​​​Taking care of ourselves is an important part of life. But more than that, we should be able to prevent, manage and understand any health problems that arise. This is called health literacy.

Health literacy is important because it helps people find the right health care and services, take care of a chronic condition or disease, or simply maintain their health and wellness.
​
The National Academies of Sciences, Engineering, and Medicine define health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
​
​​ACCORDING TO OFFICIAL WEB SITE OF THE U.S. HEALTH RESOURCES​ "Health Literacy"

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.
Low health literacy is more prevalent among:
Older adults
Minority populations
Those who have low socioeconomic status
Medically underserved people

What is our role in promoting health literacy?

Health literacy is a common thread through all of our programs. A large portion of the people we serve are poor and medically underserved.

They need help understanding and navigating a complex health care system. They require culturally competent providers who speak their language so they can make informed health care choices.

A number of patients may be confused with certain medical language, have difficulty understanding English, struggle with filling out forms, or have limited access to health providers in their community.

With the proper training, health care professionals can identify patients' specific health literacy levels and make simple communication adjustments."

​A systematic review of the past 20 years literature showed "Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services (see Fact Sheet: Health Literacy and Health Outcomes). Both of these outcomes are associated with higher healthcare costs." 

In 2015 the U.S. spent nearly $9,000 for the health of every American — far more than what the governments of other countries spend on the health of their citizens – yet life expectancy and health outcomes are generally worse for Americans than for citizens of other developed nations in North America and Europe.

​​The primary responsibility for improving health literacy lies with public health professionals and the healthcare and public health systems. We must work together to ensure that health information and services can be understood and used by all Americans. We must engage in skill-building with healthcare consumers and health professionals. Adult educators can be productive partners in reaching adults with limited literacy skills.
​
​​​Due to the increased complexity of the healthcare system, it is not surprising that this is creating more people with limited health literacy. ​As our healthcare system gets more complex and as a larger share of responsibility for self-management is moving into patients' hands, the ability to understand and process complex information is becoming increasingly important for getting good health outcomes. 

​For the reasons of the high cost to treat disease in America, "disease prevention should be woven into all aspects of our lives, including where and how we live, learn, work and play. Everyone—government, businesses, educators, health care institutions, communities and every single American—has a role in creating a healthier nation.”

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​Date Last Reviewed:  August 2019

Recovering after stroke   

 A stroke happens when blood flow to any part of the brain stops.

Each person has a different recovery time and need for long-term care. Problems with moving, thinking, and talking often improve in the first weeks or months after a stroke. Some people will keep improving months or years after a stroke.

Information

WHERE TO LIVE AFTER A STROKE

Most people will need stroke rehabilitation (rehab) to help them recover after they leave the hospital. Stroke rehab will help you regain the ability to care for yourself.
Most types of therapy can be done where you live, including in your home.

• People who are not able to care for themselves at home after a stroke may have therapy in a special part of a hospital or in a nursing or rehabilitation center.
• Those who are able to go back home might go to a special clinic or have someone come to their home.

Whether you can go back home after a stroke depends on:

• Whether you can take care of yourself
• How much help there will be at home
• Whether the home is a safe place (for example, stairs in the home might not be safe for a stroke patient who has trouble walking)

You may need to go to a boarding home, adult family home, or convalescent home to have a safe environment.
For people who are cared for at home:

• Changes may be needed to stay safe from falls in the home and bathroom, prevent wandering, and make the home easier to use. The bed and bathroom should be easy to reach. Items (such as throw rugs) that may cause a fall should be removed.
• A number of devices can help with activities such as cooking or eating, bathing or showering, moving around the home or elsewhere, dressing and grooming, writing and using a computer, and many more activities.
• Family counseling may help you cope with the changes needed for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, adult day care, and other community resources (such as a local Department of Aging) may be helpful.
• Legal advice may be needed. Advance directives, power of attorney, and other legal actions may make it easier to make decisions about care.

SPEAKING AND COMMUNICATING

After a stroke, some people may have problems finding a word or being able to speak more than one word or phrase at a time. Or, they may have trouble speaking at all. This is called aphasia.

• People who have had a stroke may be able to put many words together, but they may not make sense. Many people do not know that what they are saying is not easy to understand. They may get frustrated when they realize other people cannot understand. Family and caregivers should learn how best to help communicate.
• It can take up to 2 years to recover speech. Not everyone will fully recover.

A stroke can also damage the muscles that help you speak. As a result, these muscles do not move the right way when you try to speak. This is called dysarthria.
A speech and language therapist can work with you and your family or caregivers. You can learn new ways to communicate.

THINKING AND MEMORY

After a stroke, people may have:

• Changes in their ability to think or reason
• Changes in behavior and sleep patterns
• Memory problems
• Poor judgment

These changes may lead to:

• An increase in the need for safety measures
• Changes in ability to drive
• Other changes or precautions

Depression after a stroke is common. Depression can start soon after a stroke, but symptoms may not begin for up to 2 years after the stroke. Treatments for depression include:Increased social activity. More visits in the home or going to an adult day care center for activities.

• Medicines for depression.
• Visits to a therapist or counselor.

MUSCLE, JOINT, AND NERVE PROBLEMS

Moving around and doing normal daily tasks such as dressing and feeding may be harder after a stroke.
Muscles on one side of the body may be weaker or may not move at all. This may involve only part of the arm or leg, or the whole side of the body.

• Muscles on the weak side of the body may be very tight.
• Different joints and muscles in the body may become hard to move. The shoulder and other joints may dislocate.

Many of these problems can cause pain after a stroke. Pain may also occur from changes in the brain itself. You may use pain medicines, but check with your health care provider first. People who have pain due to tight muscles may get medicines that help with muscle spasms.

Physical therapists, occupational therapists, and rehabilitation doctors will help you relearn how to:

• Dress, groom, and eat
• Bathe, shower, and use the toilet
• Use canes, walkers, wheelchairs, and other devices to stay as mobile as possible
• Possibly return to work
• Keep all of the muscles as strong as possible and stay as physically active as possible, even if you cannot walk
• Manage muscle spasms or tightness with stretching exercises and braces that fit around the ankle, elbow, shoulder, and other joints

BLADDER AND BOWEL CARE
A stroke can lead to problems with bladder or bowel control. These problems may be caused by:

• Damage to part of the brain that helps the bowels and bladder work smoothly
• Not noticing the need to go to the bathroom
• Problems getting to the toilet in time

Symptoms may include:

• Loss of bowel control, diarrhea (loose bowel movements), or constipation (hard bowel movements)
• Loss of bladder control, feeling the need to urinate often, or problems emptying the bladder

Your provider may prescribe medicines to help with bladder control. You may need a referral to a bladder or bowel specialist.

Sometimes, a bladder or bowel schedule will help. It can also help to place a commode chair close to where you sit most of the day. Some people need a permanent urinary catheter to drain urine from their body.
To prevent skin or pressure sores:

• Clean up after incontinence
• Change position often and know how to move in a bed, chair, or wheelchair
• Make sure the wheelchair fits correctly
• Have family members or other caregivers learn how to watch out for skin sores

SWALLOWING AND EATING AFTER A STROKE

Swallowing problems may be due to a lack of attention when eating or damage to the nerves that help you swallow.
Symptoms of swallowing problems are:

• Coughing or choking, either during or after eating
• Gurgling sounds from the throat during or after eating
• Throat clearing after drinking or swallowing
• Slow chewing or eating
• Coughing food back up after eating
• Hiccups after swallowing
• Chest discomfort during or after swallowing

​A speech therapist can help with swallowing and eating problems after a stroke. Diet changes, such as thickening liquids or eating pureed foods, may be needed. Some people will need a permanent feeding tube, called a gastrostomy.

Some people do not take in enough calories after a stroke. High-calorie foods or food supplements that also contain vitamins or minerals can prevent weight loss and keep you healthy.

OTHER IMPORTANT ISSUES

Both men and women may have problems with sexual function after a stroke. Medicines called phosphodiesterase type 5 inhibitors (such as Viagra, Levitra, or Cialis) may be helpful. Ask your provider whether these drugs are right for you. Talking with a therapist or counselor may also help.

​Treatment and lifestyle changes to prevent another stroke are important. This includes healthy eating, controlling illnesses such as diabetes and high blood pressure, and sometimes taking medicine to help prevent another stroke.

Stroke Treatment

Calling 9-1-1 at the first symptom of stroke can help you get to the hospital in time for lifesaving stroke care.

Your stroke treatment begins the moment emergency medical services (EMS) arrives to take you to the hospital. Once at the hospital, you may receive emergency care, treatment to prevent another stroke, rehabilitation to treat the side effects of stroke, or all three.

On the Way to the HospitalIf someone you know shows signs of stroke, call 9-1-1 right away.

Do not drive to the hospital or let someone else drive you. The key to stroke treatment and recovery is getting to the hospital quickly. Yet 1 in 3 stroke patients never calls 9-1-1.1 Calling an ambulance means that medical staff can begin life-saving treatment on the way to the emergency room.

Stroke patients who are taken to the hospital in an ambulance may get diagnosed and treated more quickly than people who do not arrive in an ambulance.1 This is because emergency treatment starts on the way to the hospital. The emergency workers may take you to a specialized stroke center to ensure that you receive the quickest possible diagnosis and treatment. The emergency workers will also collect valuable information that guides treatment and alert hospital medical staff before you arrive at the emergency room, giving them time to prepare.

Learn more about the important role emergency medical services (EMS) plays in improving stroke care.

What Happens at the HospitalAt the hospital, health professionals will ask about your medical history and about the time your symptoms started. Brain scans will show what type of stroke you had. You may also work with a neurologist who treats brain disorders, a neurosurgeon that performs surgery on the brain, or a specialist in another area of medicine.

If you get to the hospital within 3 hours of the first symptoms of an ischemic stroke, you may get a type of medicine called a thrombolytic (a “clot-busting” drug) to break up blood clots. Tissue plasminogen activator (tPA) is a thrombolytic.

tPA improves the chances of recovering from a stroke. Studies show that patients with ischemic strokes who receive tPA are more likely to recover fully or have less disability than patients who do not receive the drug.2,3 Patients treated with tPA are also less likely to need long-term care in a nursing home.4 Unfortunately, many stroke victims don’t get to the hospital in time for tPA treatment. This is why it’s so important to recognize the signs and symptoms of stroke right away and call 9-1-1.

Medicine, surgery, or other procedures may be needed to stop the bleeding and save brain tissue. For example:

• Endovascular procedures. Endovascular procedures may be used to treat certain hemorrhagic strokes. The doctor inserts a long tube through a major artery in the leg or arm and then guides the tube to the site of the weak spot or break in a blood vessel. The tube is then used to install a device, such as a coil, to repair the damage or prevent bleeding.
• Surgical treatment. Hemorrhagic strokes may be treated with surgery. If the bleeding is caused by a ruptured aneurysm, a metal clip may be put in place to stop the blood loss.

What Happens NextIf you have had a stroke, you are at high risk for another stroke:

• 1 of 4 stroke survivors has another stroke within 5 years.5
• The risk of stroke within 90 days of a TIA may be as high as 17%, with the greatest risk during the first week.6

That’s why it’s important to treat the underlying causes of stroke, including heart disease, high blood pressure, atrial fibrillation (fast, irregular heartbeat), high cholesterol, and diabetes. Your doctor may give you medications or tell you to change your diet, exercise, or adopt other healthy lifestyle habits. Surgery may also be helpful in some cases.

Stroke RehabilitationAfter a stroke, you may need rehabilitation (rehab) to help you recover. Before you are discharged from the hospital, social workers can help you find care services and caregiver support to continue your long-term recovery. It is important to work with your health care team to find out the reasons for your stroke and take steps to prevent another stroke.

Learn more about recovering from stroke.

More Information
Learn about CDC programs that address stroke.
From CDC:

• Stroke
• Signs and Symptoms of Stroke
• Heart Attack

​From other organizations:

• What You Need to Know About Strokeexternal icon–National Institute of Neurological Disorders and Stroke
• Know Stroke: Know the Signs. Act in Time.external icon–National Institutes of Health
• Mind Your Risksexternal icon–National Institutes of Health
• Strokeexternal icon–Medline Plus
• Brain Health Resource Pageexternal icon–American Heart Association/American Stroke Association
• Stroke warning signs quiz (Englishexternal icon and Spanishexternal icon)–American Heart Association/American Stroke Association
• What to Expect at the Hospitalexternal icon–National Stroke Association 

REFERENCES

1. Ekundayo OJ, Saver JL, Fonarow GC, Schwamm LH, Xian Y, Zhao X, et al. Patterns of emergency medical services use and its association with timely stroke treatment: findings from Get With the Guidelines-Strokeexternal icon. Circulation: Cardiovascular Quality and Outcomes. 2013;6:262-269.
2. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333(24):1581–7.
3. Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, et al. Early stroke treatment associated with better stroke outcome: the NINDS rt-PA stroke study. Neurology 2000;55(11):1649–55.
4. National Institute of Neurological Disorders and Stroke. (2009). Stroke: challenges, progress, and promiseexternal icon. Bethesda, MD: National Institutes of Health.
5. American Heart Association (AHA), Heart Disease and Stroke Statistics – 2010 Update. http://circ.ahajournals.org/content/121/7/e46#sec-23external icon.
6. Lambert M. Practice Guidelines: AHA/ASA guidelines on prevention of recurrent stroke. Am Fam Physician 2011;83(8):993–1001.

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Heart Disease and Stroke
Risk Factors and CDC's Response

• High Blood Pressure and High Cholesterol
• Diabetes
• Smoking and Secondhand Smoke Exposure
• Obesity, Unhealthy Diet, and Physical Inactivity

More than 877,500 Americans die of heart disease, stroke, or other cardiovascular diseases every year. Heart disease and stroke are the first and fifth leading causes of death in the United States.
​
CDC supports programs that help millions of Americans control their high blood pressure, prevent risk factors for heart disease and stroke, and reduce health disparities, which are differences in health across different geographic, racial, ethnic, and socioeconomic groups. These efforts have helped lower death rates from heart disease and stroke.

Fast StatsIn the United States, cardiovascular diseases cause:1 IN 3 DEATHSor more than 859,000
people each year.$216 BILLIONin health care system costs.$147 BILLIONin lost productivity
on the job from premature death.

The Nation’s Risk Factors and CDC’s Response
Leading risk factors for heart disease and stroke are high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking and secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity.

High Blood Pressure and High CholesterolHigh blood pressure is a leading cause of heart disease and stroke because it damages the lining of the arteries, making them more susceptible to the buildup of plaque, which narrows the arteries leading to the heart and brain. About 116 million US adults (nearly 1 in 2) have high blood pressure, defined as 130/80 mm Hg or higher. Only about 1 in 4 of these people have their high blood pressure under control. About 7 in 10 people who have a first heart attack and 8 in 10 people who have a first stroke have high blood pressure.

Eating too much sodium can lead to high blood pressure. Americans aged 2 years or older consume an average of about 3,400 mg of sodium each day, well over the 2,300 mg recommended by the Dietary Guidelines for Americans. More than 70% of the sodium Americans consume is added outside the home (before purchase), not added as salt at the table or during home cooking.

High LDL cholesterol can double a person’s risk of heart disease. That’s because excess cholesterol can build up in the walls of arteries and limit blood flow to a person’s heart, brain, kidneys, other organs, and legs. Although nearly 86 million US adults could benefit from taking medicine to manage their high LDL cholesterol, only about half (55%) are doing so.

People can improve their blood pressure and cholesterol levels by eating a healthy diet that is low in sodium, being physically active, maintaining a healthy weight, and taking medicines as recommended.

CDC’s Response

​CDC’s Division for Heart Disease and Stroke Prevention (DHDSP) works with partners across government, public health, health care, and private sectors to improve prevention, detection, and control of heart disease and stroke risk factors, with a focus on high blood pressure and high cholesterol. DHDSP also works to improve recognition of the signs and symptoms of a heart attack or stroke and the quality of care prior to and following these events.

Through its scientific and programmatic investments, DHDSP advances proven strategies such as using electronic health records to identify patients at risk and using teams to deliver high-quality care. These teams extend beyond the doctors and nurses to include pharmacists, community health workers, and others outside of the doctor’s office. The division also promotes strategies that link patients to community programs and resources that help them take their medicines consistently, manage their risks, and make healthy lifestyle changes, such as quitting smoking, becoming more physically active, or losing weight.
​
The following major programs support the division’s goals:

• DHDSP funds heart disease and stroke prevention and management activities in all 50 states, the District of Columbia, 12 tribes, 23 tribal-serving organizations, 5 large cities or counties, and 2 groups of city and county health departments. These programs work to reduce risk factors for heart disease and stroke and eliminate health disparities through community and health system interventions.
• WISEWOMAN funds 21 states and 3 tribal organizations to reduce heart disease and stroke risk factors for women aged 40 to 64 with low incomes and little or no health insurance.
• The Paul Coverdell National Acute Stroke Program funds 13 states to use coordinated systems of care to improve the quality of care for patients who have a stroke.

Million Hearts®external icon provides national leadership to promote changes in communities and health care systems across the country to prevent heart attacks and strokes.


DiabetesAdults with diabetes are twice as likely to have heart disease or a stroke as people who do not have diabetes. Over time, high blood sugar from diabetes can damage blood vessels in the heart, brain, kidneys, and other organs, leading to heart attacks, kidney disease, and stroke. More than 2 in 3 people with diabetes have high blood pressure. Diabetes also raises triglycerides and LDL cholesterol.

CDC’s ResponseCDC’s Division of Diabetes Translation is at the leading edge of the nation’s efforts to end the devastation of diabetes. The division works with federal, state, and community organizations to prevent type 2 diabetes and improve the health of all people with diabetes.

The CDC-led National Diabetes Prevention Program delivers an evidence-based lifestyle change program to help adults with prediabetes prevent or delay type 2 diabetes. In partnership with the American Medical Association and the Ad Council, CDC leads the award-winning Do I Have Prediabetes campaign—the first ever to raise awareness across the nation about prediabetes.  The campaign encourages people to find out their risk by taking a 1-minute test at DoIHavePrediabetes.orgexternal icon.

CDC also works to increase access to diabetes self-management education and support (DSMES) services. DSMES services can help people with diabetes better manage their blood sugar levels, reduce their risk for complications, reduce or eliminate the need for medications and emergency room visits, and access cost-savings programs.
These activities support CDC’s overall efforts to reduce death rates from heart disease and stroke by preventing and controlling risk factors.

Smoking and Secondhand Smoke ExposureSmoking is a major cause of heart disease and stroke and causes 1 in every 4 deaths from these conditions. Smoking can damage the body several ways by:

• Raising triglycerides (a type of fat in the blood) and lowering high-density lipoprotein (HDL) cholesterol, also called “good” cholesterol.
• Making blood sticky and more likely to clot, which can block blood flow to the heart and brain.
• Damaging cells that line the blood vessels.
• Increasing the buildup of plaque (fat, cholesterol, calcium, and other substances) in blood vessels.
• Causing thickening and narrowing of blood vessels.

About 34 million US adults smoke cigarettes, and every day, about 1,600 young people under age 18 try their first cigarette.

CDC’s ResponseCDC’s Office on Smoking and Health is at the forefront of the nation’s efforts to reduce deaths and prevent chronic diseases that result from commercial* tobacco use, including heart disease and stroke. OSH prioritizes health equity by creating resources and opportunities for all people to be as healthy as possible.

CDC and its partners promote efforts to:

• Prevent young people from starting to use tobacco.
• Promote quitting among adults and young people.
• Reduce people’s exposure to secondhand smoke.
• Advance health equity by identifying and eliminating tobacco-related disparities.

CDC’s Tips From Former Smokers® (Tips®) campaign, the first federally funded tobacco education campaign, focuses on motivating US adults who smoke to try to quit. Tips features real people who are living with serious health conditions caused by smoking and secondhand smoke exposure. The newest Tips series compelling stories from family members who take care of loved ones affected by a smoking-related disease or disability.

Tips connects people who smoke with resources to help them quit, including 1-800-QUIT-NOW, which directs people to free services from their state quitlines.
* When CDC references tobacco on this web page, we are referring to the use of commercial tobacco and not the sacred and traditional use of tobacco by some American Indian communities.

Obesity, Unhealthy Diet, and Physical InactivityCompared to people at a normal weight, those with overweight or obesity are at increased risk of heart disease and stroke and their risk factors, including high blood pressure, high LDL cholesterol, low HDL cholesterol, high triglycerides, and type 2 diabetes. In the United States, nearly 74% of adults have overweight or obesity.

A healthy diet can reduce a person’s chances of getting heart disease. A healthy diet emphasizes fruits and vegetables, whole grains, and lean proteins and limits saturated and trans fat, added sugars, and sodium.

Physical inactivity can also lead to heart disease—even for people who have no other risk factors. It can increase the chance of other risk factors, including obesity, high blood pressure, high cholesterol, and type 2 diabetes. Only 24% of adults and 16.5% of high school students meet the guidelines for aerobic and muscle-strengthening activity.
CDC’s Response

CDC’s Division of Nutrition, Physical Activity, and Obesity develops and shares proven approaches that make healthy living easier for everyone, which can help people reduce their risk of heart disease and stroke. For example, the division works with hospitals to support breastfeeding moms, early care and education centers to promote healthy eating standards, and workplaces to change policies so that employees have more healthy food choices.

To increase physical activity opportunities, the division partners with states and communities to promote improvements in equitable community design. For example, sidewalks and parks make physical activity safer and more convenient for people of all ages and abilities.

Content provided and maintained by the US Centers for Disease Control and Prevention (CDC). Please see our system usage guidelines and disclaimer.

​STROKE ARTICLES:  1. Brain              2. Speech