nasam

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Founder Chairman’s Message
What can you expect when you have a stroke?
Stroke strikes without warning, catching you and your family by
surprise. The confusion and chaos that follows is unimaginable.
In split seconds your life, as you knew it, is turned upside down.
Everything becomes so surreal, until that one day when an unseen
hand guides you to fight, to re-learn and to move on with life.
For me all this happened 27 years ago when I had a stroke. Years
into recovery, I asked God: “What is the purpose of my stroke?” The
answer came loud and clear: “Go out and help other stroke survivors.”
And I did!
The day before I sat to write this message I met a young man in Singapore. He had a stroke six years ago,
soon after he completed his final year medical studies at the National University of Singapore. It was a major
stroke.
With full medical treatment he expected to get well, but sadly he didn’t. He tried every alternative therapy
available, but still there was not much improvement.
He was young, so armed with faith and courage he moved on with his life. Today, he is married, has a son,
and operates a tuition centre employing eight tutors. He gives inspirational talks to students and organisations,
emphasising that one has to move ahead in life despite the odds.
I learned from him, and from my own experience, that we do the best we can to recover from stroke, but we
must accept that life will never be the same again and learn to move on, regardless of the state of our recovery.
So, what can one expect after a stroke?
I would say...a second chance to live life to the fullest no matter what the odds!
Janet Yeo
Founder Chairman
Overview
WHAT TO
EXPECT WHEN YOU
HAVE A STROKE
Imagine waking up one morning feeling as normal as you always do. You go about your daily routine. Minutes
later you experience a strange feeling. Your hand falls limp and you may even have difficulty standing. You
feel uneasy as if in a daze. But within seconds, just as quickly, a feeling of normalcy returns. You proceed
with your morning rituals, choosing not to pay any attention to what you have just experienced.
At this stage you should be concerned…that feeling
of uneasiness may be the early warnings of a stroke
or a brain attack that could return later and cripple
you completely. The above is just one scenario.
A stroke can come in many different forms. It is
devastating and affects the whole family.
A stroke is a serious medical emergency that needs
urgent treatment. The sooner one is diagnosed
and treated, the less debilitating it is and the better
the recovery. Even if symptoms are temporary,
immediate medical attention is very important.
Some treatments that can reverse the effects of
stroke can only be used in the first few hours, so
go to the emergency department of a hospital fast.
Strokes happen when the blood supply to part of
our brain is suddenly cut off or reduced. Without
blood, which carries essential nutrients and oxygen,
our brain cells can die or get damaged.
Remembering
Stroke FAST
Two million brain cells die every minute
during a stroke, increasing risk of permanent
brain damage, disability or death. Recognising
symptoms and acting FAST to get medical
attention can save a life and limit disabilities.
Other symptoms:
• Sudden blurred vision of one or both eyes
• Confusion, unsteadiness or clumsiness
• Epileptic fit
• Tingling of jaw
• A sudden, severe headache
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Even if symptoms
are temporary,
immediate medical
attention is
very important.
Our body usually warns us of an impending
stroke. Recognise the signs and take prompt
medical action!
The brain - its parts (boxed) and functions.
Voluntary Movement
Sensation
PARIETAL LOBE
FRONTAL LOBE
OCCIPITAL LOBE
Sight
TEMPORAL LOBE
Emotions
CEREBELLUM
Hearing
F
A
S
T
Balance &
Coordination
Facial Drooping:
Ask the person to smile.
Does one side of the face droop?
Arms Weakness:
Ask the person to raise both arms.
Is one arm weak and drifting downwards?
Speech Difficulty:
Ask the person to repeat a simple phrase.
Is the speech slurred or strange?
Time To Call –
If you observe any of these signs,
call 999 immediately!
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Overview
Our brains control everything we do, think
and feel – things that we often take for granted
like being able to move, speak, understand
and remember. If the part of our brain that
controls any of these activities is damaged,
our ability to do these things is also affected.
RIGHT BRAIN DAMAGE
LEFT BRAIN DAMAGE
Paralyses
right side
Paralyses
left side
Language/
speech deficits
Perceptual/
spatial deficits
Behavioral style:
slow, cautious
Memory deficits
(Language)
Behavioral style:
quick, impulsive
Memory deficits
(Performance)
The diagram shows how most stroke patients are affected.
A stroke on the right of the brain affects the left side and
vice versa.
Strokes can be classified into two major
categories: Ischaemic and Haemorrhagic.
About four out of every five strokes are caused
by a blockage (Ischaemic stroke) in or around
the brain. For patients with Ischaemic stroke
there is a “clot-busting” treatment to manage
blockages of blood vessels. However, it
can only be used in the first four-and-a-half
hours after the onset of stroke symptoms.
Unfortunately, most patients go to the hospital
too late to be considered for this treatment.
Anti-platelet medications (that make blood
less sticky) are given to these patients to
prevent recurrence of the stroke. (See page 8).
Hospitalisation
When you have a stroke it’s best to go to
a hospital with a specialist stroke ward for
better care and assessment. You can, at first,
go to Accident and Emergency (A&E) where
you will be put through tests to confirm you
have had a stroke. Most patients with stroke
are admitted. The duration of hospitalisation
depends on various factors and the severity of
the stroke.
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JANET YEO MY JOURNEY
THROUGH STROKE
“In mid-1988, six months before my stroke, I
experienced many short giddy spells. Just spiltsecond disorientations. At that time I put it down
to being tired and from lack of sleep. Now I know
they were TIA* (Transient Ischaemic Attack), or mini
strokes caused by temporary interruption of blood
supply to the brain, usually preceding a major stroke.
Sure enough, in April 1989, I suffered a stroke. On
the morning of April 5, I tried to make a pot of tea
at home, but my right hand wasn’t cooperating and
I couldn’t complete the task. Once again, I ignored
the signs and proceeded to dress up and drove to the
hairdressers before going to my office.
While I was at work my head kept pounding. When
the phone rang, I was not able to pick it up with my
right hand. It was then that I decided I was really sick
and needed to go to a hospital. By the time I reached
the hospital, I was totally paralyzed on my right side,
and my speech was slurred.
At the hospital I was told I had a stroke. I had no
clue what it was but told the doctor to treat me, as I
had a full week ahead and did not wish to stay in the
hospital too long. I ended up staying for a full month.
The stroke had taken place during my sleep. It had
evolved into a full blown stroke while I was at the
office. Had I gone to the hospital in the morning,
when my hand wasn't taking instructions while I was
trying to make tea, I would probably have suffered
less damage. I lost four precious hours!
I was 44-years old! I was confused, frustrated, scared,
and kept asking God “Why Me?” For the first time in
my adult life, I had to depend on someone to bathe,
feed, dress and turn me over in bed. It was very
The following are
excerpts from a
conversation with Janet
Yeo, Founder Chairman
of NASAM.
humbling and humiliating as well. The longer I was
in self-denial, the more frustrated and angry I became.
In fact, I was so terrified I asked everyone to pray for
me.
One night, I turned to God and told him that I accepted
his decision to allow the stroke to happen in my life. I
was ready to trust God to walk me through the valley
of death and had no fear. Once I finished my prayer,
I was at total peace. I no longer struggled or was
fearful. I felt a deep sense of hope and excitement.
During the hospitalisation period, you
will undergo several tests, procedures and
consultations, including brain scans (a CT
scan or an MRI) and blood tests (See page 9
for Tests And Procedures In Hospital). These
will assist your doctor to diagnose the type
and cause of stroke, as well as your stroke
risk factors, which in turn will influence your
treatment. A brain scan should be done as
soon as possible – always within 12 hours of
your stroke (or sooner as you will benefit from
urgent treatment).
A stroke may have physical, cognitive and/or
emotional effects on you.
Physical Effects
Poor coordination
Abnormal posture
Loss of movement or abnormal movement
on one side of the body
Loss of speech or difficulty in talking
Incontinence
Partial loss of vision
Inability to swallow
The next day, I asked the nurses to wheel me to the
bathroom as I wanted to shower and not be sponged.
I made it a point to be dressed in a clean hospital
gown each morning, have my breakfast sitting up in a
chair, ready for my husband’s visit before he went off
to work. I felt great and chirpy, and the nurses were
surprised with this change.
In the therapy room, I became very competitive, as I
tried my best to excel in every exercise given to me no
matter how hard and challenging. I was so positive
and motivated that the nurses would wheel me around
to cheer up stroke patients in other wards.
With quality rehab a stroke survivor’s recovery is faster.
My husband challenged me at every angle, never
allowing me to feel sick or incapable. I had to attend
dinner functions, children’s outings, go for therapy on
my own with the driver. In Singapore, where I went
for further treatment, he would take me out to dinner
once or twice a week, against the hospital’s advice.
He insisted that I dress up for dinner and we would
walk to the restaurant.
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Overview
Cognitive & Behavioural Changes
More cautious, anxious and
disorientated
Depression, unable to control emotions
Poor concentration
Inability to understand speech and/or to
communicate verbally
Ignore/neglect affected side of the body
Perceptual deficits
Inability to judge distance, size, position
Loss of feeling on one side of body
Unable to picture your body in your
mind
Immediately after a stroke there can be
serious complications, such as an increase in
the size of brain damage and swelling around
the area of brain damage. The risks of these
complications vary from patient to patient.
Your doctor will discuss these risks with you
and your family.
While in hospital, you will be managed by
a team of healthcare professionals, including
physio therapists, occupational and speech
therapists, counsellors and dieticians.
Treatment includes oral medications and
close monitoring for any deterioration and
complications. In some cases, it may involve
medications via infusions and surgery. If you
have swallowing difficulties, are being fed
using a tube, are underweight, have diabetes
or no appetite, a dietician can recommend a
healthy and nutritious diet.
Rehabilitation
Following a stroke it’s critical to begin
rehabilitation early to re-learn skills you have
lost, acquire new skills and find ways to manage
any long term disability you may have. Once
you are medically stable, your doctor will
advise and recommend a programme tailored
to your symptoms and specific needs.
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At the restaurant I would be so embarrassed because
I could not handle a fork and spoon or a knife. I
struggled to hold the cutlery in my left hand and eat
or go hungry. And to add to my embarrassment,
my dress would slip off my shoulder because you
become lopsided after a stroke.
It may sound cruel, but it was very good for me. I
learned faster and with time I channelled my anger
and frustration towards recovering. I started using
my brain and other faculties again, which was so
important for my recovery.
Seven months later, I was able to travel alone to the
Los Gatos rehab hospital in California, in the US.
There I stayed in an apartment with another stroke
survivor for a month, and each day we walked to the
bus stop to catch a bus to the rehab hospital. It was
here that I learned to be totally independent, as we
had to cook, do our laundry, go to the hospital, do
our exercises and stay focused and not break down.
Janet after her stroke
in 1989…
After a
stroke early
rehab is
crucial.
Stroke brought me to my knees. It humbled me
and made me realise that money, fame and glory
is of no use when you don’t have good health
or family and friends. Today I am going for
treatments, therapy, exercising and living a full
life. I believe in keeping busy, doing positive
things, persevering, staying focused and being
thankful and happy. I have real friends and an
extremely supportive family who stayed with
me throughout my journey of recovery. And, I
found God!
Before returning home, the Los Gatos hospital
decided I need an AFO (ankle-foot orthosis)
to insert into my shoe to help me walk better.
After the stroke I had a collapsed arch and a
dropped right foot, which meant I walked with
my toes sweeping the floor, and in due course,
the collapsed arch would affect my spine. I can
remember clearly the day when I had to wear the
AFO. My heart sank and I was in tears. At that
time I felt like a cripple. I had to buy men's shoes
so the AFO could be inserted, and overnight my
wardrobe changed. No more dresses, it was down
to pants. To me this was a precious sacrifice –
from pretty dresses and elegant designer shoes to
pants and thick, bulky walking shoes.
A group therapy session at NASAM.
Today, 27 years later, I am still working hard at
rehabilitating my collapsed arch and dropped
foot and am determined to keep going. I am
nearly there!”
The sooner therapy starts, the faster the brain relearns normal movements. The longer rehab
therapy is delayed the harder it will be for a survivor
to recover and be independent.
... and today a picture of wellness.
Transient Ischaemic Attack
TIA or Transient Ischaemic Attack occurs
when the blood flow to part of the brain stops
for a short period. It can mimic stroke-like
symptoms which appear and last less than 24
hours before disappearing. The temporary
interruption of blood supply causes brain cells
to die. About 40% of people with TIA will
have a stroke within five years. Hence, it is
important to seek medical attention as soon as
you notice the onset of any symptoms.
*
It is common to have problems with vision after a
stroke. An ophthalmologist can assess your vision
and recommend special glasses or other visual aids.
After a stroke you may have to deal with emotional
issues such as anxiety, depression and mood
swings. Many survivors also find that they cry
a lot. This crying may not mean that the person
is depressed. It could mean experiencing other
emotions such as sadness or happiness and is
known as reflex crying. Stroke can also impact
sex and relationships. Sexual issues include loss of
libido, erectile dysfunction and decline in vaginal
lubrication. Start your sexual rehabilitation when
you are ready. Ask questions and seek professional
advice.
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Overview
Your rehabilitation may be continued at the hospital
after discharge or you can seek rehab at NASAM or any
professional centre near your home. NASAM offers
stroke specific rehab that includes speech, physical,
occupational and recreational therapies, group activities
and counselling. (Read more about NASAM’s goal to
make stroke survivors mobile, independent and active
on page 14).
Long-term complications associated with a stroke
include epilepsy, clots in the veins of the legs due
to prolonged immobilisation, infection, depression,
joint pains and contractures, increased stiffness
of the affected limbs and constipation. Ask your
healthcare team how to prevent these complications
as well as how to manage them.
Ischaemic stroke accounts for 87% of all stroke
cases. It occurs when a blood vessel carrying
blood to the brain is blocked by a clot. This
prevents blood from reaching the brain and
deprives the brain of oxygen and nutrients.
Haemorrhagic stroke or a bleed in the brain occurs when a
weakened blood vessel ruptures. This causes blood to leak
into the brain, again stopping the delivery of oxygen and
nutrients. There are usually two types of weakened blood
vessels that cause this type of stroke – aneurysms (a weak
or thin spot on a blood vessel wall, usually present at birth)
and arteriovenous malformation or AVM (arteries and veins
that are bunched together anywhere including the brain and
also usually present at birth). But the most common cause
of haemorrhagic stroke is uncontrolled hypertension (high
blood pressure). Patients will be assessed for the need for
emergency surgery to drain the accumulated blood.
Stroke Prevention
To prevent stroke, live a healthy,
balanced and active life. Have
regular medical checks, you are
never too young to have a stroke.
Seek professional care and make
sure you monitor your condition
regularly if you have any of these
risk factors –
High blood pressure (people
with high BP are at greater risk)
High cholesterol
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Diabetes
Atrial Fibrillation (irregular
heart beat)
Heart disease/disorders
Physical inactivity
Obesity
High alcohol consumption
Smoking
Stress
Depression
Take the necessary precaution or medication and reduce the risk of
getting a stroke.
MRI (Magnetic Resonance Imaging) scans are taken
in a large tunnel-shaped scanner that produces a more
detailed picture of the blood vessels in the brain.
Blood-thinning medication – Unless your brain scan
shows that you have a bleed, you should be given an
anti-platelet drug as soon as possible.
Part of the rehab programme will involve learning how
to adapt and cope with these effects. This may involve
learning new ways to help you perform daily tasks, use
of tools and aids such as walking frames, ankle-foot
orthotic braces and installation of home modifications.
Participation in rehabilitation and keeping active is
known to improve outcomes following a stroke.
Two Major Categories Of Stroke
A CT (Computer Tomography) scan is a form of
X-ray of the brain. The results show which part of the
brain has been damaged.
Thrombolysis – If you have had a stroke caused by a
blood clot, you may be given a ‘clot-busting’ treatment
called thrombolysis to improve chances of recovery.
Thrombolysis can only be given within four- and- ahalf hours of stroke symptoms starting, though the
sooner it is given the better.
Stroke recovery is a slow process. After an initial stroke
has occurred, generally one of two scenarios will exist.
Either the patient will have residual impairments such
as paralysis, deafness or blindness on one side or will
make a recovery without any long-lasting effects. Up to
60% of stroke survivors have some disability.
NASAM has a wide range of stroke specific rehab therapies.
Tests And Procedures In Hospital
High blood pressure is the most common cause of
stroke. You will have your blood pressure checked and
given medication to reduce (if needed).
The effect of stroke varies and depends on the extent of
brain damage.
Following a stroke, survivors are at risk of another
stroke and other vascular diseases such as heart
attacks. Seek advice from experts on how to reduce
this risk. It may include taking medication, keeping
regular medical appointments and adopting new
lifestyle habits, such as a healthy diet and exercising
regularly.
Recovery
Good nursing care in the early days of stroke also
plays a critical part in recovery. It helps avoid
complications, for example if you have a paralysis
in your arm or leg, a nurse or therapist can make
sure you are positioned and supported correctly
to prevent further damage or pain. If you cannot
move about in bed yourself, you may need a special
mattress or be moved regularly to avoid pressure
sores and blood clots. It’s also not unusual to
have difficulty controlling your bladder and bowel
movements soon after stroke. As you progress in
your recovery these abilities can return.
Some people who have a minor stroke can recover
well quite quickly. If a stroke is very severe, you
may be left with long-term disabilities. Around
20% of people die from a stroke if parts of the brain
An ECG (ElectroCardioGram) records the rhythm
and electrical activity of you heart. This test can help
to diagnose a type of irregular heartbeat called Atrial
Fibrillation (AF), which increases your risk of having
a stroke.
A carotid Doppler examines the rate the blood flows
through the carotid arteries in the front of your neck.
A doctor uses this if it’s thought your stroke has been
caused by the narrowing of this artery.
Swallowing – If you cannot swallow properly after
your stroke there is a risk that food and drink may
get into your lungs (aspiration), which can lead to
serious chest infections and pneumonia. If you have
difficulty swallowing you may have to be given pureed
food or thickened drinks. You can also have fluids
through a drip to prevent dehydration and receive your
medication in a safe way.
Tube feeding – Your overall recovery will be better
if you can start to eat and drink again. If this is not
possible, you can be given food and drink through a
tube. There are two types of tubes: a nasogastric (NG)
tube, which goes up your nose and down your throat
into your stomach; and a gastrostomy tube (PEG),
which goes straight into your stomach. If you have a
tube fitted, it can be removed in the future once you can
swallow safely again. To help your mouth feel fresh,
you (or with the help of your carer) can regularly brush
your teeth and keep your mouth moist with a wet swab.
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Overview
The information on What To Expect When You Have
A Stroke has been extracted from various sources.
Read more at: www.nasam.org/www.stroke.org.
uk/www.healthxchange.com.sg/www.webmd.com/
www.mayoclinic.org/www.strokeassociation.org.
The Monkey
Swings Into
NASAM
NASAM clubs burst into the Chinese New Year mood in February.
Stroke survivors, carers, friends and staff celebrated with the
traditional lion dance and ‘lo hei’ tossing. Our heartfelt Thank You
to all sponsors who made the celebration possible at the various
Clubs. We wish you a healthy, prosperous and peaceful year.
Events
Gong Xi Fa Cai
from NASAM to all
our Club Members,
Friends and
Families!
Regular exercise helps survivors recover faster.
that control vital functions, such as breathing, stop
working.
In the first few days it is normal to feel very tired,
anxious, emotional or depressed, and to lose your
appetite. With help and plenty of encouragement from
your caregiver, family and others, improvements will
take place and you will start to feel more confident.
You can also refer to NASAM’s handbook
‘understanding STROKE’ available in English,
Bahasa Malaysia and Mandarin.
This list of hospitals providing stroke care is not
comprehensive.
welcomes hospitals
to contact us so we can further expand our list.
Where To Go
Private Hospitals
The following list of private hospitals providing stroke care has been compiled with the help of the Neurology
Department of Hospital Kuala Lumpur.
Public Hospitals
Public hospitals may not have dedicated stroke wards although some may allocate a few beds in the medical
ward for stroke management. Survivors will be looked after by neurologists and other specialists.
Hospital Alor Setar
(Hospital Sultanah Bahiyah)
Hospital Ipoh
(Hospital Raja Permaisuri
Bainun)
Gleneagles Kuala Lumpur
Pantai Hospital Kuala Lumpur
Prince Court Medical Centre
Tel.: +603 4141 3000
Tel: +603 2296 0888
Emergency: +603 2296 0999
Tel: +603 2160 0000
Emergency: +603 2160 0999
KPJ Tawakkal Specialist
Hospital
Sunway Medical Centre
KPJ Sentosa KL Specialist
Hospital
Hospital Pulau Pinang
Hospital Kuala Lumpur
Tel: +603 4043 7166
Tel: +604 222 5333
Tel: +603 2615 5555
Hospital Kuala Terengganu
(Hospital Sultanah Nur
Zahirah)
Hospital Kota Bahru
(Hospital Raja Perempuan
Zainab II)
Tel: +609 623 3333
Tel: +609 748 6951
Tel: +603 4026 7777
Emergency: Ext - 1046
KPJ Seremban Specialist
Hospital
Tel: +606 767 7800
Emergency: +606 763 6900
Emergency: +603 7491 1162
Tel: +603 7491 9191 /
+603 5566 9191
KPJ Kajang Specialist Hospital
Tel: +603 8769 2999
Emergency: +603 8769 2911
* Ara Damansara Medical Centre * ParkCity Medical Centre
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When You Have A Stroke
Stroke Hotline: +6019 217 9442
KPJ Selangor Specialist
Hospital
Tel: +603 5543 1111
* Subang Jaya Medical Centre
Emergency: +603 7839 9210
Tel: +604 740 6233
Hospital Sungai Buloh
Tel: +603 6145 4333
Tel: +605 208 5000
Hospital Johor Bahru
(Hospital Sultanah Aninah)
Tel: +607 225 7000
Hospital Kuching
(Hospital Umum Sarawak)
Tel: +6082 276 666
In hospitals without neurologists, a stroke patient is managed by general physicians and other specialists.
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NASAM PJ
NASAM Sabah
The upbeat mood for the Chinese New Year party
was set by dynamic lion dancers from the Sheng Wai
troop. The young, agile dancers kept their audience
mesmerised and later sportingly posed for the cameras.
Before leaving for their next performance the troop
shared their goodwill by donating to NASAM their
ang pow collection – a gesture NASAM greatly
appreciates.
Entertainment at the PJ Club included an erhu
performance by volunteer Tony Lim. Some survivors
joined him and sang popular Mandarin songs. Members
also showed their goodwill during an auction, when
an artwork by stroke survivor George See closed on a
bid of RM150. The proud owner Betty Ng decided to
donate the piece to NASAM. Another highlight was
selecting the best dressed stroke survivor. The winner
was Soong Chun Wei.
NASAM Penang
The celebration ended after the traditional tossing of
‘lo hei’ and a sumptuous lunch.
NASAM Kuantan
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13
Health
Qamer Iqbal Khan,
NASAM’s Rehab Training and
Development Head,
(BPTh,MPTh).
Stroke survivors who are able to walk
independently may be exempted from having a
caregiver in attendance if their balance abilities,
for example, while sitting or when changing
from sitting to walking, are up to mark.
WHAT HAPPENS
AFTER STROKE
Once the person’s overall condition has stabilised, often
within 24 to 48 hours after the stroke, rehabilitative
therapy can begin. Stroke rehab is important for recovery.
It helps you to cope and adapt to your situation so you
can become as independent as possible after your stroke.
In hospital, once you start to recover, you may be moved
from the intensive care unit to a normal or rehabilitation
ward. The people in your stroke team will work with you
and your family to assess the effects of your stroke and
what that means for your rehabilitation.
A group participating in trunk control therapy.
Group and Individual Sessions
Whilst you’re in hospital you will have daily sessions with
your different therapists to help you re-learn the skills you
have lost and prepare you on how to manage any longer
term issues. Because every stroke is different, there is no
set recovery pattern.
NASAM provides therapy in a group as well
as individual sessions. Group therapy is found
to be motivational. It provides stroke survivors
the opportunity to exercise with others
experiencing similar challenges and encourages
them to strive harder for better results. The
peer support tends to create a healthy, happier
environment. The one-on-one sessions, on the
other hand, are more personalised as they focus
more on the specific needs of the survivor.
Some people who suffer a stroke do recover quite quickly,
but unfortunately not everyone gets better. If a stroke is
very severe, you may be left with long-term disabilities.
Your own motivation plays an important role in your
recovery. The more you practise your therapy exercises
the more likely you are to re-learn skills and adapt to new
ways of doing things. But it also takes time and patience,
as well as practise and determination.
Generally all new stroke survivors go through
one-on-one sessions to educate them about
the stroke and its risk factors as well as the
lifestyle changes they have to make, to prevent
recurrence. Cases that require one-on-one
attention include survivors who are young and
need intensive rehab and those with complex
medical histories.
NASAM and Rehabilitation
Therapy sessions at NASAM are designed specifically for
stroke survivors. There is no age limit and the suitability
for admission is at the discretion of the RTIC/ RT (Rehab
Therapist In Charge/Rehab Therapist) who makes the
initial assessment.
One of the stipulations for registration is that all dependent
stroke survivors, e.g. those who need assistance walking
or going to the toilet, must be accompanied by a caregiver
at all times. This helps prevent falls and injuries.
14
Stroke survivors at NASAM are grouped into three
categories – advance, intermediate and early level of
impairment. This allows the RT to develop therapy
programmes based on their functional levels. All stroke
survivors are monitored regularly to evaluate their
progress. Decisions regarding progression within the
group or from one-on-one sessions to group or from
group to one-on-one depend upon the evaluation.
Support Groups
A stroke can trigger depression. Recovery takes time
but treatments are effective. Some of the treatment
strategies at NASAM include:
Cognitive Behavioural Therapy (CBT) - A
type of psychotherapy, or talk therapy, that helps
people change negative thinking and behaviours
that may contribute to depression. Sessions
organised by volunteers from Befrienders are
an important element for cognitive behavioural
therapy.
Peer support group - A peer supporter is skilled in
listening non-judgementally, offering emotional
support, and discussing community resources
and healthy coping mechanisms. By serving as
a role model, sharing experiences, and offering
support to another individual, the peer supporter
also enhances his or her own self-confidence.
important step in the recovery process. With the
guidance of the counsellor, the survivor will have
the opportunity to talk about how the stroke has
affected his/her life and discover ways of moving
forward. Having the space to talk things through
can be very helpful.
Club Outings - Each club organises trips for
stroke survivors and their carers, either locally or
to other states, a few times a year. These outings
provide an opportunity for the survivors to
explore life beyond their normal routine. It also
provides a perfect opportunity for the survivors
to bond with each other and share their personal
experiences after stroke.
A club outing to Sekinchan.
Entertainment Therapy - Games, laughter
sessions and parties are arranged on a regular
basis to motivate stroke survivors. Other activities
include cooking, arts and crafts and gardening.
Our peer support group is managed by a stroke
survivor and is under the supervision/ guidance
of the therapist in charge of the club.
Counselling - Acknowledging what has happened
and accepting how life has changed is an
Therapy through
cooking.
The NASAM Stroke Rehabilitation Team
Rehabilitation is a team effort. Hence stroke survivors are likely to work with a multi-disciplinary team during
rehabilitation. NASAM’s stroke rehabilitation team consists of qualified physio, speech and occupational
therapists, counsellors and volunteers to support a stroke survivor’s recovery.
Physiotherapists – If you have balance problems, paralysis or muscle weakness a physio or rehabilitation
therapist can develop exercises to help you move more easily and prevent a joint from becoming stiff and
painful.
Speech therapists – assess and teach stroke survivors to deal with swallowing problems and re-learn speech,
reading, writing and language skills.
Occupational therapists – focus on improving a stroke survivor’s ability to perform daily tasks such as
eating, bathing and dressing while at the same time showing how to avoid injuries.
Counsellors – help stroke survivors and their families to accept and deal with emotional and behavioural
issues. The counsellors listen to stroke survivors in a calm and non-judgemental manner to allow a sharing
of feelings and issues. Counselling is also provided to caregivers who have trouble coping or adapting to
the increased responsibilities and changed lifestyle.
Qamer paying
individual attention
to young survivor
Jordan Ong.
Volunteers – those who have time to spare and are in good health, friendly, compassionate and love
interacting with people or have special skills. They are trained to lend support in specific areas.
15
The Role Of Family And Carers
“Although the recovery
of a stroke survivor
depends on self-motivation
and the strength of
the individual, family
support is very crucial.
Recovery is not an overnight
thing but a journey which
takes a lot of time, care,
perseverance and love.”
Janet Yeo, Founder of
NASAM.
Stroke can be sudden and unexpected, so caring for a
stroke survivor can be challenging. Caregivers – a family
member, friend, domestic helper and/or a healthcare
professional – play an important role throughout the
post-stroke recovery process.
Caring for stroke survivors can cause high levels of
emotional, mental and physical stress. There will also
be disruption of employment and family life that makes
caregiving very challenging.
Tips to remember when care giving:
Learn from healthcare experts how to help with daily
exercises, diet and other forms of care.
Set sensible recovery goals.
Give the survivor lots of time to complete a task.
Encourage participation in daily activities such as
household chores (independently if possible)
Motivate and praise the survivor. Be cheerful and
hopeful.
Remind the survivor to look, touch and move affected
limbs.
Be actively involved in therapy sessions (e.g. at
NASAM) and give feedback.
Include the survivor in discussions, outings and
leisure activities.
Get other family members and friends to support the
recovery programme.
While caregivers can promote positive post-stroke
recovery, they need to care for themselves as well.
NASAM also has a support programme for caregivers
who have trouble coping or adapting to the increased
responsibilities and changed lifestyle.
If you have any questions related to caring for
a stroke survivor contact Qamer at qamer_pt@
nasam.org / 014-3239843 or 03-79561876 ext. 103.
16
Some Tips To Remember When
Your Loved One Suffers A Stroke
1) Medication – Be aware of the medications
that have been prescribed to your loved one
and their side-effects.
2) Reduce risks – Survivors who have had one
stroke are at high risk of having another one
if the treatment recommendations are not
followed. Make sure your loved one is on
a healthy diet, exercises (walking is a great
exercise), takes medications as prescribed
and has regular visits with their physician to
help prevent a second stroke.
3) Recovery – This depends on many
different factors: where in the brain the
stroke occurred, how much of the brain
was affected, the patient’s motivation,
caregiver support, the quantity and quality
of rehabilitation, and how healthy the
survivor was before the stroke. The most
rapid recovery usually occurs during the
first three to four months after a stroke, but
some stroke survivors continue to recover
well into the first and second year poststroke. Every stroke and stroke survivor is
unique, avoid comparisons.
4) Falls – After a stroke it’s common to fall.
Use an ice-pack immediately to reduce
pain and swelling. If there is severe pain,
bruising or bleeding, go to the Emergency
Department. If it’s a minor fall (with no
injury) that occurs more than two times
within six months, see your doctor or
physiotherapist for treatment.
5) Depression – Be alert and look out for
post-stroke depression which is common,
with as many as 30-50% of stroke
survivors developing depression in the
early or later phases of recovery. Find out
about counselling services. Don’t allow
depression to delay the recovery process.
6) Support – Malaysian citizens with stroke
can apply for government aid. Kad OKU is
issued for free by the Department of Social
Welfare. For more information visit www.
jkm.gov.my
THE DANGERS OF ATRIAL
FIBRILLATION– A MAJOR
CAUSE OF STROKE
Health
Atrial Fibrillation (AF or AFib) is an irregular and rapid heart rate, which has been shown to increase the risk
of stroke by five times1. Rapid heart rate may also damage the heart if the condition is left untreated. When
this happens, the heart’s two upper chambers (the atrial) beat irregularly - out of coordination with the two
lower chambers (the ventricles) of the heart. Symptoms often include any of the following: heart palpitations,
shortness of breath, weakness, dizziness or light headedness, and chest pain or pressure1. Some people do not
exhibit any symptoms, hence are unaware that they have AF.
AF attacks can come and go, or may even be persistent and present throughout the day. Although the condition
itself isn’t usually life-threatening, it is a serious medical one that should be treated by a doctor. This is
because AF can lead to blood clots in the heart that may circulate to your brain and lead to a blocked blood
flow (Ischaemic stroke).
The risk of stroke in AF arises with the presence of heart failure, high blood pressure, or if a person is elderly,
female or diabetic. Anyone who has suffered a stroke and is over 74-years old, is at a greater risk of getting a
stroke if AF is present.2
There are two parts to the treatment of AF:
1) The heart rate is controlled to alleviate symptoms of rapid heartbeats
2) Blood thinning drugs are given to patients to reduce their risk of stroke2.
Living a healthy lifestyle also can help you reduce the risk of developing AF.
Some healthy habits you can include in your life are:
Keeping a healthy weight
Regular exercise
Eating healthy foods
Avoiding smoking
Limiting or avoiding alcohol
Keeping blood pressure and cholesterol levels under control
Reducing stress, as intense stress and anger can cause heart rhythm problems
References:
1) Marini C, De Santis F, Sacco S et al. Contribution of Atrial Fibrillation to incidence
and outcome of Ischemic Stroke: results from a population based study. Stroke
2005;36:1115–19
2) ESC guidelines for the management of Atrial Fibrillation. European Heart Journal
doi:10.1093/eurheartj/ehs253
Partnering NASAM In Stroke Education
17
NASAM Needs Your Help
Spotlight – Volunteer
We are a non-profit organisation depending solely on public goodwill and generosity to give LIFE to stroke survivors.
Many of those who come to NASAM are not able to afford post-stroke rehabilitation which is critical to every survivor’s
recovery. Partner us and share a journey of a second chance.
TO SERVE
WITH LOVE
How You
Can Help
By donating
(one-off or monthly contributions)
By sponsoring a therapist
or a stroke centre
By volunteering
Lim going through the paces with survivor Christine Lim at the PJ Club.
reach them and motivate them. Every breakthrough,
no matter how small, is significant and must be
recognised so that the survivor is encouraged to do
better.”
When some survivors come to him they keep their eyes
closed and sometimes show no response for weeks.
The challenge, he adds, is to continue acknowledging
them as part of the group and keep going because one
day they will sit up and willingly participate. “Each
week you try something new…it could be sound or
may be a song and finally, something clicks and you
get a response. That moment is unforgettable. The
satisfaction is indescribable.” And at the end of the
day it is this satisfaction that keeps Lim on the roll.
He recalls how years ago, when he felt he was ready
to serve the community, he searched hard to find the
right fit. He considered a few other organisations,
communicated with them but didn’t really get very
far. One day he read about NASAM offering to train
volunteers in various fields. He signed up for the His message to stroke survivors is: “Keep up your
spirits and will power.” To families and caregivers
training and has never looked back.
he says: “Exercise more patience and tolerance.
Lim started as a volunteer physiotherapist but wasn’t Understand the needs of your loved ones and ensure
able to cope well so, a month later, he decided to that they continue their rehab programmes when they
switch to speech therapy. He conducts sessions in are out of hospital.”
both English and Cantonese. “I am comfortable
sharing my skills which have to be continuously Lim encourages family members to sit in during his
updated so that my students are not bored and are sessions so that they know how to practise with the
happy to participate,” shared Lim. “I enjoy learning survivor at home. “Dedication and commitment from
from other speech therapists too. Over the years my the family is crucial. I welcome their feedback and
experiences with stroke survivors have enriched my participation.”
life. I am now more positive, tolerant and patient. I He also points out that sometimes carers get depressed
have learned to live life at a slower pace.”
and find it hard to cope because they are inundated
Lim stresses that volunteers must have an open mind, with other commitments. When he meets them he
be flexible and able to meet individual needs. “A encourages them to seek counselling at NASAM to
volunteer must have a love and compassion for doing help them cope better. “They are frustrated and still
service. You have to be committed, responsible and coming to terms with the upheaval that the stroke has
caring. Each survivor is fighting a different battle and caused in their family. They too need help so they can
you must be prepared to work hard to find ways to do better at caregiving.”
18
✂
Lim, as he prefers to be known, has been a volunteer
at NASAM for eight years now. He spends about two
to three hours every Monday at the PJ Club, helping
stroke survivors recover their speech abilities. Both
painstakingly and patiently he takes them through
exercises to help them with their vocal chords or to
practice on sounds, words or sentences. A business
owner, this energetic 50-something has found his
niche and reveals that he derives great satisfaction
from this service.
Donation Form
March 2016
DONOR PARTICULARS (PLEASE USE CAPITAL LETTERS)
ONLINE DONATIONS
Name/Company :
You can also donate through our website at
www.nasam.org
I.C. No. :
Address :
City : HP : Home :
State : Postcode :
Office :
Fax :
Email :
OR
Donations can be made directly to our account
(Maybank 5122 3152 0534). Please fax/scan
your bank-in-slip to 03-7931 0087 or email to
[email protected].
Please provide your name as per your MyKad so
that tax exempt receipts can be issued.
National Stroke Association of Malaysia | No. 12, Jalan Bukit Menteri Selatan (7/2), 46050 Petaling Jaya.
Tel: +603 7956 1876 | Fax: +603 7931 0087 | Email: [email protected] | Website: www.nasam.org
✂
Stroke rehabilitation is a crucial part of stroke
recovery. NASAM’s stroke rehabilitation
programme focuses on the physical, emotional
and social wellbeing of stroke survivors
and offers physiotherapy, speech therapy,
recreational activities, alternative therapy and
counselling services. Contact your nearest
NASAM Centre for more details.
AGAINST THE WIND
THE SPIRIT OF NASAM
AS SEEN THROUGH THE LIVES
OF STROKE SURVIVORS
A copy of this documentary is available on DVD
for a donation of RM30. NASAM also welcomes
requests for corporate screenings.
Please contact Nancy Yap at 03-7956 1876
or email [email protected] for more details.
NASAM Head Office
No. 12, Jalan Bukit Menteri Selatan (7/2), 46050 Petaling Jaya, Selangor Darul Ehsan, Malaysia.
Tel: +603 7956 1876 | Fax: +603 7931 0087 | Email: [email protected]
www.nasam.org
NationalStrokeAssociationMalaysia
Our Branches
NASAM Petaling Jaya
No. 12, Jalan Bukit Menteri Selatan (7/2)
46050 Petaling Jaya
Selangor Darul Ehsan
Malaysia
Tel
: +603 7956 4840
Fax : +603 7931 0087
Email : [email protected]
NASAM Ampang
No. 9, Lorong Awan 1
68000 Ampang
Selangor Darul Ehsan
Malaysia
Tel
: +603 4256 1234
Fax : +603 4251 5360
Email :[email protected]
NASAM Penang
No. 9-C, Lebuhraya Maktab
10250 Pulau Pinang
Malaysia
Tel
: +604 229 8050
Email :[email protected]
NASAM Perak
No. 9, Lorong Pinji
Off Jalan Pasir Puteh
31560 Ipoh
Perak Darul Ridzuan
Malaysia
Tel
: +605 321 1089
Fax : +605 322 4759
Email :[email protected]
NASAM Malacca
No. 5132-C, Jalan Datuk Palembang
Bukit Baru
75150 Melaka
Melaka Darul Azim
Malaysia
Tel/Fax: +606 231 0177
Email :[email protected]
NASAM Kuantan
No. A2134, Lorong Kubang Buaya 2
25250 Kuantan
Pahang Darul Makmur
Malaysia
Tel/Fax: +609 566 8195
Email :[email protected]
NASAM Sabah
Kompleks Badan-Badan Sukarela
Wisma Pandu Puteri
KM4, Jalan Tuaran
88400 Kota Kinabalu
Sabah
Malaysia
Tel
: +6 088 261 568
Email :[email protected]
NASAM Johor
No. 59, Jalan Chendera
Serene Park
80300 Johor Bahru
Johor Darul Takzim
Malaysia
Tel
: +607 223 0075
Fax : +607 223 0076
Email : [email protected]
We warmly invite you to visit any of our eight centres to understand the determination
and courage of stroke survivors and the commitment of caregivers, volunteers and staff.
Call our centres: 9am-5pm (Monday-Friday)
Closed Weekends/Public Holidays
20