Managing Cerebral Vascular Accidents
Main Discussion Post:
Caregivers for patients who have experienced a cerebral vascular accident, also referred to as a CVA or a stroke, have to be aware of a variety of biological and emotional information to assist them in their role as a provider and often rehabilitative assistant. A CVA can occur in the right or left cerebral hemisphere and can usually be categorized as a transient ischemia (loss of oxygen to tissue) attack, compression, cerebral ischemia, hypoxia, embolism (blood clot), or thrombosis (Andrewes, 2002; Walden University, 2008). A stroke most often occurs in the middle cerebral arteries and as these arteries cover a wide portion of the lateral brain, damage can be extensive (Andrewes, 2002). 
If a patient experiences a stroke on the left side of the brain, the patient may experience paralysis on the right side of the body as well as deficiencies in areas of reasoning, organization, verbal flow (expressing thoughts verbally) comprehension, anxiety, depression, and decreased response depending upon the exact location of the lesion(s) (Andrewes, 2002; Stirling, 2002). A variety of tests will be executed to determine demonstration of aphasia, which is a degree of loss of language capability, and or apraxia, which is a degree of loss in the motor capability to verbalize (Stirling, 2002). Additionally, patients who experienced a stroke in the left hemisphere may suffer an inability to perform complex natural hand gestures and sequential hand movements although research suggests that this may not be limited to only those suffering from damage in the left hemisphere (Buxbaum, Schwartz, & Montgomer, 1998).
Most CVA patients will need to have physical therapy, occupational therapy, speech therapy, and will have a complex support team often consisting of a rehabilitation nurse, dietician, social worker, case manager, recreation therapist, and a neuropsychologist (National Stroke Association, 2008). As a caregiver, it will be important to familiarize yourself with this team. As there will be complexities with normal everyday caretaking tasks such as modifying the home to support the patient, managing health insurance bills, learning new grooming and hygiene processes, and working to prevent polypharmacology it would also be beneficial to reach out to support groups for social support (National Stroke Association, 2008; Schatzberg, Cole, & DeBattista, 2007).
Andrewes, D. (2002) Neuropsychology: From theory to practice. New York: Psychology Press.
Buxbaum, L. J., Schwartz, M. F., & Montgomery, M. W. (1998). Ideational apraxia and naturalistic action. Cognitive Neuropsychology, 15(6-8), 617-644.
National Stroke Association. (2008, April 15). Hope: The stroke recovery guide. Retrieved from: http://www.stroke.org/site/PageServer?pagename=HOPE
Schatzberg, A.F., Cole, J.O., DeBattista, C. (2007). Manual of clinical
psychopharmacology (6th ed.). Washington, DC: American Psychiatric Publishing, Inc.
Stirling, J. (2002). Introducing neuropsychology. New York: Psychology Press.
Walden University. (2008, April 15). Cerebral vascular accident (cva) (stroke). Week 7 Study Notes. Retrieved from www.sylvan.live.ecollege.com.
Dr. Lisa Samuel
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