‘Irregular heartbeat can cause stroke’

Dr Eliezer Okirie is a Consultant Physician in Neurological and Specialist Rehabilitation at the University Hospital, Coventry, United Kingdom. In this interview with SADE OGUNTOLA, he said rehabilitation services are a must to improve quality of life of persons with disability and wellness in old age.

Uncontrolled blood pressure is well known reason for stroke. Why will irregular heart beat also predispose to stroke?

There are number of risk factors for stroke. These include uncontrolled high blood pressure and diabetes.  Irregular heartbeat is also a risk factor for stroke.

How can irregular heartbeat cause stroke? When the heart is pumping blood and it is irregular, such can throw up a blood clot. Such a blood clot when it gets dislodged and finds its way into the brain can cause stroke. This is why it is crucial that the rate and speed of irregular heartbeats should be controlled to prevent a stroke.

What constitutes disability? Why does diseases like stroke cause disability?

Disability can be caused by any disease or disorder of the body that makes it difficult for an individual to be able to function and meet his everyday activities of living.

Conditions that affect muscles and bones such as arthritis and joint disorders can also lead to disability. Rheumatologic disorders are much more common cause of disability abroad, but neurological disorders such as stroke is common in developing countries. About 80 per cent of neurological disorders are in the low to medium income countries due to stroke.

However, signs and symptoms of stroke and other neurological disorders are more complex, the individual may develop communication difficulty, physical difficulty, emotional difficulties, physiological difficulties and so on.

In a bid to rehabilitate such individuals, a lot of things have to be taken into perspective unlike bone fractures that the orthopaedic surgeon merely fixes in order that the person can start to walk normally again.

More people tend to survive stroke and do better in the developed countries unlike the low and medium income countries. Why is this so?

Many factors account for this. In developed countries, there is a lot of education among the populace on a slogan called FAST. It is an acronym that stands for Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services. Time is important; the person must go immediately to a stroke clinic.

Most places in the United Kingdom (UK) now have stroke units and usually within the first hour, they take them to the acute stroke unit where they receive acute care such as clot bursters to reduce the damage to the brain that might have happened.

There is a lot of evidence showing that a lot of people’s brains are being saved. Stroke is a brain attack. The more of the brain tissue that is saved, the lesser the amount of impairment.

Fortunately, stroke caused by blood clot is much commoner than that caused by bleeding into the brain. Of course at the stroke unit, a scan is done to distinguish whether the stroke is due to a blood clot or bleeding.

So the organised stroke units, early intervention and the step down care into post acute wards where there are dedicated teams of medics, nurses, physiotherapists, and so on intervening early to ensure rehabilitation intervention starts have made a difference.

Of course, they are very quick in investigating the risk factors in order to prevent a recurrent stroke. That is why the outcome in developed countries is increasingly getting better.

They learnt from treatment of heart attack that bursting the blood clot to the heart that is causing heart attack actually has saved lives. So they use the same principle, although brain attack was more challenging.

Of what significance is rehabilitation in the management of diseases like stroke and in restoration of quality of life?

Rehabilitation is about using every means humanly possible to ensure that the function in a patient is optimised in order to reduce the disability, dependence and its disadvantages.

Rehabilitation is not for the unwilling; it is not about recuperation, it is a dynamic process that is facilitated by at least two people who are members of a multidisciplinary team.

Is rehabilitation effective? There is evidence that demonstrate that it is cost effective in terms of economy and that it is good for the patient’s wellbeing. You return people not only to employment, to education, or revocation as it may be, even life is made better for those who are quite limited in activity.

For instance, an individual who requires support of three people to move from one place to another with rehabilitation might only need the help of just one person.

Rehabilitation is not only for people who are walking, it is also for those who are still fairly limited.  It is also targeting the care giver to lessen the burden of care.

Of course, other aspects of rehabilitation include toilet training for those with incontinence because a disabled person is not necessarily a sick person.

Is rehabilitation the way to go for Nigeria giving increasing incidence of non communicable diseases that may cause disability?

We do not have a choice on this, giving the fact that the ageing population is also rising as well as man-made disasters that maim people. We need to prepare for the 21st century diseases and its accompanying disability; it is a way for Nigeria.

Already, developed countries and developing countries that Nigeria is far better in terms of financial resources have taken on board the philosophy and ethics of rehabilitation and running with it.

But it is important to begin education and training to increase capacity, knowledge and understanding of what rehabilitation is all about, starting with clinicians before we begin to reach out to the service users.