Stroke: A Case Study
Taylor Taunton
Specific Aims: Strokes are the third leading cause of death in the United States and affect over 750,000 people each year. When a person has a stroke the brain is temporarily deprived of oxygen, which causes brain cells to die. The longer it takes a person to receive the medical attention they need the more likely they are to suffer greater and long lasting effects. Therefore, if the symptoms are better understood then getting correct and more efficient medical attention would be easier. In recent studies, researches have found a direct correlation with the level of severity of speech impairments and the severity, or higher mortality rate, of the stroke. This is a critical advancement in the medical field. If doctors …show more content…
were able to recognize the severity of the stroke from a person’s speech patterns then they would more quickly be able to recognize how to properly treat the stroke. This could be extremely crucial in the future of the treatment of strokes. My goal is to develop criteria for doctors to use to more readily treat stroke patients. The proposed study will create a documentation page for doctors to fill out for their stroke patients. This document will help to formulate a way to put these stroke patients in groups based on symptoms, outcomes, and areas of the brain affected. This document will be formatted in a way that is nonbiased and consistent among health professionals. The document will firstly assess the patient’s symptoms. The doctor will then continue to document the progression of the exhibited symptoms. This assessment will mostly consist of a written portion. These criteria will be a new advancement in speed of treating stroke patients. At the present moment there is no such criteria.
Specific Aim 1: Determine if in fact a database can be created based off of doctor’s assessments of their stroke patients’ speech patterns and if there are correlations between speech and region of the brain.
We will do this by assisting doctors with the documentation of the level of speech impairment. Also how the speech is impaired; is there no speech, are you only using rhyming words, are you only using profanities, etc. Then we will determine based off of these types of speech impairments what is the outcome of the stroke. We will also determine if there is a correlation between severity of the stroke and the region of the brain that is affected. We want to be able for doctors to determine, very quickly what region of the brain is affected based off of symptoms alone. Our document we will create will help us to determine this information.
Specific Aim 2: Determine what treatment options need to be changed or adjusted based on speech disturbances. Based on the data we will collect from specific aim one we will be able to assess the affectivity of the current treatment options. We will assess this by testing the effectiveness of current methods. We hypothesize that the majority of current treatments will correspond to our findings. However, based on the particular region of the brain affected it may be more beneficial to use a different treatment than the one currently in place. Not necessarily a new treatment, just one that complies with the symptom and affected areas better.
Specific Aim 3: Using the data we collect from the doctors in the first study, we will categorize strokes based on their severity and location, we will then make a criteria that doctors across the nation could use to assess stroke patients quickly. We want to make a set of criteria that doctors across the nation can use to easily assess their stroke patients. Based on the data we collect we want to categorize the strokes based on severity and location. We will then, place the symptoms into their own categories. In each category it will display what region of the brain is affected and what course of action needs to be used to treat the stroke. By creating this criteria doctors would have an easy, quick way to look at a stroke patient and quickly and efficiently decide the proper course of action to take. As of right now there is not an easy way for doctors to tell where the stroke is occurring without extensive testing. This therefore, prolongs the treatment of the stroke, which in turn can negatively affect the outcome for the patient.
Background and Significance:
Strokes occur in the body when an area of the brain is temporarily deprived of crucial blood supply, causing the brain to be without oxygen for an extended period of time.1 Strokes are currently the third leading cause of death in the United States affecting over 750,000 people each year.2 There are three major types of strokes that can occur: Ischemic, Hemorrhagic, and Transient Ischemic, all of which exhibit speech determent, a common symptom.3 Ischemic strokes occur when the arteries to the brain become narrowed or blocked, which reduces the blood flow to the brain.3 Ischemic are the most common of the three strokes, making up over 85% of stroke cases.3 Hemorrhagic strokes are caused by the leakage or rupturing of a blood vessel in the brain.3 Transient Ischemic are more commonly defined as mini strokes. Transient Ischemic strokes show brief symptoms common of strokes, caused by a brief decrease in oxygen levels in the brain.3 Emergency care is extremely critical in the treatment of strokes. The sooner a patient receives medical attention the more minimal the long-term effects.1
Since speech determent is such a common symptom among stroke victims it should be widely known how severity of speech correlates to the severity of the stroke.3 However, a better system to determine speech severity correlations is needed. Recent studies have proven that there is in fact a reason to research speech disturbance in greater detail.4 In a study by Shigematsu et al. researchers found speech disturbances are commonly observed in patients at the onset of the stroke. Therefore speech disturbance could be used as a more immediate method to identify the severity at the earliest stage of the stroke. His study also shows a direct link to patients with a higher speech disturbance and higher mortality rates.4 One way we plan to continue and build upon these findings is by creating criteria for doctors to initially fill out upon the patient’s entrance to the hospital.
These criteria will include a way for doctors to accurately determine and document the severity of the patient’s speech upon entrance. When a stroke patient enters the emergency care facility, a doctor should be able assess whether or not the patient is exhibiting speech disturbances in correlation with the stroke. The doctor should then be able to determine what type of stroke and where in the brain the stroke is occurring. This in turn will help doctors quickly recognize what treatment options are the best for the patient. This is extremely critical in the care of stroke patients, the less time it takes to provide treatment for a stroke patient, the more likely the patient is to survive. This is innovative in the way that if this scale is approved for use in hospitals it could potentially lower the mortality rates across the country. Since, 130,000 American die each year from strokes, our scale could potentially save 1,000s of …show more content…
lives.2
As the patient continues to receive care, the doctors will periodically document their progress. This documentation will include aspects such as vitals, regions of the brain involved, and improvements or regression of symptoms. We will then analyze this data and more clearly distinguish a relationship between speech severity and mortality. We will also rule out other health factors that could potentially be a cause in death. We will then use this data to attempt to find a correlation between speech severity and patterns, and the regions of the brain affected by the stroke. This is a completely new and innovative concept for the area of stroke research. If there is a link between severity of speech and types of patterns associated with speech and the regions of the brain, this could provide a brand new approach for physicians to use. Our hope is to create a stroke severity scale that physicians could use to help assess their stroke patients immediately. It could potentially cut down on the time it takes for doctors to try and pinpoint where the stroke is occurring. This evaluation is crucial in the treatment, the longer it takes for the doctor to recognize what is happening and where in the brain it is occurring the higher chance of mortality the patient has. This particular study is innovative and significant because it is the first study to consider other causes of death such as underlying medical problems. This study will also document patients who do not exhibit any speech disturbance while exhibiting other symptoms of strokes. We will determine if these patients have a milder or more severe outcome overall. This study will follow the general health of the stroke patients for two years post stroke onset. This is the longest anyone has followed these patients. In a more recent study patients were only followed for 30 days.
Approach:
Specific Aim 1: Determine if in fact a database can be created based off of doctor’s assessments of their stroke patients’ speech patterns and if there are correlations between speech and region of the brain.
Rationale:
There have been recent studies showing that there is a link between the severity of speech impairment and mortality following stroke.4 However, this will be the first study to show if in fact there are any correlations between speech severity, speech patterns, and the regions of the brain affected by a stroke. This will test the hypothesis that the type of speech disturbance can help to detect the area of the brain affected. Therefore speech disturbance could be used as a more immediate method to identify the severity at the earliest stage of the stroke. This is particularly important due to the fact that time is especially critical in stroke treatment, minutes can save lives.
Preliminary Data:
To determine if a database can be created based off of doctors’ assessments of their patient’s stroke and their speech patterns upon entrance to a hospital, we first had to create a way for doctors to document and assess speech severity in a way that would be easy and consistent.
One previous study shows this correlation between speech severity and mortality rates. They initially set up a database called the Kyoto Stroke Registry (KSR) that recorded the patient’s existence or absence of speech disturbances.4 It also included information such as: sex, age, date of stroke onset, blood pressure and arrhythmia on arrival, history of hypertension, arrhythmia, diabetes mellitus and hyperlipemia, use of tobacco and/or alcohol, type of paresis, consciousness level, delay time, and clinical outcome 30 days after the onset.4 Slurred and non-fluent or incoherent speech was documented as a speech disturbance.4 Table 1: Characteristics of Stroke Patients. From Shigematsuet, Kazuo et al. BMC Neurology 13(87): 3. 2013.
Table 2: Characteristics of patients with and without speech disturbance. From Shigematsuet, Kazuo et al. BMC Neurology 13(87): 3. 2013.
In their study they show that more speech disturbances occur with women than men and in general these patients had a higher blood pressure overall.4 They also noted that speech disturbance was almost always observed at the onset of the stoke resulting in the early identification.4 However, patients with this speech disturbance also had a higher chance of mortality 30 days following the stroke.4
Experimental Design & Approach:
A document will be created that the doctor will fill out upon the patient’s entrance to the hospital. This document will be created in such a way that it will be relatively easy for doctors to use and consistent among all doctors. The first question on the document will be does the patient exhibit symptoms associated with strokes such as: trouble walking, trouble speaking or speech disturbance, paralysis or numbness of face, arm or leg, vision troubles, and headaches. The doctor will then document if the patient is having any problems talking or is talking in an unusual pattern.
If the answer is no, the doctor will document this as well and continue to document their procedures and the results of these procedures. The results from tests would also be documented, such as MRIs and CT scans. The specific regions of the brain that are affected would also be documented. However, if the doctor sees symptoms of stroke in a patient who is also exhibiting symptoms of speech determent, they will then have to document the level of speech severity.
Any patterns associated with speech disturbances would also be documented such as: rhyming words, only saying words that start with a certain letter, only or more commonly saying curse words, etc. The doctor would then continue the documentation in the same way as a patient who is not exhibiting speech disturbances. Basic family history and background information would also be documented. The patient’s health would then be documented and monitored for two years post stroke.
The MRIs and CT scans will then be compared to determine if there is in fact a correlation between stroke type, level of speech severity, and affected brain regions.
Anticipated Results & Interpretation:
I hypothesize that there is a correlation between the level of speech severity and the affected brain regions. At this time it is unknown which particular regions will be associated with what symptoms, however; we definitely expect to see an association of the hypothalamus and several other regions. It is very important that doctors gain criteria to assess stroke victims upon their entrance to the hospital. If this study succeeds and there are in fact distinctive regions affected that produce very certain and predictable symptoms, this could lead to huge advancements in the assessment and treatment of stroke patients.
Potential Pitfalls & Alternatives:
It is very possible that there will not be a correlation between speech disturbance severity and the affected regions of the brain, although based on past studies there most likely will be a correlation between the two. However, if this does occur it will still be advantageous to document what symptoms occur, which are easily recognized, and in what region or section of the brain they occur. This data would still be beneficial and could potentially be built upon in other studies.
Specific Aim 2: Determine what treatment options need to changed or adjusted based on speech disturbances
Rationale:
This aim has not been studied in any previous studies, however it will be important, because based on the previous aim it might be necessary to adjust preliminary treatments accordingly. If in fact there is a correlation between speech disturbance and the severity and location of the stroke, doctors could then quickly determine effective treatment options. This could give a family the chance to say their goodbyes or even be life saving.
Preliminary Data:
There is not much preliminary data on this subject, mainly because our potential funding for the first aim will help determine the data for this particular aim. However, if data suggests that a specific location can easily be pinpointed and associated with distinguishable symptoms then it would also lead to suggest that current treatments might in fact need to be adjusted.
However, if the reverse were true an assessment of the current treatment methods would still need to be evaluated. Treatments currently in place are the same ones that have been in place for decades. Therefore, it would stand to reason that they might need to be reevaluated to determine if they are the best treatment option or if there is a newer or different option that doctors just are not familiar with.
Experimental Design & Approach:
We will use the data from the previous study to match the distinct region of the brain to the best method, be it new or old, which has been proven in the lab setting as well as the clinical setting to work effectively. We will do this by extensively looking through the literature and finding proven methods and distinguishing based on the literature which treatments are most effective.
Based on these proven methods we will then match the method to the brain region affected, more or less making a chart that doctors could use to easily look for the known affected brain region and quickly find known treatment options.
This will be especially helpful if a correlation is found between speech disturbance severity and the affected regions of the brain, because an extended chart or criteria could be formatted for doctors to easily, quickly, and effectively treat their patients.
Anticipated Results & Interpretation: We hypothesize that current methods are the most effective in the treatment of strokes, however doctors treatments may need to be adjusted based on the brain region involved.
This again would be an extremely important development in the treatment and care of stroke patients. As mentioned earlier, when caring for stroke patients, time is of the essence. It is very vital that correct treatment start as soon as possible. Therefore, if there is a correlation between speech disturbance and the severity and location of the stroke, doctors could then quickly determine effective treatment options, which could in turn save hundreds of thousands of lives each year.
Potential Pitfalls & Alternatives: There really are not any potential pitfalls that are foreseen in this particular aim. This particular aim will assess the current treatment methods and match the associated brain region with the corresponding treatment method. Therefore, due to its straightforwardness the only pitfall or alteration would depend on the presence or lack of the correlation between speech disturbance severity and the affected regions of the brain. If there were a correlation, then that would be factored into the methodology of the treatments. If no correlations are found, then the treatments will still be assessed as described above.
Specific Aim 3: Using the data we collect from the doctors in the first study, we will categorize strokes based on their severity and location, we will then make a criteria
that doctors across the nation could use to assess stroke patients quickly.
Rationale:
This aim has also not been studied in any previous studies, however it will be important, because the previous two aims will determine the material that will be included on the criteria. If in fact there is a correlation between speech disturbances and the severity and location of the stroke, this criteria will help doctors have an easy way to look at a stroke patient and quickly decide the course of action to take. Currently there is not an easy way for doctors to tell where the stroke is occurring without extensive testing. Therefore, if a criterion were in place it would shorten the treatment and diagnosis time and help save more lives.
Preliminary Data: Because this is a clinical trial and much of the preliminary data is very dependent on number of participants and the data collected from the previous sections of the trial, there is not any actual preliminary data for this particular aim. We strongly hypothesize that there is a correlation between speech disturbance severity and the affected regions of the brain; therefore the creation of the criterion should be an effective tool for doctors. However, even if there is not a correlation between the two a criterion would still be made based on the data collected in the trials and the proven effective treatments for the different regions of the brain that the stroke occurs.
Experimental Design & Approach:
We will use the data from the previous study to hopefully match the level and type of speech disturbance to a distinct region of the brain to the best treatment method. This criterion would then be used in hospitals all over the nation as an effective way to assess stroke patients and efficiently treat their symptoms. We will test its effectiveness by having a multi-center trial in which doctors would use these criteria along with their current methods. They would then provide feedback and make suggestions for improvements.
However, this criterion could be created and used effectively with any of the data that may come from aims 1 and 2.
Anticipated Results & Interpretation: We hypothesize that creation of this criteria will be used in hospitals all over the nation and will become crucial in diagnosing stroke patients effectively and efficiently. If successful it will lead to an extremely important development in the treatment and care of stroke patients. As mentioned earlier, when caring for stroke patients, time is of the essence. It is very vital that correct treatment start as soon as possible. Therefore, with the creation of this criterion it could potentially save millions of lives.
Potential Pitfalls & Alternatives: There really are not any potential pitfalls that could really occur with this aim. In this particular aim we will be collecting the data from the previous aims and arranging it in a way that would allow for the creation of the criteria that would allow doctors to look for the affected brain region and find the correct treatment. The only pitfall or alteration would depend on the presence or lack of the correlation between speech disturbance severity and the affected regions of the brain and the assessment of the treatment options. If there were a correlation, then that would be factored into the methodology of the treatments. If no correlations are found, then the treatments will still be assessed as described above.
References
1. “Types of Stroke.” National Stroke Association. 2013. Web. 18 Nov. 2013.
2. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. (2012). Stroke facts and ststistics. Retrieved from Centers for Disease Control and Prevention website: http://www.cdc.gov/stroke/facts.htm
3. Mayo Clinic. (n.d.). Retrieved from http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=causes
4. Shigematsu, K., Nakano, H., Watanabe, Y., Sekimoto, T., Shimizu, K., Nishizawa, A., & ... Makino, M. (2013). Speech disturbance at stroke onset is correlated with stroke early mortality. BMC Neurology, 13(1), 1-7. doi:10.1186/1471-2377-13-87
Specific Aims: Strokes are the third leading cause of death in the United States and affect over 750,000 people each year. When a person has a stroke the brain is temporarily deprived of oxygen, which causes brain cells to die. The longer it takes a person to receive the medical attention they need the more likely they are to suffer greater and long lasting effects. Therefore, if the symptoms are better understood then getting correct and more efficient medical attention would be easier. In recent studies, researches have found a direct correlation with the level of severity of speech impairments and the severity, or higher mortality rate, of the stroke. This is a critical advancement in the medical field. If doctors …show more content…
were able to recognize the severity of the stroke from a person’s speech patterns then they would more quickly be able to recognize how to properly treat the stroke. This could be extremely crucial in the future of the treatment of strokes. My goal is to develop criteria for doctors to use to more readily treat stroke patients. The proposed study will create a documentation page for doctors to fill out for their stroke patients. This document will help to formulate a way to put these stroke patients in groups based on symptoms, outcomes, and areas of the brain affected. This document will be formatted in a way that is nonbiased and consistent among health professionals. The document will firstly assess the patient’s symptoms. The doctor will then continue to document the progression of the exhibited symptoms. This assessment will mostly consist of a written portion. These criteria will be a new advancement in speed of treating stroke patients. At the present moment there is no such criteria.
Specific Aim 1: Determine if in fact a database can be created based off of doctor’s assessments of their stroke patients’ speech patterns and if there are correlations between speech and region of the brain.
We will do this by assisting doctors with the documentation of the level of speech impairment. Also how the speech is impaired; is there no speech, are you only using rhyming words, are you only using profanities, etc. Then we will determine based off of these types of speech impairments what is the outcome of the stroke. We will also determine if there is a correlation between severity of the stroke and the region of the brain that is affected. We want to be able for doctors to determine, very quickly what region of the brain is affected based off of symptoms alone. Our document we will create will help us to determine this information.
Specific Aim 2: Determine what treatment options need to be changed or adjusted based on speech disturbances. Based on the data we will collect from specific aim one we will be able to assess the affectivity of the current treatment options. We will assess this by testing the effectiveness of current methods. We hypothesize that the majority of current treatments will correspond to our findings. However, based on the particular region of the brain affected it may be more beneficial to use a different treatment than the one currently in place. Not necessarily a new treatment, just one that complies with the symptom and affected areas better.
Specific Aim 3: Using the data we collect from the doctors in the first study, we will categorize strokes based on their severity and location, we will then make a criteria that doctors across the nation could use to assess stroke patients quickly. We want to make a set of criteria that doctors across the nation can use to easily assess their stroke patients. Based on the data we collect we want to categorize the strokes based on severity and location. We will then, place the symptoms into their own categories. In each category it will display what region of the brain is affected and what course of action needs to be used to treat the stroke. By creating this criteria doctors would have an easy, quick way to look at a stroke patient and quickly and efficiently decide the proper course of action to take. As of right now there is not an easy way for doctors to tell where the stroke is occurring without extensive testing. This therefore, prolongs the treatment of the stroke, which in turn can negatively affect the outcome for the patient.
Background and Significance:
Strokes occur in the body when an area of the brain is temporarily deprived of crucial blood supply, causing the brain to be without oxygen for an extended period of time.1 Strokes are currently the third leading cause of death in the United States affecting over 750,000 people each year.2 There are three major types of strokes that can occur: Ischemic, Hemorrhagic, and Transient Ischemic, all of which exhibit speech determent, a common symptom.3 Ischemic strokes occur when the arteries to the brain become narrowed or blocked, which reduces the blood flow to the brain.3 Ischemic are the most common of the three strokes, making up over 85% of stroke cases.3 Hemorrhagic strokes are caused by the leakage or rupturing of a blood vessel in the brain.3 Transient Ischemic are more commonly defined as mini strokes. Transient Ischemic strokes show brief symptoms common of strokes, caused by a brief decrease in oxygen levels in the brain.3 Emergency care is extremely critical in the treatment of strokes. The sooner a patient receives medical attention the more minimal the long-term effects.1
Since speech determent is such a common symptom among stroke victims it should be widely known how severity of speech correlates to the severity of the stroke.3 However, a better system to determine speech severity correlations is needed. Recent studies have proven that there is in fact a reason to research speech disturbance in greater detail.4 In a study by Shigematsu et al. researchers found speech disturbances are commonly observed in patients at the onset of the stroke. Therefore speech disturbance could be used as a more immediate method to identify the severity at the earliest stage of the stroke. His study also shows a direct link to patients with a higher speech disturbance and higher mortality rates.4 One way we plan to continue and build upon these findings is by creating criteria for doctors to initially fill out upon the patient’s entrance to the hospital.
These criteria will include a way for doctors to accurately determine and document the severity of the patient’s speech upon entrance. When a stroke patient enters the emergency care facility, a doctor should be able assess whether or not the patient is exhibiting speech disturbances in correlation with the stroke. The doctor should then be able to determine what type of stroke and where in the brain the stroke is occurring. This in turn will help doctors quickly recognize what treatment options are the best for the patient. This is extremely critical in the care of stroke patients, the less time it takes to provide treatment for a stroke patient, the more likely the patient is to survive. This is innovative in the way that if this scale is approved for use in hospitals it could potentially lower the mortality rates across the country. Since, 130,000 American die each year from strokes, our scale could potentially save 1,000s of …show more content…
lives.2
As the patient continues to receive care, the doctors will periodically document their progress. This documentation will include aspects such as vitals, regions of the brain involved, and improvements or regression of symptoms. We will then analyze this data and more clearly distinguish a relationship between speech severity and mortality. We will also rule out other health factors that could potentially be a cause in death. We will then use this data to attempt to find a correlation between speech severity and patterns, and the regions of the brain affected by the stroke. This is a completely new and innovative concept for the area of stroke research. If there is a link between severity of speech and types of patterns associated with speech and the regions of the brain, this could provide a brand new approach for physicians to use. Our hope is to create a stroke severity scale that physicians could use to help assess their stroke patients immediately. It could potentially cut down on the time it takes for doctors to try and pinpoint where the stroke is occurring. This evaluation is crucial in the treatment, the longer it takes for the doctor to recognize what is happening and where in the brain it is occurring the higher chance of mortality the patient has. This particular study is innovative and significant because it is the first study to consider other causes of death such as underlying medical problems. This study will also document patients who do not exhibit any speech disturbance while exhibiting other symptoms of strokes. We will determine if these patients have a milder or more severe outcome overall. This study will follow the general health of the stroke patients for two years post stroke onset. This is the longest anyone has followed these patients. In a more recent study patients were only followed for 30 days.
Approach:
Specific Aim 1: Determine if in fact a database can be created based off of doctor’s assessments of their stroke patients’ speech patterns and if there are correlations between speech and region of the brain.
Rationale:
There have been recent studies showing that there is a link between the severity of speech impairment and mortality following stroke.4 However, this will be the first study to show if in fact there are any correlations between speech severity, speech patterns, and the regions of the brain affected by a stroke. This will test the hypothesis that the type of speech disturbance can help to detect the area of the brain affected. Therefore speech disturbance could be used as a more immediate method to identify the severity at the earliest stage of the stroke. This is particularly important due to the fact that time is especially critical in stroke treatment, minutes can save lives.
Preliminary Data:
To determine if a database can be created based off of doctors’ assessments of their patient’s stroke and their speech patterns upon entrance to a hospital, we first had to create a way for doctors to document and assess speech severity in a way that would be easy and consistent.
One previous study shows this correlation between speech severity and mortality rates. They initially set up a database called the Kyoto Stroke Registry (KSR) that recorded the patient’s existence or absence of speech disturbances.4 It also included information such as: sex, age, date of stroke onset, blood pressure and arrhythmia on arrival, history of hypertension, arrhythmia, diabetes mellitus and hyperlipemia, use of tobacco and/or alcohol, type of paresis, consciousness level, delay time, and clinical outcome 30 days after the onset.4 Slurred and non-fluent or incoherent speech was documented as a speech disturbance.4 Table 1: Characteristics of Stroke Patients. From Shigematsuet, Kazuo et al. BMC Neurology 13(87): 3. 2013.
Table 2: Characteristics of patients with and without speech disturbance. From Shigematsuet, Kazuo et al. BMC Neurology 13(87): 3. 2013.
In their study they show that more speech disturbances occur with women than men and in general these patients had a higher blood pressure overall.4 They also noted that speech disturbance was almost always observed at the onset of the stoke resulting in the early identification.4 However, patients with this speech disturbance also had a higher chance of mortality 30 days following the stroke.4
Experimental Design & Approach:
A document will be created that the doctor will fill out upon the patient’s entrance to the hospital. This document will be created in such a way that it will be relatively easy for doctors to use and consistent among all doctors. The first question on the document will be does the patient exhibit symptoms associated with strokes such as: trouble walking, trouble speaking or speech disturbance, paralysis or numbness of face, arm or leg, vision troubles, and headaches. The doctor will then document if the patient is having any problems talking or is talking in an unusual pattern.
If the answer is no, the doctor will document this as well and continue to document their procedures and the results of these procedures. The results from tests would also be documented, such as MRIs and CT scans. The specific regions of the brain that are affected would also be documented. However, if the doctor sees symptoms of stroke in a patient who is also exhibiting symptoms of speech determent, they will then have to document the level of speech severity.
Any patterns associated with speech disturbances would also be documented such as: rhyming words, only saying words that start with a certain letter, only or more commonly saying curse words, etc. The doctor would then continue the documentation in the same way as a patient who is not exhibiting speech disturbances. Basic family history and background information would also be documented. The patient’s health would then be documented and monitored for two years post stroke.
The MRIs and CT scans will then be compared to determine if there is in fact a correlation between stroke type, level of speech severity, and affected brain regions.
Anticipated Results & Interpretation:
I hypothesize that there is a correlation between the level of speech severity and the affected brain regions. At this time it is unknown which particular regions will be associated with what symptoms, however; we definitely expect to see an association of the hypothalamus and several other regions. It is very important that doctors gain criteria to assess stroke victims upon their entrance to the hospital. If this study succeeds and there are in fact distinctive regions affected that produce very certain and predictable symptoms, this could lead to huge advancements in the assessment and treatment of stroke patients.
Potential Pitfalls & Alternatives:
It is very possible that there will not be a correlation between speech disturbance severity and the affected regions of the brain, although based on past studies there most likely will be a correlation between the two. However, if this does occur it will still be advantageous to document what symptoms occur, which are easily recognized, and in what region or section of the brain they occur. This data would still be beneficial and could potentially be built upon in other studies.
Specific Aim 2: Determine what treatment options need to changed or adjusted based on speech disturbances
Rationale:
This aim has not been studied in any previous studies, however it will be important, because based on the previous aim it might be necessary to adjust preliminary treatments accordingly. If in fact there is a correlation between speech disturbance and the severity and location of the stroke, doctors could then quickly determine effective treatment options. This could give a family the chance to say their goodbyes or even be life saving.
Preliminary Data:
There is not much preliminary data on this subject, mainly because our potential funding for the first aim will help determine the data for this particular aim. However, if data suggests that a specific location can easily be pinpointed and associated with distinguishable symptoms then it would also lead to suggest that current treatments might in fact need to be adjusted.
However, if the reverse were true an assessment of the current treatment methods would still need to be evaluated. Treatments currently in place are the same ones that have been in place for decades. Therefore, it would stand to reason that they might need to be reevaluated to determine if they are the best treatment option or if there is a newer or different option that doctors just are not familiar with.
Experimental Design & Approach:
We will use the data from the previous study to match the distinct region of the brain to the best method, be it new or old, which has been proven in the lab setting as well as the clinical setting to work effectively. We will do this by extensively looking through the literature and finding proven methods and distinguishing based on the literature which treatments are most effective.
Based on these proven methods we will then match the method to the brain region affected, more or less making a chart that doctors could use to easily look for the known affected brain region and quickly find known treatment options.
This will be especially helpful if a correlation is found between speech disturbance severity and the affected regions of the brain, because an extended chart or criteria could be formatted for doctors to easily, quickly, and effectively treat their patients.
Anticipated Results & Interpretation: We hypothesize that current methods are the most effective in the treatment of strokes, however doctors treatments may need to be adjusted based on the brain region involved.
This again would be an extremely important development in the treatment and care of stroke patients. As mentioned earlier, when caring for stroke patients, time is of the essence. It is very vital that correct treatment start as soon as possible. Therefore, if there is a correlation between speech disturbance and the severity and location of the stroke, doctors could then quickly determine effective treatment options, which could in turn save hundreds of thousands of lives each year.
Potential Pitfalls & Alternatives: There really are not any potential pitfalls that are foreseen in this particular aim. This particular aim will assess the current treatment methods and match the associated brain region with the corresponding treatment method. Therefore, due to its straightforwardness the only pitfall or alteration would depend on the presence or lack of the correlation between speech disturbance severity and the affected regions of the brain. If there were a correlation, then that would be factored into the methodology of the treatments. If no correlations are found, then the treatments will still be assessed as described above.
Specific Aim 3: Using the data we collect from the doctors in the first study, we will categorize strokes based on their severity and location, we will then make a criteria
that doctors across the nation could use to assess stroke patients quickly.
Rationale:
This aim has also not been studied in any previous studies, however it will be important, because the previous two aims will determine the material that will be included on the criteria. If in fact there is a correlation between speech disturbances and the severity and location of the stroke, this criteria will help doctors have an easy way to look at a stroke patient and quickly decide the course of action to take. Currently there is not an easy way for doctors to tell where the stroke is occurring without extensive testing. Therefore, if a criterion were in place it would shorten the treatment and diagnosis time and help save more lives.
Preliminary Data: Because this is a clinical trial and much of the preliminary data is very dependent on number of participants and the data collected from the previous sections of the trial, there is not any actual preliminary data for this particular aim. We strongly hypothesize that there is a correlation between speech disturbance severity and the affected regions of the brain; therefore the creation of the criterion should be an effective tool for doctors. However, even if there is not a correlation between the two a criterion would still be made based on the data collected in the trials and the proven effective treatments for the different regions of the brain that the stroke occurs.
Experimental Design & Approach:
We will use the data from the previous study to hopefully match the level and type of speech disturbance to a distinct region of the brain to the best treatment method. This criterion would then be used in hospitals all over the nation as an effective way to assess stroke patients and efficiently treat their symptoms. We will test its effectiveness by having a multi-center trial in which doctors would use these criteria along with their current methods. They would then provide feedback and make suggestions for improvements.
However, this criterion could be created and used effectively with any of the data that may come from aims 1 and 2.
Anticipated Results & Interpretation: We hypothesize that creation of this criteria will be used in hospitals all over the nation and will become crucial in diagnosing stroke patients effectively and efficiently. If successful it will lead to an extremely important development in the treatment and care of stroke patients. As mentioned earlier, when caring for stroke patients, time is of the essence. It is very vital that correct treatment start as soon as possible. Therefore, with the creation of this criterion it could potentially save millions of lives.
Potential Pitfalls & Alternatives: There really are not any potential pitfalls that could really occur with this aim. In this particular aim we will be collecting the data from the previous aims and arranging it in a way that would allow for the creation of the criteria that would allow doctors to look for the affected brain region and find the correct treatment. The only pitfall or alteration would depend on the presence or lack of the correlation between speech disturbance severity and the affected regions of the brain and the assessment of the treatment options. If there were a correlation, then that would be factored into the methodology of the treatments. If no correlations are found, then the treatments will still be assessed as described above.
References
1. “Types of Stroke.” National Stroke Association. 2013. Web. 18 Nov. 2013.
2. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. (2012). Stroke facts and ststistics. Retrieved from Centers for Disease Control and Prevention website: http://www.cdc.gov/stroke/facts.htm
3. Mayo Clinic. (n.d.). Retrieved from http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=causes
4. Shigematsu, K., Nakano, H., Watanabe, Y., Sekimoto, T., Shimizu, K., Nishizawa, A., & ... Makino, M. (2013). Speech disturbance at stroke onset is correlated with stroke early mortality. BMC Neurology, 13(1), 1-7. doi:10.1186/1471-2377-13-87