Life after a stroke, post-stroke care crucial

The after-effects of a stroke – whether physical, emotional or psychological – are challenging to navigate. 

STROKE, sometimes called a brain attack, occurs when there is a blockage of blood supply to part of the brain or when a blood vessel in the brain ruptures.

Star Graphic: Vecteezy

Stroke survivors have a wide range of long-term healthcare needs.

After the stroke, they often experience a variety of cognitive, psychosocial and physical difficulties.

The most challenging problems post-stroke are usually physical and cognitive impairment, depressive symptoms, and fatigue.

Even survivors of a mild stroke struggle to regain full independence due to persistent symptoms.

A stroke survivor’s ability to carry out activities of daily living is likely to still be impaired even a year after they had their stroke.

As survivors work towards recovery, they may experience times when they feel like they have taken two steps forward, only to end up taking one step back.

This is normal and to be expected as rehabilitation gains often occur more slowly as time goes by.

Survivors with communication disorders like aphasia (which is caused by damage to the part of the brain that controls language expression and comprehension), would face even more challenges on top of their physical difficulties.

Maintaining basic communication would be a challenging task, let alone engaging in social networks and meaningful activities to reintegrate into their communities.

Unmet needs

After a stroke, survivors often experience emotional and behavioural changes.

The reason is simple: Stroke impairs our brain’s control over our behaviour and emotions.

You or your loved one may experience feelings of irritability, forgetfulness, carelessness or confusion.

About a third of survivors report depressive symptoms and one in five report anxiety in the first months or years after the stroke.

Many stroke survivors and their caregivers also feel abandoned and marginalised by community health services.

Inadequate post-stroke care can create unmet needs for survivors and their caregivers, which are often associated with poor quality of life for the survivor.

These unmet needs can include:

> Rehabilitation and recovery

Stroke patients often require long-term rehabilitation to regain lost function and mobility.

Many patients require ongoing physical, occupational and speech therapy, but may not have access to these services or the financial resources to cover the costs.

> Mental health support

Stroke patients may experience depression, anxiety and other mental health issues because of the physical and emotional challenges of recovery.

Access to mental health services can be limited, and there may also be stigma associated with seeking mental health care.

> Caregiver support

Caregivers play a critical role in supporting stroke patients, but may themselves experience significant stress and burnout.

They may also lack the training and resources needed to provide effective care.

> Social support

Stroke can be a life-changing event that can result in significant changes to a survivor’s social support network.

They may need help rebuilding their social connections and may benefit from peer support groups.

> Education and information

Many stroke survivors and their families have reported feeling overwhelmed and underinformed about the condition and its treatment.

Therefore, they may benefit from access to educational materials, support groups and resources to help them navigate the recovery process. 

> Access to healthcare

Stroke patients may face barriers to accessing healthcare, particularly if they live in rural or remote areas.

They may also face challenges in accessing specialised care, such as neurology and rehabilitation services.

Beyond a year

It is a common belief that a survivor’s physical recovery will plateau a year after the stroke.

In the early stages of rehabilitation after a stroke, you can often recover quickly.

However, after a few months, your progress may slow or stagnate – therapists call this the plateau phase. It is a stage most survivors experience.

But contrary to widespread belief, it doesn’t mean that you can no longer recover any further.

In fact, it is possible to get through the plateau phase and recover even more function.

The goal of rehabilitation is to maintain your function and prevent any deterioration, as well as to better adapt to your longterm limitations.

Maximising physical independence may indeed turn out to be a lifelong task.

The best way to overcome this challenge is to make sure things at home are adapted as necessary to help you get back to your daily life safely.

You may seek advice from a healthcare professional, specifically an occupational therapist, to prescribe customised assistive devices and assistive technology for home modification.

Emotional impact

A stroke is sudden and shocking, and can affect every part of your life, including your emotional well-being.

Every stroke experience is unique, but to most survivors, it feels like a loss of life.

Most survivors come to accept their physical disability, but many remain emotionally vulnerable years after their stroke.

The loss of physical independence may result in a loss of sense of identity, as well as guilt over the burden they are now posing to their family members.

Hence, ongoing psychological support from family, friends and/or healthcare professionals may be needed.

Providing flexible psychological support for stroke survivors can be achieved through a variety of approaches, including:

> Individual therapy

Stroke survivors may benefit from individual therapy sessions with a licensed therapist.

These sessions can be tailored to the person’s specific needs. 

> Teletherapy

Teletherapy allows stroke survivors to receive psychological support remotely, via video conferencing or phone calls.

This can be particularly helpful for patients who are unable to travel to the counselling centre, or who live in rural or remote areas.

> Group therapy

In addition to providing therapy in a group, group therapy sessions can give stroke survivors the opportunity to connect with others who have had similar experiences.

This can help survivors realise they are not alone, as well as both receive from and give support to their fellow survivors in the process of undergoing the therapy.

> Peer support

Stroke survivors may benefit from peer support groups, which provide a supportive and empathetic environment for survivors to share their experiences and learn from others who have been through similar challenges.

While group therapy is led by a healthcare professional and aims to bring about a change in mindset or behaviour, peer support groups comprise only of fellow survivors and are meant to help their members cope with their situation.

> Caregiver support

Providing psychological support for caregivers can also benefit stroke survivors, as it can help reduce caregiver stress and improve the quality of care they provide.

This support can be provided through individual or group therapy sessions, or through educational programs designed specifically for caregivers. 

> Online resources

There are many online resources available for stroke patients and their caregivers, including educational materials, support groups and forums.

These resources can provide flexible support for patients who may have limited access to in-person services.

It’s important to note that psychological support for stroke survivors should be tailored to the individual’s needs and preferences, and should be provided in a flexible and compassionate manner.

See next 

The financial impact of having a stroke

 

By Dr Lee Tze Yan,  a senior lecturer in molecular medicine at Perdana University. Matthew Teo Yong Chang is an occupational therapist specialising in stroke rehabilitation and senior lecturer at Manipal University College Malaysia. For more information, email starhealth@thestar.com. my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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STROKE EXERCISES FOR YOUR BODY; Recognising the warning signs of stroke; Caring for a stroke survivor

 

Know your fit­ness lingo

To nav­ig­ate the fit­ness world, it helps to have know­ledge of cer­tain terms and acronyms.

When it comes to strength train­ing, using your body­weight to per­form the exer­cise is adequate for begin­ners. — Pho­tos: 123rf.com 

On your act­ive recov­ery day, gentle stretch­ing is a good way to relax the body. 

 

 

 Little jumps that can raise your heart rate count as car­dio activ­ity.

GYM-GOERS and some per­sonal train­ers like to throw jar­gon and acronyms around, even if they may not fully under­stand what the terms mean.

A few months ago, I met a col­lege-going chap who had just star­ted lift­ing weights and I quer­ied him on his workout regime.

Most of his know­ledge was taken off the inter­net – he was work­ing out his arms and legs on altern­ate days six days a week, and look­ing tired, but good.

“I’m set­ting a PR every day,” he proudly told me.

PR? I was puzzled (I’m old school) and asked what that was because I only knew of PB (per­sonal best).

The PR that I’m famil­iar with is the abbre­vi­ation for pub­lic rela­tions – after all, as media prac­ti­tion­ers, we fre­quently deal with PR pro­fes­sion­als.

“Per­sonal record, aunty!” he said, smil­ing while won­der­ing which era I came from.

“Oh, that’s pos­sible to do on a daily basis, huh?” I com­men­ted, intrigued.

Try­ing to keep up with the young­ster, I then ques­tioned: “Are you doing super­sets or tris­ets?

“And don’t you suf­fer from DOMS, espe­cially if you’re lift­ing so fre­quently?”

He gave me a blank stare because the terms threw him off.

Never assume middle-aged souls with mini muscles don’t know much!

So, I patiently explained them to him.

This encounter is not quite reflect­ive of the gen­er­a­tional gap, but is bound to hap­pen to any­one as the fit­ness world has its own lingo and it’s tough to keep up with all the abbre­vi­ations and acronyms, espe­cially the newly-cre­ated ones.

And it can be daunt­ing for the begin­ner who enters the gym or has a con­ver­sa­tion about fit­ness.

Upon check­ing with my per­sonal trainer friends, I dis­covered that PR (the fit­ness acronym) is gym lingo that can be used for any kind of fit­ness activ­ity.

It is, however, nor­mally asso­ci­ated with the heav­iest weight you’ve lif­ted for a par­tic­u­lar exer­cise, or the max­imum num­ber of repe­ti­tions you per­formed using a cer­tain weight.

People usu­ally toss around this acronym when speak­ing about big lifts.

There are no hard and fast rules over using PR, but some people sub­sti­tute it for PB.

They also use it to refer to other isol­a­tion exer­cises such as biceps curls, jump height, sprints, or even the length of time it takes to run a cer­tain dis­tance.

Here are a few com­mon fit­ness terms you might want to know – and use – when neces­sary.

Car­dio

Car­dio, or car­di­ovas­cu­lar or aer­obic exer­cise, is any rhythmic activ­ity that makes your heart beat faster and increases your breath­ing.

This is as you would require more oxy­gen to keep up with the pace of move­ment.

Examples of car­dio activ­it­ies are run­ning, brisk walk­ing, cyc­ling, march­ing in place, etc.

Get­ting your heart pump­ing at a faster rate on a reg­u­lar basis keeps it in shape and healthy, thus redu­cing the risk of heart dis­ease.

The role of car­dio exer­cises is to help burn cal­or­ies so that you can shed weight.

Strength/res­ist­ance train­ing

This form of exer­cise is inten­ded to increase mus­cu­lar strength and endur­ance.

It involves exer­cising muscles using some form of res­ist­ance, i.e. weights, bands, or even your own body­weight work­ing against grav­ity.

To lose weight faster, com­bine your car­dio with strength train­ing, and watch how your body trans­forms.

Your bones can bene­fit from res­ist­ance train­ing too.

Stud­ies have shown that doing res­ist­ance train­ing con­sist­ently can main­tain or increase bone mass and dens­ity.

This is something most doc­tors are ask­ing their older patients to do as it also helps improve bal­ance and sta­bil­ity.

Hyper­trophy

This refers to an increase or growth in muscle size achieved through strength-train­ing exer­cises.

This style of train­ing is pop­u­lar within the body­build­ing com­munity, where there is often a focus on the growth of cer­tain muscles, e.g. thighs, calves, biceps or arms, to achieve an ideal physique.

Achiev­ing this hap­pens via mod­er­ate weight-lift­ing and mod­er­ate repe­ti­tions.

On the oppos­ite end, muscle atrophy is the decrease in size and wast­ing of muscle tis­sue.

Rep/set

Rep is the short form for repe­ti­tion, i.e. how many times you do the exer­cise.

One rep means one time, two reps mean two times, and so on.

The term “set” tells you how many times you are to repeat a par­tic­u­lar num­ber of repe­ti­tions of a given exer­cise.

For example, if you are doing squats, say­ing three sets of 15 reps means you’ll be doing 15 squats three times in total, with a rest (for an allot­ted time, per­haps 30 seconds or a minute) in between sets.

Super­sets/tris­ets/giant sets

Super­sets are doing two exer­cises back to back with no break.

Giant sets are doing four or more exer­cises back to back with no break.

Dur­ing these sets, you can either pair exer­cises that are non-com­pet­ing, i.e. oppos­ing muscle groups, or you can tar­get the same muscle.

For example, you may do one set of 12 reps of chest presses, fol­lowed by another set of 12 reps of push-ups.

This is a super­set exer­cising the same muscle group.

Or you may do one set of 12 reps of push-ups, fol­lowed by another set of 12 reps of squats, then another set of 12 reps of calf raises.

This is a triset exer­cising dif­fer­ent muscle groups.

DOMS

All of us exper­i­ence DOMS, or delayed onset muscle sore­ness, at some point from doing any activ­ity that is either new, done for a longer dur­a­tion, and/or at a harder intens­ity.

It’s caused by inflamed muscle and con­nect­ive tis­sues.

Symp­toms range from muscle ten­der­ness or sore­ness, to severe debil­it­at­ing pain.

The tem­por­ary dis­com­fort starts a day or two after a workout, and eases off by day three or four.

The sore­ness is a sign that your muscles have been worked and your fit­ness is pro­gress­ing, but you shouldn’t be get­ting DOMS after every workout unless you’re exer­cising only once a month!

HIIT

High intens­ity inter­val train­ing (HIIT) is a form of car­dio exer­cise char­ac­ter­ised by short peri­ods of all-out exer­cise, inter­spersed with rest or act­ive recov­ery ses­sions.

It com­bines both car­dio and strength train­ing, with the inten­tion to max­im­ise ath­letic per­form­ance.

It incor­por­ates sev­eral rounds that altern­ate between sev­eral minutes of high intens­ity move­ments to sig­ni­fic­antly increase the heart rate to at least 80% of one’s max­imum heart rate, fol­lowed by short peri­ods of lower intens­ity move­ments.

There is a ratio that is fol­lowed, i.e. the amount of time spent work­ing versus the amount of time spent recov­er­ing – also known as the work-to-recov­ery ratio.

For example, when you per­form 60 seconds of work, fol­lowed by 60 seconds of recov­ery, your HIIT ratio is one-to-one.

Tabata

This is another form of HIIT con­sist­ing of short workout blocks.

Tabata train­ing breaks a workout down into clearly defined inter­vals – typ­ic­ally, 20 seconds of a push-it-to-the-limit exer­cise, fol­lowed by 10 seconds of rest.

One cycle is repeated eight times for a total of four minutes.

You can mix two exer­cises in a cycle, e.g. 20 seconds jump­ing jacks, 10 seconds rest, 20 seconds crunches, 10 seconds rest, then repeat.

The recom­mend­a­tion is to do four to five cycles for a 16-20 minutes’ workout – you’ll be sweat­ing buck­ets by then!

Tabata, foun­ded by Japan­ese sci­ent­ist Izumi Tabata, is a highly effect­ive train­ing style for build­ing power and car­di­ovas­cu­lar fit­ness.

However, bear in mind that Tabata is gruelling and you’ll need to be fit enough to meet its phys­ical demands without get­ting injured.

Also note that Tabatha is HIIT, but not all HIIT is Tabata.

Act­ive rest or recov­ery

This is usu­ally one day in a set time period when you give your body a “break” and do some sort of move­ment that is less intense than your reg­u­lar workout days.

But this does not mean you can lounge on the couch or scroll through social media throughout the day.

Instead, act­ive rest means schedul­ing a low-intens­ity activ­ity like a leis­urely stroll, foam-rolling or gentle yoga to help with cir­cu­la­tion. 

You can even opt for a mas­sage. Your body needs time to recover (just like the mind needs to recharge) so that the muscles can rebuild stronger.      

By Revathi Mur­ugap­pan, a cer­ti­fied fit­ness trainer who tries to battle grav­ity and con­tin­ues to dance to express her­self artist­ic­ally and nour­ish her soul. For more inform­a­tion, email star­health@the­star.com. my. The inform­a­tion con­tained in this column is for gen­eral edu­ca­tional pur­poses only. Neither The Star nor the author gives any war­ranty on accur­acy, com­plete­ness, func­tion­al­ity, use­ful­ness or other assur­ances as to such inform­a­tion. The Star and the author dis­claim all respons­ib­il­ity for any losses, dam­age to prop­erty or per­sonal injury suffered dir­ectly or indir­ectly from reli­ance on such inform­a­tion.

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Happy and healthy, not hunky

 

 

 

There are many benefits to weighlifting

 

Merry Christmas Holiday fitness hacks

Holiday fitness hacks The festive season usually means diets and workouts are out the window, but to assuage your guilt, try these tips to moderate the eating and get a little exercise in.

 Chewing gum can actually help reduce food cravings and appetite, so pop some in after you’ve eaten enough at the party. — AFP

ONCE again, Christmas is here.

Your diet and workout may go out the window today, but never mind; it’s a day to find some merriment to light up your heart.

Even if you’re not celebrating Christmas, everyone can savour the holiday and hope that present troubles will pass.

As Malaysians, no doubt the first thing we want to do is get together and feast today – and this activity will probably continue until 2023 rings in.

Excessive eating is one of the main reasons for the additional weight gain, but it is also due to lack of physical activity and exercise.

After bingeing on good food and drinks, we feel guilty and sign up for gym memberships – a new year, a new start.

That’s what we’d like to believe anyway! But, instead of going downhill speedily, why not put your brakes on and glide steadily down the slope for a softer landing?

Try these useful tips to stay fit this holiday season.

Eat before heading out

There will be plenty of parties, dinners, lunches and gatherings, even if they are small ones.

So, eat something before leaving home so that you won’t be tempted to overeat there.

Some people prefer to skip their meals for the day to enjoy the festive spreads later, but that only means you will be enticed to eat more and thwart your digestion.

Foregoing meals actually leads to faster weight gain.

If you have a lot of invitations, eat smaller meals and chew food well.

Remember, the slower you eat, the faster you’ll feel full.

Fill up on salads and veggies

Chances are, if you are at a big party, there will be a variety of dishes to choose from.

Fill up at least half your plate with salads (minimise the dressing) and veggies (potatoes don’t count) as these choices contain very few calories and sugar.

Also, sit further away from the food, especially desserts, so that you have to get up and walk to get second or third helpings. Every little walking step counts!

It also helps prevent you from continuing to pick at a certain food just because it is in front of you.

Load up on water

Drink a lot of water to satiate your appetite and keep hydrated.

It will also prevent a possible hangover if you go overboard with the alcohol.

A dry mouth and a nagging headache are classic symptoms of dehydration.

As a rule of thumb, experts recommend drinking one full glass of water for every alcoholic beverage that you consume.

Bear in mind to drink moderately, and if you’re driving, definitely stick to non-alcoholic beverages.

If you do have one too many alcoholic beverages, have a glass of warm water with lemon or a green tea the next morning.

This will help to activate your system and begin any detoxification process needed.

Also, just prior to going out, have something like some yoghurt and a banana – the protein contained in them slows down stomach digestion, and the potassium will assist in balancing out any salty foods that might exacerbate dehydration.

Many Christmas treats and snacks are full of salt or sugar, which tends to throw your metabolism completely out of balance (including when it come to alcohol), so nibble instead of gobble.

Chew gum after meals

If you chew gum after tucking into your meal, that minty fresh taste and the action of chewing will help you avoid going back for more helpings, even if you’re still hungry.

A few small studies have shown that chewing gum can help reduce cravings and appetite, as well as shave calories.

Research conducted by the University of Rhode Island, United States, found that people who chewed gum every day consumed 68 fewer calories and did not bingeeat later.

Plus, gum chewers actually burned about 5% more calories than non-gum chewers.

Go ahead, chew gum when you have the urge to snack and right after your meals to prevent mindless munching.

However, note that chewing gum can also lead to swallowing air, which can cause bloating, so if you are prone to getting “wind” in your tummy, ignore this tip.

Get out of the house

Fret not if you don’t receive any invitations this year as many are struggling to make ends meet.

Allocate time for family and perhaps plan some outdoor activities that do not involve costs.

Maybe a hike in the forest, a picnic in the park, a frolic in the playground or a walk about town – if the weather permits.

All these will help burn calories while keeping the children entertained.

Squeeze in some strength training

Staying active and maintaining a semblance of an exercise routine may seem like an impossible task with a calendar full of holiday parties and family obligations. But it can be done.

Plan to exercise in the morning before starting your day, when there are minimal distractions.

To maintain the muscle mass that you’ve worked so hard to build, perform your strength-training exercises as you can burn just as many calories as a cardiovascular workout in a shorter span of time. No weights?

No problem, just use your own bodyweight – 20 minutes daily or every other day is enough during this period.

Here are some examples of exercises you can do:

> One-minute jumping jacks and/or marching on the spot with knees high (to warm up).

> Twenty parallel squats.

> Twenty walking lunges.

> A one-minute plank.

> Ten push-ups.

> Twenty bicycle crunches.

> Twenty tricep dips.

> Twenty duck squats (with legs separated and feet turned out).

Opting for meat dishes at the parties and buffets might even mean you will gain some extra muscle – definitely much better than gaining some extra fat!

So, stay healthy, indulge a little bit, keep your face masks on in crowded areas, and as Ella Fitzgerald would sing, Have yourself a merry little Christmas.

See you next year!

RevMathi urugappan is a certified fitness trainer who tries to battle gravity and continues to dance to express herself artistically and nourish her soul. For more information, email starhealth@thestar.com. my. The information contained in this column is for general educational purposes only. neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. 

  The Star Malaysia 25 Dec 2022REVATHI MURUGAPPAN starhealth@thestar.com.my

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Sure-fire, get-in-the-best-shape-of-your-life-or-your-money-back fitness fads have been around for thousands of years.

Just in my lifetime, I’ve seen boot camps, Bowflex, CrossFit, hula hooping, Insanity, Jazzercise, kettle bells, P90X, Pilates, pole dancing, spinning, Tabata — and that’s by no means a complete list.

Over the years — centuries really — one method won’t ever show up on a list of fads, but, despite the lack of hype, it may very well be the most beneficial of the bunch: good, old-fashioned weightlifting. Let’s take a look at some of the proven benefits of weight training.

Testosterone

In excessive quantities, testosterone can be problematic. But in normal quantities, it motivates us, gives us energy, helps us take the initiative and gives us a sex drive (women have testosterone, too).

Below-normal levels of testosterone have been linked with depression, lack of drive, concentration problems, fatigue, irritability, physical weakness, diminished or absent sex drive, sleep problems, trouble coping with stress, your overall risk of mortality and more. Strength training boosts the body’s natural testosterone production.

Overall health

Weight training has been shown to increase bone density (thereby reducing the risk of fractures in older adults), improve balance (which reduces the risk of falls that might cause fractures), reduce the risk of stroke by as much as 40%, lower blood pressure (some studies show that two weight-training sessions per week is as effective as blood-pressure-lowering meds), strengthen the heart, reduce diabetes risk and cance, and improve longevity.

“The greater your muscle mass, the lower your risk of death,” said UCLA researcher Dr. Arun Karlamangla. “Thus, rather than worrying about weight or body mass index, we should be trying to maximize and maintain muscle mass.”

Physical performance

Strength training helps offset the half-pound of muscle mass we lose every year after about age 30. It also increases your strength, flexibility and endurance. That makes us less likely to get injured doing other athletic activities. Strength, flexibility and stamina are also quite helpful to maintaining your sex life.

Theoretically, we spend about 30% of our life sleeping. But in reality, many of us are chronically tired. Regularly getting less than 6 hours of sleep is associated with a host of serious health risks, heart disease, high blood pressure, stroke, obesity, mental illness, car accidents and general cognitive impairment.

Researchers Patrick O’Connor, Matthew Herring and Amanda Caravalho found that people with sleep problems who did regular strength training for 8-10 weeks had a 30% improvement in the quantity of their sleep. Older adults who did regular weight training reduced the number of times they got up at night compared to those who didn’t do any exercise.

Mental health

By changing the shape of your body in a good way, weight training may improve your self-esteem. It also training triggers a release of endorphins, which help reduce the symptoms of anxiety and depression.

A little anxiety is a good thing— it keeps us aware, makes us focus, and gives us the energy to run away from dangerous situations. But too much anxiety can ruin your sleep, cause physical pain, and have a negative effect on your whole life.

O’Connor, Herring, and Caravalho found that people who did weight training and cardio three times per week experienced less depression than those who didn’t get that exercise.

Cognitive function

Strength training builds strong brains as well as strong muscles and bones. People who lift weights tend to have a larger hippocampus, the part of the brain that helps with verbal processing and memory.

According to O’Connor, Herring, and Caravalho, resistance training is especially beneficial to older adults, especially in memory and memory-related functions. Other researchers have found that weight training improves executive function, which is the brain’s capacity to keep us organized and on task.

Social status

Like it or not, we’re animals. And like most other animals, we have a social structure that in many ways operates out of our control. Here’s how it works: physically strong men tend to be more confident. Confident (and muscular) men tend to be more respected by others, are seen as better leaders and more competent in general.

As a result, they’re able to motivate others to work harder, they get more promotions, and they make more money. They’re also seen as more attractive than their less-confident (and less-muscular) brothers.

“Studies have demonstrated that people assign positive personality traits to drawings or photographs of mesomorphic (muscular) men and mostly negative traits to nonmesomorphic men,” said researchers Timothy Judge from the University of Florida and Daniel Cable from the London Business School.

For example, traits ascribed to mesomorphic men were very positive (i.e., best friend, has lots of friends, polite, happy, helps others, brave, healthy, smart and neat). By contrast … ectomorphic men were described with a different set of negative traits (i.e., nervous, sneaky, afraid, sad, weak, and sick).”

Future of the species- For the men

Besides making men more attractive to the opposite sex, weight training can have an influence on future generations. Weight training gives our DNA an improved capacity to repair itself. That keeps our genes healthy. And since our children get half of their genes from dad, at least some of our healthy genes will be passed on to our children, thereby making them healthier too.

In addition, a 2004 study of Danish men found that muscular men had more semen volume, a greater number of healthy sperm and were more fertile than either skinny or obese men.

Easy implementation

Tapping into the benefits of weight training isn’t all that complicated. While cardio exercise, almost by definition, can take a lot of time, many experts say that 30-60 minutes of weight training per week is plenty.

By Armin Brott |  Armin Brott is the author of “Blueprint for Men’s Health,” “Your Head: An Owner’s Manual,” and many other works on men’s health. Visit him at HealthyMenToday.com or send questions or comments to armin@healthymentoday.com 

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Core Exercises for Stroke Patients to Improve Balance and Walking (Gait)

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Seated Core Exercises


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Flint Rehab

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The best way to improve balance after stroke is with core exercises. You can also download 13 pages of free rehab exercises here: https://flnt.rehab/2JGii7r

These core exercises for stroke patients are guided by Cassi, DPT (Doctor of Physical Therapy).

Cassi's core exercises are relatively easy and will help you improve your balance and gait (manner of walking).

To get more information on stroke recovery, download our FREE ebook here:https://flnt.rehab/2zg3yt0

Best Hand Exercises for Stroke Patients at Home

https://youtu.be/i0JYsLyJEnE 

These hand exercises for stroke patients are guided by Barbara, OTA. You can also download 13 pages of free rehab exercises here: https://flnt.rehab/2JGii7r

Best Stroke Recovery Hand Exercises - Stage 1


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Dr. Scott Thompson shares the best stroke recovery hand exercises. Use these hand exercises and hand therapy tools to advance your stroke recovery. 

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We hope you get good use from the ebook! Now let's back up a bit... Who is the company behind the stroke recovery blog and ebook? Hello there! We are so happy to have you here. We are Flint Rehab, and we're pretty passionate about stroke rehabilitation. And we're even more passionate about helping stroke survivors just like you achieve a higher recovery. Because we believe that... ...You can defy the odds and achieve a higher recovery - if you believe in yourself. ...Stroke education is of the utmost importance because it can help you achieve that higher recovery.  ...Emotional healing is just as important as physical healing, so we always talk about both. ...Regaining movement after stroke does not have to be boring. That's why we pour so much energy into both maintaining an extensive stroke education blog and creating fun, effective rehabilitation devices. What to Expect from Us To help boost your stroke education, we send a newsletter every Monday that contains brand new stroke recovery articles. Two of them are usually brand spankin' new, and the other 3 are goodies pulled from the archives. Since our archives contain 300+ stroke recovery articles, our Monday newsletter is the best way to stay on top of our best stuff. Do you think we're a good match? If so, we'll help catch you up to speed by sending you a quick lesson on the best way to massively improve movement after stroke. If you aren't interested, we understand. You can opt out here or at the bottom of any email at any time. No hard feelings! For those who stick around, we're really happy to have you here! Your resource for recovery, ​The team at Flint Rehab

Better access for stroke patients, and Helping stroke survivors in a pandemic

 

Knowing the Signs of Stroke Can Save Lives - Avera Health

Learn More Stroke Warning Signs and Symptoms | American ...

How to recognise signs of a stroke, and what to do to minimise ...

The Health Ministry is mulling over an additional six stroke centres by 2024, while more medical teams will be trained by the Malaysia Stroke Council to address the lack of neurologists to treat the condition.

WHEN it comes to stroke, every second counts.

The bigger the delay in getting treated, the smaller the chances of full recovery.

In fact, two million brain cells die every minute until blood flow is restored.

“In other words, time is brain.

“The more time passes, the more brain cells are lost and may not be re-generated, ” says Malaysia Stroke Council president Assoc Prof Dr Hoo Fan Kee.

As it will be World Stroke Day this Thursday (Oct 29), there’s a need to look into main issues involving the disease here – the lack of neurologists to treat patients and limited access to stroke centres, especially in rural areas.

The good news is steps are underway to smoothen the road ahead for patients.

Currently, there are a total of 61 public and private stroke centres in Malaysia, according to Dr Hoo.

“It’s almost a double-fold increase from 34 in 2017.

“But we still need about 90 centres in the country, ” Dr Hoo adds.

For this, the Health Ministry is proposing to increase the number of public stroke centres to beef up treatment here.

“A proposal to add six more centres by 2024 is being considered.

“This is subject to budget availability to develop or upgrade such facilities, ” the ministry tells Sunday Star.

On Aug 14, the World Stroke Organisation recognised five Malaysian hospitals for achieving international standards in their stroke care practices.

Such news is encouraging but the challenge remains that there aren’t enough neurologists, or specialist doctors who treat diseases involving the brain, spinal cord, nerves and muscles.

“There are 99 registered practising neurologists in Malaysia.

“Of this total, 25 are working under the ministry, 24 are with the Education Ministry while the remaining 50 are in the private sector, ” the ministry says.

But this is a far cry from the recommended ratio of one neurologist per 100,000 population.

“Now, the ratio in Malaysia stands at one neurologist per 330,303 population, ” the ministry explains.

At the current population of 32.7 million, we would need to have another 228 neurologists.

Boosting medical help

Nevertheless, more trainees are being accepted for sub-specialisation training compared to the past.

“Over the last few years, about 10 trainees were accepted annually in public hospitals under the ministry while academic hospitals accepted one to two trainees each year, ” says the Health Ministry.

Concurring about the lack of neurologists, Dr Hoo says it doesn’t help that the distribution of such specialists is uneven, with most or about 40% being based in the Klang Valley.

“There’s still a need to boost the number of stroke-ready hospitals – centres with doctors and medical teams who are trained to handle cases.

“Some states only have a handful of hospitals that can treat stroke, ” he says.

For example, Kelantan, Terengganu and Pahang each have only two stroke centres.

To address this, Dr Hoo says the Malaysia Stroke Council will be coming up with a virtual training programme to grow the pool of medical teams that are able to treat stroke.

This will help equip non-neurologists to be able to treat stroke patients and increase the number of stroke-ready hospitals.

“The council will set up an online certification programme for the theory section of the training by the end of this year.

“After going through the theory online, the doctors and the rest of the medical team will go through practical training before they can be certified to treat stroke patients, ” Dr Hoo explains.

Previously, the council had also trained non-neurologists who are likely to come across stroke cases like geriatricians, general physicians and emergency physicians.

So far, he estimates that there are 12 hospitals now operating with non-neurologists who have been trained to accept stroke cases.

In order to be a stroke-ready hospital, such hospitals need to have a physician trained to read computerised tomography (CT) scans to diagnose stroke and have neurosurgery support.

Dr Hoo says the council hopes to improve the outcome of treatment, with the aim of having 60.2% of patients being fully independent after suffering a stroke by 2024.

Currently, only 34.4% of patients are independent after the episode.

At present, the mortality rate is 8.7% for stroke but by 2024, the council hopes that it can be decreased to 5%.  

Getting more common

For now, Malaysia needs to be prepared as stroke has become more prevalent over the years.

From a prevalence rate of 0.3% among Malaysians in 2006, it jumped to 0.7% in 2011.

This is based on the Health Ministry’s National Health and Morbidity Surveys in past years.

The ministry also notes that stroke is becoming more common among young Malaysians these days.

“It’s mainly caused by the increase in non-communicable diseases (NCDs) among the younger age group, including obesity, ” it says.

With about 50,000 new cases of stroke every year, it’s also worrying that 40% of those affected are aged below 60, says the National Stroke Association of Malaysia (Nasam).

As such, Nasam rehabilitation head Tracy Chan says there is a need to have greater awareness about stroke among the young.

“It is when people are young that prevention should start.

“Educate them on healthy lifestyles and have an environment that promotes greater healthy living.

“Start them young on healthy living, work ethics and balanced lifestyles, ” she says.

Employers should also understand that staff wellbeing is just as important as a healthy balance profit and loss sheet.

“In fact, happy staff always improves the balance sheets, ” Chan quips.

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 ‘It’s not an old person’s disease 

I am 33 - and I just had a stroke | The Star

BING hit with a stroke at the age of 32 was something he did not expect at all.

For Joshua Lim Shaun Wu, it also happened when he was going through a difficult time in May last year.

He was caring for his grandfather who was admitted to hospital due to a fall.

After four days, Lim suffered a stroke and had to be admitted to hospital himself.

Sadly, his grandfather did not make it, but Lim managed to be discharged after several months of speech, occupational and physical therapy.

“I was discharged late last year with further doctor appointments every three months, ” says the former community manager and student services worker.

As the stroke impacted his communication skills, Lim says it took some time to ensure other people understood him when he tried to talk.

“We often think stroke is an ‘old person’s disease’. Well, it’s not.

“More needs to be done to inform and educate youths in Malaysia about stroke, ” he says.

Lim believes his underlying hypertension and existing medical conditions triggered the stroke.

“Also, I was stressed out – over my job, life and grandfather, ” he says.

But the incident did teach him many things – he now eats a healthier diet and monitors his blood pressure regularly.

Lim says perhaps, it was also a sign that he needed to slow down – he had spent 10 years in the United States before coming back in 2018 and immediately found a job in Malaysia within a month.

For Pang Sook Lee, 45, and a mother of three, a stroke hit her five years ago without prior signs.

“I went jogging every weekend, and had regular medical check ups, which showed good results.

“The stroke came suddenly after I didn’t get much sleep from the night before, ” she says.

Today, her left hand and leg has yet to fully recover but she is still able to do things independently.

“I can still drive my son around, go to the gym daily, buy groceries on my own and cook during weekends, ” Pang says. Having survived the stroke, she hopes others will maintain a positive mindset and never give up if they are struggling to recover from an attack. Ong Kian Leong, 45, a playground equipment salesperson, suffered a stroke when he woke up one morning in June this year and couldn’t stand up.

After his wife called the ambulance, he was rushed to the hospital.

“I’m better now but I can’t eat normally yet and the left side of my body is weak, ” he says.

“My advice to everyone is to look after their health, regardless of their age.

“Everyone should exercise and get sufficient rest, ” Ong adds.

Helping stroke survivors in a pandemic

 THE Covid-19 pandemic has made things tougher for stroke patients.

There’s been a decline in stroke admissions worldwide this year compared to the same period last year, according to the World Stroke Organization (WSO).

“The most likely explanation is that patients with mild symptoms are ignoring them and do not want to come to the hospital for evaluation because of fear of being exposed to Covid-19, ” says WSO president-elect Prof Marc Fischer in a recent statement.

A similar trend is also seen in most hospitals in Malaysia, based on a preliminary survey by the Malaysia Stroke Council.

With the Covid-19 pandemic, there are extra steps needed to be taken: the stroke patients have to be tested for the coronavirus.

“We will treat the patient first for their stroke, but admission will be in a different ward while waiting for confirmation on their Covid-19 test, ” explains council president Assoc Prof Dr Hoo Fan Kee.

The question also arises as to whether the doctor needs to wear the full PPE (personal protective equipment) or not.

“This may cause a delay. A stroke patient should receive treatment within 4.5 hours.

“After 4.5 hours, the risk of disability is increased. If treated within three hours, chances of fully recovering is higher, ” Dr Hoo says.

Some stroke patients also delayed follow-up checks or reviews at hospitals due to fears of the virus, says National Stroke Association of Malaysia (Nasam) rehabilitation head Tracy Chan.

“I have heard of urinary catheters not changed for the entire movement control order (MCO) period from March to June.

“There were other messy and unhealthy situations as a result of this pandemic, ” she says.

It doesn’t help that stroke survivors are part of the group of people that respond very poorly to Covid-19 infections.

“They also need quick access to services and medical treatment even though there is a pandemic that may kill them out there, ” Chan adds.

She says fewer stroke admissions has led WSO, of which Nasam is a member, to launch campaigns to encourage those with signs of acute stroke to rush to hospitals for emergency treatment on the onset of a stroke.

“Delaying and avoiding going to the hospital can lead to greater disability and mortality, ” she stresses.

Due to Covid-19, Chan says many non-essential services and follow ups were moved to later dates to allow the hospitals to accommodate the coronavirus cases and to put into place the standard operating procedures to reduce its spread.

“Some services like collection of medication were moved to delivery services which required a certain amount of mobile phone literacy and skill, ” she points out.

Outpatient rehabilitation services at some hospitals were suspended for a while during the MCO.

“Hence, many who were in the rehabilitation stage of stroke recovery had their progress hindered.

“When services resumed there were issues of fear while for many, there was the issue of affordability.

“Many families had reduced income and could not afford or spare the time to bring a family member for therapy, ” she adds.

With its nine centres across the country, Nasam provides rehabilitation facilities and services for stroke survivors but with the pandemic, it has been tough.

“Following the MCO, one of the first things we did was to create a helpline (018- 2221878), for our stroke community and also to serve anyone having a stroke. It has been a busy line.

“During the MCO, stroke survivors had to learn to use social media to continue with interaction.

“It was difficult for most of our stroke survivors who were already having a tough time coping with everyday struggles. The added burden of the new normal was very challenging, ” Chan describes.

Nasam lost contact with many stroke survivors especially those from the disadvantaged groups who lacked access and support to handle the social media platforms.

“Many have been affected as their recovery was halted abruptly and we were unable to undertake reviews of their progress in recovery.

“While we are still not offering our popular face-to-face group therapy session, we have started Telehealth to complement the one-on-one therapies offered at our centres and to help those not living near a Nasam centre, ” Chan adds.

Under their Telehealth programme, Nasam conducts group sessions on aerobics, exercises to improve strength and balance and qi gong for body and mind relaxation on the teleconferencing app Zoom. “Nasam believes it is essential for stroke survivors to remain as active as possible and that rehab is critical for a stroke survivor’s recovery.

“It is a trying time for Nasam and also the community at large on whom we rely to help sustain the recovery of stroke survivors and at the same time keep them safe in this pandemic, ” she says.

Nasam is also offering free rehabilitation for stroke survivors in the low income group or B40 community.

“They can receive free rehab care at Nasam centres. The participating stroke survivors will be sponsored for a period by Yayasan Hasanah.

“The rehab offer is open to only 300 participants on a first-come, first-served basis and has been running since September, ” she says.

Nasam’s centres are located in Petaling Jaya, Ampang, Melaka, Johor Baru, Kuantan, Ipoh, Penang, Kulim in Kedah and Kota Kinabalu.

For more information, call Nasam’s helpline at 018-2221878 or log on to www.nasam.org for details.

Confusion, stroke, memory loss: How coronavirus affects the brain

Damage to brain: Some people hospitalised with Covid-19, experience delirium. A few others suffer from stroke, brain haemorrhage, memory loss and other neurological symptoms.

CONFUSION, loss of smell, behavioural changes – these are some of the neurological symptoms of the novel coronavirus as witnessed in Covid-19 patients lately.

Some people, hospitalised with Covid-19, experience delirium – they are confused, disorientated and agitated. Stroke, brain haemorrhage and memory loss are some other serious impacts coronavirus has on few patients.

Robert Stevens, MD, Johns Hopkins University, estimated that at least half of the patients he’s seeing in the Covid-19 units have neurological symptoms. However, scientists are struggling to understand why the brain may be harmed due to the virus.

Stevens listed some theories by scientists researching the subject in an article.

It pointed out that several Covid-19 cases across the world can have a variety of conditions related to the brain. These include confusion, loss of consciousness, seizures, stroke, loss of smell and taste, headaches, trouble focusing and changes in behaviour.Less common peripheral nerve issues, which may lead to paralysis and respiratory failure, have also been noticed among some Covid patients. Similar symptoms have been seen in outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), also caused by coronaviruses, another report in a leading science journal said.

How Covid-19 affects the brain

The Johns Hopkins article mentions four ways, based on current research, how Covid-19 may harm the brain. It stressed nonetheless that each “needs to be studied rigorously before any conclusions can be made”.

Severe infection: “The first possible way is that the virus may have the capacity to enter the brain and cause a severe and sudden infection, ” the article read.

It further said that some cases reported in China and Japan found the “virus’s genetic material in spinal fluid, and a case in Florida found viral particles in brain cells. This might occur due to the virus entering the bloodstream or nerve endings.”

According to the article, the loss of smell that occurs in some Covid-19 patients could indicate that the “virus entered through the olfactory bulb, which is located right above the nose and communicates information about smell to the brain”.

Immune system: The immune system is affected in an attempt to fight the novel coronavirus, producing a “maladaptive” inflammatory response that may cause much of the tissue and organ damage seen in this disease.

Physiological changes: The physiological changes induced in the body by coronavirus – ranging from high fevers to low oxygen levels to multiple organ failures – contribute to, or account for, brain dysfunction, such as delirium or coma seen in many severe Covid-19 patients.

Stroke: The blood-clotting system in Covid-19 patients with illness is highly abnormal. Clots are much more likely to occur in these patients than in others. “Clots can form in veins deep inside the body or in the lungs, where they can cut off blood flow. A stroke could occur if a blood clot were to block or narrow arteries leading to the brain.”

How common is brain damage in Covid patients?

According to a study published in The Lancet in June, research was conducted with a sample size of 125 Covid patients in the UK who had neurological or psychiatric effects.

According to the results, 62% of the sample size had experienced damage to the brain’s blood supply, such as strokes and haemorrhages, and 31% had altered mental states, such as confusion or prolonged unconsciousness – sometimes accompanied by encephalitis, the swelling of brain tissue.

Ten people, who had altered mental states, developed psychosis.

“Not all people with neurological symptoms have been seriously ill, ” the study revealed.

A similar study published in July compiled detailed case reports of 43 people with neurological complications from Covid-19.

According to Michael Zandi, a neurologist at University College London and a lead author on the study, the most common neurological effects are stroke and encephalitis.

The study revealed that some of the worst-affected patients had only mild respiratory symptoms. “This was the brain being hit as their main disease, ” says Zandi.

It is not unheard of for serious diseases to cause such effects, but the scale of the Covid-19 pandemic means that thousands or even tens of thousands of people could already have these neurological effects, and some might be facing lifelong problems as a result.

As Alysson Muotri, a neuroscientist at the University of California, San Diego, put it in science journal Nature, “The neurological symptoms are only becoming more and more scary”. — Wires

Leading cause of disability, fatality

 ACCORDING to the Institute of Health Metrics and Evaluation, stroke is the third leading cause of male mortality in Malaysia after ischaemic heart disease and pneumonia, and the second leading cause of female mortality after ischaemic heart disease. Stroke is expected to become the second leading cause of mortality by 2040, according to the Global Burden of Disease report. The increasing trends of noncommunicable diseases such as diabetes, hypertension and obesity are posing substantial threats to stroke incidences in Malaysia.

On average, there are about 90 stroke admissions at Malaysian hospitals daily – with 40% comprising those aged below 60, and an average of 30 deaths owed to stroke. Almost 70% of stroke survivors live with many disabilities.

Stroke is a clinical entity characterised by a sudden disruption to brain functions through a disturbance in the brain’s blood supply. With the sudden cessation of blood supply, the brain cells receive neither adequate oxygen, nor the necessary nutrients to function – and eventually, the brain cells die.

 MSU Medical Centre consultant neurosurgeon Prof Dr Badrisyah Idris says, “There are two types of stroke – ischaemic and haemorrhagic. Occurring in 80% of stroke cases, an ischaemic stroke is owed to a narrowing of blood vessels by fat deposits or blood clots disrupting blood supply to the brain. The other 20%, owed to ruptured blood vessels, can be caused by uncontrolled high blood pressure or a weakened blood vessel wall.

“Stroke survivors suffer different deficits according to the affected brain area. They may suffer from memory and/or emotional disturbances, or be challenged by speech, vision, sensory or movement difficulties. In a transient ischaemic attack, commonly called a mini-stroke, the symptoms hit for only a few minutes or hours and then disappear. Mini-strokes happen when blood supply to the brain is interrupted only momentarily, though the chance of getting a permanent stroke within 48 hours rises tenfold and the risk remains high within the subsequent three months.

“With increasing age, the likelihood of getting an ischaemic stroke rises with the increased narrowing of blood vessels. Other factors that would lead to a stroke include smoking, obesity, alcoholism, high blood pressure, high blood cholesterol and high blood sugar. Lifestyle changes and treatment optimisation may reduce the risk of getting a stroke.”

Anyone who has had a stroke should receive treatment at a hospital within three hours after the onset of stroke signs to reduce further damage to the brain. Yet, the majority of stroke patients reach the hospital only after seven hours when the window of opportunity to save the brain has narrowed.

Recognising an onset of stroke is crucial to reducing deaths and disabilities from delayed stroke treatment. Techniques such as BE FAST help make an informed society and enable individuals to seek early stroke treatment.

• B –Balancing difficulties • E –Eye, vision disturbances • F –Facial weakness • A –Arm and/or leg weakness • S –Speech difficulties • T –Time to call an ambulance

When a person with stroke reaches the hospital, a doctor will establish the circumstances leading to the stroke event by noting the patient’s history and then performing a physical examination to identify the risks and associated deficits. A brain scan will be done to determine whether the stroke is ischaemic or haemorrhagic, and which part of the brain is involved.

Another test known as an angiography may be performed to assess the brain’s blood flow pattern and blood vessel structure.

Treatment for stroke depends on the stroke type. For ischaemic strokes, restoring blood flow to the affected area is crucial and should be carried out within four hours of the stroke’s onset. This can be done by injecting a blood-thinning medication called alteplase into a vein in the arm to dissolve blood clots inside the brain’s blood vessel.

Another technique called endovascular therapy dissolves blood clots inside the blocked brain vessel by directly injecting alteplase through a small catheter placed inside the affected blood vessel, or removes blood clots by retrieving them with a special device through a catheter placed inside the affected blood vessel.

For haemorrhagic strokes, the main goal of treatment is to control bleeding and to reduce the increased pressure in the brain. The high blood pressure has to be controlled by antihypertensive drugs, and the effect of the bloodthinning medication has to be reversed to reduce further bleeding. Ruptured blood vessels caused by cerebral aneurysms or arteriovenous malformations need to be treated by surgical intervention or endovascular

Following the stroke treatment, the recovery phase for each patient will depend on the extent of disabilities resulting from the stroke. 

 

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