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Editorial: One of Life's Journeys
My mother had been treated for high blood pressure for several years. She was a White woman less than 5 feet in height and 100 pounds in weight, but she had genetic links to high blood pressure, heart disease, and stroke. In addition, she smoked cigarettes and was not very active physically. She worked in an office setting outside the home, and in the evenings and on weekends, she liked craft projects and card games. In 1975, while on vacation 1,200 miles from our town, my dad telephoned me to say that my mother had had a stroke; then the telephone line went silent. My father had hung up the phone because he was bewildered and upset about what to do. As an only child and nurse, much of the management of mother’s care came to me, and so this journey began…
High blood pressure, the “silent killer,” is a major risk factor for coronary heart disease, heart failure, and stroke. About 50 million adults in the United States have high blood pressure (Centers for Disease Control, 2005). The relative risk of stroke in heavy cigarette smokers (more than 40 cigarettes/day) is twice that of light smokers (less than 10 cigarettes/day; American Stroke Association [ASA], 2005a). Regular physical activity reduces stroke risk for both men and women (ASA, 2005a; National Stroke Association [NSA], 2005). We now know that these are just some of the risk factors that can be controlled or treated.
Nonetheless, about every 45 seconds someone in the United States has a stroke, the leading cause of serious, long-term disability. Stroke knows no barriers, neither ethnicity nor gender—these are among the risk factors that cannot be changed. Mexican Americans have an increased incidence of stroke when compared to non-Hispanic Whites. African Americans have almost twice the risk for a first-ever stroke than Whites (ASA, 2005a). Annually, 277,000 White men have a new or recurrent stroke, as do 312,000 women (ASA, 2005b). In fact each year, approximately 40,000 more women than men have a stroke, and because women live longer, more women than men die as a result of stroke (ASA, 2005a).
My mother’s stroke caused right-side brain damage that resulted in functional and cognitive impairments. Armed with what now seems like the most primitive repertoire of treatment options, she received outpatient medical care and physical and occupational therapy after her acute care hospitalization. The therapists taught her several exercises that she did on most days with encouragement. She learned to walk with a cane, with her left leg encased in a heavy metal brace, and she regained some use of her dominant, left hand.
As time passed, my father and I realized that my mother did not think or process information in a clear and comprehensive manner. My father would instruct her to not get up and answer the telephone or the door without help. Of course she did both activities when no one was closely watching her, and she fell numerous times—once in the hospital injuring her foot and another time at home injuring her coccyx.
As the years progressed, stroke affected the entire family; caring for mother became a family affair. Dad enlisted not only my help in caring for her on a daily basis but also that of my husband and two children, who were about 8 and 11 years old. We became closer as a family, but our roles changed. We became the “parents” in watching over my mother. My mother’s brother and his wife drove more than 200 miles to visit her almost every month. They provided socialization and stimulation. When the physician asked my father if he had a nurse coming in to help with her care when she became unable to walk, participate in personal care, or communicate effectively, my father smiled and told him, “the nurse is here when I need her.” Mother’s sister came and stayed for weeks on end to assist in her daily care and to offer emotional and spiritual sustenance to all of us. My mother’s life, her journey here, ended 5 years after her initial stroke.
My life’s pathway continues, in that I am passionate about stroke, caregivers and families, caring, and rehabilitation nursing. Because our knowledge of issues specific to stroke has progressed substantially in recent years, there has never been a more exciting time to be involved in stroke rehabilitation. There is vast potential for neurologic recovery that has changed clinical practice, and will likely continue to do so, until perhaps the disabling outcomes of stroke can be stopped.
I thank the authors of the articles in this issue for providing rehabilitation professionals with insight and new information about stroke, the people with stroke, and their caregivers; and for stimulating further inquiry into some unanswered questions about prevention of, treatment of, and recovery from stroke.
May your life’s road be well traveled and your journeys unending.
American Stroke Association. (2005a). Heart disease and stroke statistics—2005 update. Retrieved September 11, 2005, from www.americanheart.org.
American Stroke Association. (2005b). Statistical fact sheet-populations. Retrieved September 11, 2005, from www.americanheart.org.
Centers for Disease Control and Prevention. (2005). Heart disease and stroke. Retrieved September 11, 2005, from www.cdc.gov/cvh.
National Stroke Association. (2005). Stroke prevention. Retrieved September 11, 2005, from www.stroke.org.