Strokes on the rise among younger adults. OT can help!

Issue: Strokes on the rise among younger adults. OT can help!

The majority of strokes are occurring in older adults over the age of 50, but the number of people under 50 having strokes is increasing. The article states that about 10% of all strokes occur in people between 18 and 50 years old. This article describes the experience of a 41-year-old man who suffered from a intracerebral hemorrhage.

Articles like this help to educate the public on what it is really like to have a stroke. The individual in the article states, “You don’t think of things you do until you cant do them. You basically have to start all over again. I mean, you retrain your brain to use your limbs. You retrain your brain to remember. You retrain everything. It’s pretty devastating.”

You can find the article and podcast here:

http://www.npr.org/sections/health-shots/2016/02/18/467222400/strokes-on-the-rise-among-younger-adults

Service Delivery:

The service delivery to address this issue involves both the health care and educational systems. Educating the public on the risk factors that they can control would be a very important piece in reducing the number of strokes in young adults under 50. There are some risk factors that are uncontrollable such as age, gender, and ethnicity. However, the other factors can all be controlled. If we are able to educate the public on the importance of living a healthy lifestyle, we may be able to reduce the prevalence of strokes in younger adults under the age of 50.

            The health care system is also involved in the service delivery of the proposed policy because we would have to ensure that physicians and other health professionals would be willing to adopt these policies and actually assess for risk factors and educate their patients on how to reduce these risks. The health care system has the potential to change the lives of their patients! Providing free physicals to assess risk factors for stroke would be a great way to ensure that everyone is able to learn their risk for developing a stroke despite their financial situation.

The most common type of stroke occurring in adults under 50 is ischemic strokes. Ischemic strokes are caused by a blockage in the blood vessel. The article quotes a vascular neurologist who believes that the most likely underlying cause for the increasing incidence and prevalence in young adults under 50 is obesity. This also goes back to the healthcare system that parents should be educated by their children’s pediatricians on how to reduce risks for obesity. As childhood obesity has increased, these children grow up to be adults who if still obese, are at a great risk for stroke. As health professionals, we need to do what we can from the beginning to help prevent childhood obesity.

Policy:

There should be a policy made so that all individuals are required to get a physical at least once per year. This physical should screen for stroke risk factors such as high blood pressure, diabetes, obesity and lipid disorders. When a person has any of these risk factors, they should be educated on lifestyle factors that can be changed such as eating habits, physical activity, limiting or quitting smoking and drinking as well as medical risk factors that can be addresses such as high blood pressure, high cholesterol, diabetes, and poor circulation. To make this policy even better and more universal, the physicals should be free to all individuals. By offering free physicals, people will be more willing to get them and will not have to choose between a physical and something else they feel is more important to purchase. This policy could also incorporate an education component. If an individual is found to have any of these risk factors, they and their family should be educated on the signs of a stroke so that 9-1-1 can be called sooner. If this policy were put into place, I would hope that the number of strokes amongst young adults under the age of 50 would stop increasing and actually start to decline.

Data:

The data that would be needed to support this policy is the statistic that the number of young adults under 50 experiencing strokes is rising. In addition, the statistic that 80% of strokes can be prevented with lifestyle changes to reduce risk factors needs to be brought to the table. If a study was done in order to prove that education on prevention and signs of a stroke could help to decrease the amount of strokes and decrease the amount of time before 9-1-1 is called after witnessing a loved one’s stroke, this policy would be more supported. In order to educate the public on risk factors, there will need to be data to support the claims that these medical and lifestyle factors are indeed risk factors for having a stroke.  

Implications for OT:

Occupational therapy will be affected as we will begin to see more young adults suffering from strokes than ever before. Even though the majority of strokes occur in the older adult population, this will still have an impact on occupational therapy. Occupational therapists can work on advocating for the importance of education of the young adult population.

While some may think that because these individuals are young, they will be resilient and recovery quickly, this may not always be the case. Recovery will be difficult for anyone and these young adults are more likely to be raising children and have other responsibilities that are no longer possible to fulfill.  A stroke changes a person’s life completely. This drastic change in independence and function has the potential to lead to depression and other mental health issues.

As OTs, we have the power to make changes in peoples lives. Lifestyle redesign is “a treatment approach that has been shows to improve health and wellness by preventing and managing chronic conditions through building healthier lifestyles.” OTs can work with patients to redesign their lives so that they can acquire health-promoting habits and routines in their every day lives.

In addition, we can be training our clients and their families about FAST. FAST can help people to remember the warning signs of a stroke and recognize that their loved one is having a stroke and call 9-1-1 sooner. It has been shown that the faster an individual arrives to the hospital after a stroke the more likely they are to have a better recovery.

F= FACE. Ask the person to smile. Does one side of the face droop?

A= ARMS. Ask the person to raise both arms. Does one arm drift downward?

S= SPEECH. Ask the person to repeat a simple phrase. Is their speech slurred or strange?

T=TIME. If you observe any of these signs, call 9-1-1 immediately.  Note the time of the first symptom.

Additional Resources

http://www.stroke.org/understand-stroke/preventing-stroke

http://chan.usc.edu/patient-care/faculty-practice/about

http://www.stroke.org/understand-stroke/recognizing-stroke/act-fast

Policy Update

Policy Update

Issue:

Bill to Rewrite No Child Left Behind Act

http://www.aota.org/advocacy-policy/congressional-affairs/legislative-issues-update/2015/no-child-left-behind-signed-law-every-student-succeeds-act.aspx

Service Delivery:

The service delivery involved with this issue involves both the educational and political systems. The new bill had to be put into place by the political and governmental systems but largely affects the educational system. Without the political systems putting this bill into place, it would be difficult to assess the progress that students are making each year in the educational system. These systems are very distinct yet are both involved and necessary for educational bills to be signed into law.

Policy:

I reviewed an article that describes a new policy, “Every Student Succeeds Act” (ESSA) that has replaced “No Child Left Behind” (NCLB). NCLB was created based on the original “Elementary and Secondary Education Act” (ESEA) that was signed into law in 1965. The president signed the newest bill (ESSA) into law on December 10, 2015. This policy is supported by Nancy Pelosi, Harry Reid, Barack Obama, and 37 liberal civil rights and education groups.

I am excited for the potential of this new law but I believe that as the new law is implemented, they will find aspects that work better and things that still need improvement. Issues with NCLB were brought out in discussions early on, but it took from 2001 when it was signed into law until the end of 2015 when the new bill, ESSA was signed into law to replace NCLB. It is evident that changes in the political system will take time so it is important to advocate for our profession during the rewriting of such bills. When first beginning my masters program, I did not see the importance of having a policy and advocacy course in the curriculum. However, after only 3 short weeks of the course, I see the value and importance in this course.

Data:

The new bill, ESSA, passed both chambers of congress with strong bipartisan support. ESSA repeals the requirement that schools achieve annual progress in their student testing. One of the main issues with NCLB was that teachers began only teaching for the test in fear that if their students did not pass these tests, they would be fired. The test consists of multiple-choice reading and math questions, but as occupational therapists we understand the importance of a well-rounded curriculum as well as providing children with freedom for creativity. With the pressure of having a high pass rate, teachers focused most of their time on reading and math, limiting the time spent on other important subjects such as art, science, and physical education. Furthermore, students learn in a variety of ways and teachers should have the autonomy to teach in a way that best matches their students’ learning styles and preferences. Another issue was that all students were held to the same achievement standard (with the exception of students who had severe mental of physical disabilities) despite their varying SES, ability level, and native language.

Implications:

AOTA had two main priorities during the rewriting of this bill. Their goals were to improve the recognition that occupational therapists should be more involved in school-wide initiatives and classroom supports and maintaining accountability for students with disabilities. The new bill introduces a new term “specialized instruction support personnel” (SISP), which includes occupational therapists, and any related services under IDEA. It is required that schools, local education agencies, and states include SISPs in their planning of new programs and provision of testing accommodations. The new bill provides states with a lot of flexibility in how they implement their programs and standards for each school. This poses a challenge for occupational therapists as each school has the potential to have different accountability systems. This could be beneficial as the students in each school may have different needs, but difficult for the occupational therapists to stay up to date on each school’s programs and systems. As previously mentioned, it is important that occupational therapists advocate for the profession as well as our clients. This course is teaching us the different ways in which we can accomplish that.

Resources

http://drrichswier.com/2015/12/16/every-student-succeeds-act-common-core-by-a-new-name-and-on-steriods/

http://www.carleton.edu/departments/educ/vote/pages/Pros_and-Cons.html

http://www.ed.gov/essa