Helping stroke survivors in a pandemic

THE Covid-19 pandemic has made things tougher for stroke patients.

There’s been a decline in stroke admissions worldwide this year compared to the same period last year, according to the World Stroke Organization (WSO).

“The most likely explanation is that patients with mild symptoms are ignoring them and do not want to come to the hospital for evaluation because of fear of being exposed to Covid-19, ” says WSO president-elect Prof Marc Fischer in a recent statement.

A similar trend is also seen in most hospitals in Malaysia, based on a preliminary survey by the Malaysia Stroke Council.

With the Covid-19 pandemic, there are extra steps needed to be taken: the stroke patients have to be tested for the coronavirus.

“We will treat the patient first for their stroke, but admission will be in a different ward while waiting for confirmation on their Covid-19 test, ” explains council president Assoc Prof Dr Hoo Fan Kee.

The question also arises as to whether the doctor needs to wear the full PPE (personal protective equipment) or not.

“This may cause a delay. A stroke patient should receive treatment within 4.5 hours.

“After 4.5 hours, the risk of disability is increased. If treated within three hours, chances of fully recovering is higher, ” Dr Hoo says.

Some stroke patients also delayed follow-up checks or reviews at hospitals due to fears of the virus, says National Stroke Association of Malaysia (Nasam) rehabilitation head Tracy Chan.

“I have heard of urinary catheters not changed for the entire movement control order (MCO) period from March to June.

“There were other messy and unhealthy situations as a result of this pandemic, ” she says.

It doesn’t help that stroke survivors are part of the group of people that respond very poorly to Covid-19 infections.

“They also need quick access to services and medical treatment even though there is a pandemic that may kill them out there, ” Chan adds.

She says fewer stroke admissions has led WSO, of which Nasam is a member, to launch campaigns to encourage those with signs of acute stroke to rush to hospitals for emergency treatment on the onset of a stroke.

“Delaying and avoiding going to the hospital can lead to greater disability and mortality, ” she stresses.

Due to Covid-19, Chan says many non-essential services and follow ups were moved to later dates to allow the hospitals to accommodate the coronavirus cases and to put into place the standard operating procedures to reduce its spread.

“Some services like collection of medication were moved to delivery services which required a certain amount of mobile phone literacy and skill, ” she points out.

Outpatient rehabilitation services at some hospitals were suspended for a while during the MCO.

“Hence, many who were in the rehabilitation stage of stroke recovery had their progress hindered.

“When services resumed there were issues of fear while for many, there was the issue of affordability.

“Many families had reduced income and could not afford or spare the time to bring a family member for therapy, ” she adds.

With its nine centres across the country, Nasam provides rehabilitation facilities and services for stroke survivors but with the pandemic, it has been tough.

“Following the MCO, one of the first things we did was to create a helpline (018- 2221878), for our stroke community and also to serve anyone having a stroke. It has been a busy line.

“During the MCO, stroke survivors had to learn to use social media to continue with interaction.

“It was difficult for most of our stroke survivors who were already having a tough time coping with everyday struggles. The added burden of the new normal was very challenging, ” Chan describes.

Nasam lost contact with many stroke survivors especially those from the disadvantaged groups who lacked access and support to handle the social media platforms.

“Many have been affected as their recovery was halted abruptly and we were unable to undertake reviews of their progress in recovery.

“While we are still not offering our popular face-to-face group therapy session, we have started Telehealth to complement the one-on-one therapies offered at our centres and to help those not living near a Nasam centre, ” Chan adds.

Under their Telehealth programme, Nasam conducts group sessions on aerobics, exercises to improve strength and balance and qi gong for body and mind relaxation on the teleconferencing app Zoom.

“Nasam believes it is essential for stroke survivors to remain as active as possible and that rehab is critical for a stroke survivor’s recovery.

“It is a trying time for Nasam and also the community at large on whom we rely to help sustain the recovery of stroke survivors and at the same time keep them safe in this pandemic, ” she says.

Nasam is also offering free rehabilitation for stroke survivors in the low income group or B40 community.

“They can receive free rehab care at Nasam centres. The participating stroke survivors will be sponsored for a period by Yayasan Hasanah.

“The rehab offer is open to only 300 participants on a first-come, first-served basis and has been running since September, ” she says.

Nasam’s centres are located in Petaling Jaya, Ampang, Melaka, Johor Baru, Kuantan, Ipoh, Penang, Kulim in Kedah and Kota Kinabalu.

For more information, call Nasam’s helpline at 018-2221878 or log on to for details.

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