke every hour, according to figures from the Heart and Stroke Foundation of South Africa.

“Mobility, cognitive ability and communication are all too often diminished by a delay in seeking medical attention – a consequence that also impacts the mental wellbeing of the patient, resulting in anger and frustration. This understandable emotional response is often transferred onto those responsible for their care at home, which can be highly stressful for the carer too,” he notes.

Dr Tshabalala explains that a stroke most commonly occurs when a blood clot blocks the supply of blood to the brain – an ischemic stroke. It can also be caused by a burst blood vessel, causing bleeding in the brain – a haemorrhagic stroke. This results in damage to the affected areas, which can be fatal.

The size of a stroke and its location in the brain are closely linked to its severity, and individuals with uncontrolled co-morbidities often fare less well than those starting from a healthier baseline, he notes.

The multidisciplinary team at Netcare Pretoria East Hospital aims to improve quality of life for patients who have suffered a stroke. Pictured (left to right) are physiotherapist Richard Maseko, neurologist Dr Themba Tshabalala, speech therapist Mariandi Pretorius and occupational therapist Anri van Renssen.



Multi-disciplinary care
Commenting on the need for multi-disciplinary intervention, Dr Tshabalala notes that because the brain damage caused by a stroke has an interrelated effect on even the most basic functions, it is crucial to begin rehabilitation as soon as the patient is medically stable.

He explains that outcomes are greatly improved if a patient has the immediate attention of a neurologist, a physiotherapist, an occupational therapist and a speech therapist, as this brings specialised focus to the different areas of life that are affected. Consulting a mental health professional is also advisable for both the patient and the caregivers at home due to the lifechanging effects that stroke can have.

“Speech-language therapists help patients with the ability to consume solids and liquids safely and efficiently when experiencing difficulties with the muscles that support this function. This is one of the first interventions that needs to take place after admission. This can mean anything from assisting a severely affected patient to swallow to establishing a nutritious diet that they are able to eat without aspirating or choking,” says Mariandi Pretorius, a speech therapist practising at Netcare Pretoria East Hospital.

“Naturally, we also treat communication deficits such as trouble understanding, trouble speaking, and cognitive impairments that affect problem solving, memory, and higher-level thinking skills, although this can be one of the last functions to improve. Including a patient's family in their care from the outset is central to effective communication and continued progress at home.”

Pretorius notes that achieving positive outcomes is dependent on the interplay between her role and those of her colleagues. For example, for a patient to have the ability to eat or drink something safely, diet or texture modifications and correct positioning of the body are required, which is dependent on physiotherapy, occupational therapy and dieticians.

Richard Maseko, a physiotherapist and part of the team at Netcare Pretoria East Hospital, adds that a multi-disciplinary team is vital to the recovery of a stroke patient. For instance the ability of a patient to swallow plays a considerable role in their general muscle strength and function, so that the patient can start to do the required exercises and eventually walk. The physiotherapist will then work together with the speech therapist and dietitian to meet this end goal.

"Movement is vital for encouraging mobility in stroke patients. While at times some other functions might take longer to come back and sometimes not be fully restored, rehabilitation has a far greater chance of success if we start from day one. The attitude of the patient towards treatment is also a determining factor," he says.


According to Dr Tshabalala, while many people are aware that stroke is a life-threatening healthcare event, it is not always fully understood just how devastating an impact it can have on the daily life of an individual.

“If a patient is bedridden, they can easily develop a host of other complications, some of which can be fatal further down the line. As soon as the patient is medically stable, holistic rehabilitative therapy should begin,” he says.

The need to re-establish simple daily tasks requiring fine motor skills such as brushing teeth, getting dressed, or making a cup of coffee is emphasised by Anri van Renssen and Inge de Jager, occupational therapists practising at Netcare Pretoria East Hospital.

“When a stroke occurs, a person can have real difficulty performing these tasks due to cognitive and physical deficits,” says van Renssen. “Our main aim as a team is to help that person regain their independence, which is central to a good quality of life. We include activities to stimulate healing in the brain and encourage the use of fine motor skills, such as needlework or puzzles. For this, we need physiotherapy to activate larger muscle groups and work closely with the speech therapist in the patient’s daily routine.

“The sooner we start, the better. We can see much improved outcomes in as little as seven days because our therapeutic disciplines are working collaboratively towards a common goal,” she says.

“Time is everything when it comes to achieving better outcomes for stroke patients,” says Dr Tshabalala. “Seeking emergency care as quickly as possible gives you a far better chance of reversing the damage as far as possible. Greater societal awareness around the symptoms of stroke is therefore key. Even primary school children should be educated about calling emergency services if they recognise the sudden onset of symptoms, which can be easily remembered with the acronym BE FAST.

B – Balance difficulties
E – Eyes lose vision or become blurry

F – Facial weakness on either side of the face
A – Arm and/or leg weakness on either side of the body
S – Speech that is slurred or difficulty in speaking or swallowing
T – Time to call emergency services

“Special treatments for stroke and established multi-disciplinary teams are available at hospitals and not primary care facilities, so it is imperative to get to the nearest hospital urgently if you suspect a stroke. It is also important to highlight that stroke can largely be prevented with healthy lifestyle choices and health screenings. We strongly encourage all South Africans to be aware of this,” concludes Dr Tshabalala.


Notes to editor

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