Soprano keeps singing - despite stroke
Singing at the opening ceremony of Kuopio Stroke Symposium, Soprano Kaisa Makkonen is an example of what good treatment and rehabilitation can do for stroke patients today. Having a stroke no longer necessarily means that one has to bury life-long dreams and go into retirement.
A positive attitude, perseverance and a strong will have also significantly speeded up recovery.
“Singing is life! Singing really has enhanced my recovery. When I sing, it is easier to use words and express my feelings,” says Makkonen, mostly in English, interpreted by her mother.
Makkonen’s stroke was caused by an advanced, untreated rheumatic disease, which caused only few symptoms. This is why the stroke really took Makkonen and her family by surprise. She maintained her ability to sing, but her aphasia still makes it difficult to produce speech.
“I know the words, but they come out slowly and sometimes wrong. Other languages are easier than Finnish, and it might be easier for me to answer questions by singing.”
Approximately two years have passed since Makkonen’s stroke, and she still goes to speech, occupational and physical therapy three times a week in her home town, Vienna. She is pursuing a Master’s degree in classical music.
“I’m trying to finish my studies, although I’m slightly struggling with my final thesis. It’s difficult for me to write, as letters and numbers are a mess. I can read musical notes, though, and I sing three hours every day.”
Makkonen is hopeful about her future. For her, having a stroke didn’t come with depression, which can easily develop in difficult life situations. This was also something many speakers at Kuopio Stroke Symposium were amazed at.
“I’m not depressed because I can sing. Of course it has been really hard at times, but what can you do about it? Life just sucks sometimes. I’m hoping for the best, but I’m not sure about opera just yet. It takes time to study, and for me, going slowly is the best way,” she says.
New stent retriever treatment significantly speeds up recovery
Speaking at the symposium, Professor Andrew Demchuk from the University of Calgary said it is currently believed that the brain keeps healing slowly as the years pass.
“It was previously thought that recovery is fast during the first few months, and then it stops.”
“It was also believed that the brain has specific areas assigned to specific tasks, but that is not true, either. Thanks to the plasticity of the brain, new areas can pick up tasks from other areas,” said Professor Heinrich Mattle from the University of Bern.
A new treatment in which the clot is mechanically removed from the artery with the help of a stent retriever could have helped also Makkonen.
“This technology has been available for some 15–20 years, but its efficiency hasn’t been proven until now,” Demchuck said.
“Nowadays, patients are successfully treated by using this technology. At Kuopio University Hospital, we treat around 60–70 patients per year, and we estimate that up to 150 of our patients could benefit from this treatment,” said Chief Physician Pekka Jäkälä, Director of Kuopio University Hospital's Neuro Center.
In the treatment of stroke, speed is of the essence. In case of a major clot in the cerebral artery, access to a CT contrast scan already during the thrombolysis is important.
In Finland, clots are removed mechanically in five university hospitals and scans are performed also elsewhere. A shared scan system and telemedicine make it possible to verify the clot type from anywhere. For leaking clots, however, the treatment is not suitable.
“Time equals brain. Once the clot is removed, the spreading of the damage stops, too. The patient can be in up to 50% better shape the next day than he or she would be without the new treatment. This translates into faster and increasingly effective rehabilitation,” Jäkälä says.
“This is one of the most effective treatments we can offer at the moment. However, only interventional radiologists working in university hospitals can remove clots.”
Some causes of stroke remain in the dark
The best way to prevent a stroke is to lead a healthy life. Low levels of physical activity, overweight, diabetes, arrhythmia, smoking, elevated blood pressure and high cholesterol levels can all contribute to the development of stroke.
Sometimes, however, the underlying reason remains in the dark - one can have a stroke no matter how healthy a life one leads.
“This is called a cryptogenic stroke. There may be intermittent atrial fibrillation, and especially younger people may have a hole in between the left and the right ventricle of the heart. These are studied intensively around the globe, as the prevention and treatment methods may differ,” Mattle said.
“We don’t know what affects what just yet. We’d have to be able to screen out patients in whom it is possible to close the hole between the ventricles by using an umbrella-like catheter.”
We also need to think about how long we should monitor patients after the stroke. The risk of recurrence is also something that needs to be kept in mind.
“Prevention of stroke is the most cost-effective treatment”, said Professor Perttu Lindsberg from the Hospital District of Helsinki and Uusimaa, whose speech focused on the Finnish Current Care Guidelines.
Text: Marianne Mustonen
Photos: Raija Törrönen