Stroke Support India - Supporting Stroke Survivors and Caregivers....

Stroke Support India - Supporting Stroke Survivors and Caregivers....

What is EMRI (Emergency Management and Research Institute)?

GVK EMRI (Emergency Medical Research  Institute) is a non-profit organization providing emergency medical services in India and operating and operating under a Public Private Partnership mode (PPP).

EMRI handles medical, police and fire emergencies through the “1-0-8 Emergency Service". This is a free service delivered through well organized emergency call response centers and staffed by well trained paramedical personnel that are able to dispatch over 2600 ambulances across Andhra Pradesh, Gujarat, Uttarakhand, Himachal Pradesh, Chhattisgarh, Goa, Chennai, Rajasthan, Karnataka, Assam, Meghalaya, Madhya Pradesh, Daman & Diu and Dadra & Nagar Haveli. Beginning in 2005 in Hyderabad, EMRI has become the world's largest integrated Emergency Response Services (ERS) Provider serving 40% of India's population across 12 states and two Union Territories. EMRI has signed memorandums of understanding (MOU) with over 6800 hospitals, which have agreed to provide initial stabilization of EMRI transported patients free of cost for the first 24 hours. In some other states (Rajasthan, Bihar, Punjab, and Trivandrum), Ziqitza has been contracted by the government to operate the 1-0-8 emergency service.

Each ambulance is staffed by a trained EMT (Emergency Medical Technician) who provides pre–hospital care while transporting the patient to a hospital for stabilization. If required, the EMT is able to communicate (via cell phone) with the in house ERCP (Emergency Response Care Physician) who is a qualified medical practitioner, available 24/7 to support the EMT as and when required.

When an emergency is reported through 108, the paramedic, who answers the call, gathers the needed basic information and dispatches appropriate services. Basic information obtained includes:

• Where the call is placed from (district/taluka/city/town/exact location/landmark)
• The type of emergency
• Number of people injured and the condition of the injured
• The caller's name and contact number – for location guidance if required

Emergency help dispatched through this process is expected to reach the site of the emergency in an average of 18 minutes. Pre-hospital care will be given to patients being transported to the nearest hospital.

Ziqitza 108 Emergency Response Service operates in the following states

Apps for Stroke survivors - Apps for Aphasia

Stroke survivors might face difficulties in their day-to-day life because of deficits in speech, memory, etc. There are a number of apple/android apps that are designed to assist stroke survivors in carrying their daily activities and have proven to be very useful. In this post, we discuss some of the common apps that help patients with aphasia (speech difficulty). These apps may be downloaded on iPad/Tablet/Smartphone and help in generating speech, converting text to speech, virtual keyboards, pictures, symbols and video.

Augmentative and Alternative Communication (AAC) is the term used to describe a set of tools and strategies that an individual uses to solve everyday communication challenges. Communication can be in the form of speech, glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, speech-generating devices, etc


Free Apps

• Vox4all® - Android/Apple - is an augmentative and alternative communication (AAC) system for tablets and smartphones. Aims to give voice to those who cannot speak, bridging communication barriers. Using a system of symbols, images, synthesis and voice recording, you can create and configure an environment totally adapted to each user. Available in four languages - English, Spanish, Portuguese, Portuguese.
• Aac Talking Tabs - Android - Uses pictures & symbols-Tap and talk or build phrases. You can create tables or tales and books as well.
• Voice4u - Android/Apple - is an simple application that consists numerous of fun and memorable images that can help assist and improve language. There are over 170 icons consisting of pictures with it’s corresponding word. The icons are included with clear, easy-to-listen audios.
• JABtalk - Android - is a free speech communication application designed to help non-verbal children and adults communicate.
• TapToTalk - Android/Apple -  makes communication fun, like another “game” on on an iPad/Tablet. Just tap a picture and TapToTalk speaks. Each picture can lead to another screen of pictures 
• SmallTalk - Android/Apple - The SmallTalk™ Family of Communication apps are FREE and offer users extreme portability for practicing speech and communicating on the go
• Dragon Dictation - Android/Apple - Can be used as a therapy device for articulation (feedback on intelligibility) or for people with writing impairment (i.e speech to text)

Paid Apps

• Proloquo2Go ($190) - Apple - It provides natural sounding text-to-speech voices (American, British, and Indian English), high-resolution symbols, automatic conjugations, a default vocabulary of over 7000 items, word prediction, expandability, and accepts your own pictures.
• RocketKeys ($160) - Apple - customizable talking keyboard. This app lets you build the keyboard by choosing the exact keys, size, layout, colors, prediction, and voices you want.
• MyTalk Tools ($49.99) - Android/Apple -  helps people with communication difficulties say what they want with sequences of words, sounds and images. You choose the content (simple grids or boards with bold images) and play recorded
• TalkTablet - Android/Apple - for people who have difficulty communicating as a result of autism, aphasia, Down Syndrome, stroke, laryngectomy or any other condition that affects a persons ability to communicate effectively.TalkTablet is the only fully featured AAC speech solution that is compatible with Apple iOS, Android and Kindle handheld and tablet devices.
• Assistive Express ($25) - Apple - is designed to be simple and efficient, allowing users to express their views and thoughts at the most express manner, with natural sounding voices.

There are many more apps available depending upon the need of patients. For a complete list of apps, click on the links below

http://www.stroke.org/sites/default/files/resources/iHOPE-Aphasia-Apps-List.pdf

http://www.stroke.org/stroke-resources/resource-library/aphasia-apps

Stroke burden and prevention

Feedback Survey

Dear All,
              It has been 7 months since this blog was started with the intention of sensitizing the people and physicians to stroke. To be able to serve the audience better, I would like you all to take this short survey. In addition, we are working on creating a forum to connect stroke survivors and publish their experiences so as to benefit others. A link to the survey is here (it should not take more than 2 minutes to complete the survey):

https://docs.google.com/forms/d/1eJXB3iAU2bYzUIP_yPCfQ_832ISsxQfSIPSKVXGvUMM/edit

Thank you

Does Air Pollution Affect the Risk of Stroke?

The World Health Organization (WHO) recently published data on air pollution in various cities across the world focussing on airborne particles smaller than 2.5 micrometers known as PM2.5. The report ranked cities after studying their air for the presence of harmful gases, such as nitrogen dioxide, carbon monoxide and sulphur dioxide, besides particulate matter (PM) 10 and 2.5. 13 of the world's 20 most polluted cities are in India, New Delhi being the most polluted of all. Smaller airborne particles or particulate matter is among the most dangerous of all these pollutants. New Delhi, Patna, Gwalior, Raipur, Ahmedabad, Lucknow, Kanpur, Amritsar, Ludhiana, Allahbad, Agra and Khanna are included among the top 20 most polluted cities in the world. 

High levels of air pollution has been linked to increased rate of chronic bronchitis, lung cancer and heart disease. Long term exposure to air pollution has also been associated with higher risk of stroke and impaired cognition. Following are the effects of air pollution on brain and central nervous system:

• Increased risk of carotid atherosclerosis
• Decreased cognition in older people
• Every 2 microgram per meter cube increase in PM 2.5 leads to 1 year of accelerated brain aging and atrophy (degeneration)
• Increased risk of death from stroke among people living in areas with high air pollution, especially in people aged >60 years and non-smokers
•  In Tokyo, the risk increase for subarachnoid hemorrhage mortality per 10 μg/m3 PM2.5 or NO2 has been associated with double the risk increase for ischemic or intracerebral hemorrhage mortality
•  Stronger associations between short-term air pollution exposure and stroke mortality are observed in elderly, women, and individuals with a history of diabetes mellitus or cardiac disease
• Air pollution on warm days has been more strongly associated with both hemorrhagic and ischemic stroke

Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is a type of stroke where bleeding occurs within the brain tissue itself. The blood clot causes damage to the brain tissue in that area leading to signs and symptoms. Also, the blood clot may lead to increased pressure in the brain and subsequent symptoms. The bleeding may occur due to a number of reasons such as

• high blood pressure
• head trauma
• arteriovenous malformation rupture
• brain aneurysm rupture
• diseases that cause increased tendency of bleeding (Eg., Hemophilia)
• treatment with blood thinner medicines (Eg., Aspirin, Warfarin, Clopidogrel, Heparin)
• tumors within the brain
• cocaine and amphetamine abuse
• amyloid angiopathy (bleeding due to degeneration of arteries in elderly people)

How common is intracerebral hemorrhage?

About 10% of all strokes occur due to intracerebral hemorrhage while 80% occur due to ischemic stroke (due to blockage of arteries supplying the brain). This translates to about 12-15 cases per 100,000/year in general population. About 40% of patients with intracerebral hemorrhage eventually die and a large proportion of the rest are left with permanent disability. Advancing age and uncontrolled high blood pressure are major risk factors for ICH.

Signs and Symptoms

• Headache
• Nausea and vomiting
• weakness of arm, leg
• facial droop
• confusion, lethargy and loss of consciousness
• speech difficulty
• seizures
• visual loss
• difficulty in walking

How is the diagnosis made?

• A CT scan is the best imaging modality to detect acute bleeding within the brain
• CT angiogram / MRI / MR angiogram and a digital subtraction angiogram may be required to detect the exact cause of bleeding.

How is intracerebral hemorrhage treated?

• The first step in the treatment of intracerebral hemorrhage is to determine the cause of bleed
• High blood pressure is controlled with medications
• If the bleeding leads to increased pressure in the brain, surgery may be needed to remove the clot and relieve the pressure. Surgical procedure may involve craniotomy and evacuation, stereotactic aspiration, draining fluid from the brain.

Recovery and Outcome

Outcome following intracerebral hemorrhage depends upon the cause, location and extent of bleed. Prompt diagnosis and treatment helps to minimize complications and long term sequelae.