Scuba Diving Post-Stroke: Is It Safe?

Scuba diving after suffering a stroke is a complex issue that requires careful consideration and consultation with medical professionals. The decision to return to diving after a stroke depends on various factors, including the severity of the stroke, the individual's recovery, and their risk of experiencing another stroke. While some people may be able to resume diving with certain restrictions and adaptations, others may face long-term symptoms and complications that make diving unsafe. Consulting a diving doctor or a neurologist familiar with diving medicine is crucial for a comprehensive assessment and personalized advice.

Scuba diving after a stroke: Risk factors

Scuba diving after experiencing a stroke comes with several risk factors that should be carefully considered. While some individuals may be able to return to diving with certain restrictions and adaptations, it is crucial to assess the risks involved. Here are some key factors to consider:

Risk of Recurrence

One of the primary concerns when considering scuba diving after a stroke is the risk of having another stroke underwater. The likelihood of experiencing a stroke increases with age, and having had one stroke already makes a recurrence more probable. A stroke underwater could be fatal, so it is crucial to assess this risk with a medical professional. Consulting a neurologist familiar with diving medicine is advisable.

Underlying Health Conditions

Strokes are often caused by underlying health problems such as high blood pressure, diabetes, and high cholesterol. Addressing and effectively managing these issues can help lower the risk of recurrence and make a return to diving more feasible. It is important to work with healthcare professionals to control these risk factors and consider the overall health and fitness of the individual.

Medication

Individuals who have had a stroke are often prescribed antiplatelet medications, such as aspirin or clopidogrel, to reduce the risk of further strokes. However, these medications could increase the risk of bleeding in the event of decompression illness. Therefore, it is crucial to discuss any medications with a diving doctor to understand the potential risks and implications.

Residual Symptoms and Disabilities

The extent of disability caused by the stroke, such as paralysis, vision loss, or cognitive problems, will impact an individual's ability to dive safely. Residual symptoms represent brain tissue that has been permanently damaged, leaving the brain more vulnerable to further injury. An episode of decompression illness, for example, could result in further serious disability. It is important to establish a baseline function to distinguish new symptoms from old ones in the event of a diving accident or illness.

Physical Limitations

Lasting mobility and movement limitations after a stroke may require further training with specially trained dive buddies. Paralysis or weakness in the arms can make it difficult to work with diving gear, adjust buoyancy, clear the mask, or reach a backup regulator. Leg impairments may affect the ability to swim, kick, or move with gear, especially on a wet boat deck or rocky shore entry. Physical limitations can also impact the individual's ability to respond to emergencies and perform self-rescue or buddy rescue.

In conclusion, while some individuals may be able to return to scuba diving after a stroke, a thorough assessment of the risks is crucial. Consulting with medical professionals, including a diving doctor and a neurologist familiar with diving medicine, is essential to making an informed decision. The individual's overall health, risk of recurrence, residual symptoms, and physical limitations will all play a role in determining their ability to dive safely.

Diving doctor assessment

A diving doctor's assessment will consider several factors when determining whether an individual can scuba dive after experiencing a stroke. Here is a detailed outline of the assessment process:

Risk of Recurrence

Firstly, the diving doctor will assess the risk of the individual experiencing another stroke. This involves evaluating the underlying causes of the stroke, such as high blood pressure, diabetes, or high cholesterol. Addressing and effectively managing these risk factors can lower the chances of recurrence and potentially allow for a return to diving. However, it's important to note that even with proper management, the individual may still be considered high risk, impacting their ability to dive safely.

Residual Symptoms and Functional Impairment

The diving doctor will also need to assess any residual symptoms and functional impairments resulting from the stroke. This includes evaluating the extent of brain damage, permanent disability, and lasting mobility and movement limitations. Residual symptoms such as paralysis, vision loss, or cognitive problems can impact an individual's ability to dive safely. For example, paralysis can make it difficult to work with diving gear and respond to emergencies, while cognitive issues like poor memory or information processing can prevent an individual from diving altogether.

Medication Considerations

The individual's medication regimen after a stroke is an important consideration. Antiplatelet medications, such as aspirin or clopidogrel, are commonly prescribed to reduce the risk of further strokes. However, these medications can increase the risk of bleeding in the event of decompression illness. Therefore, the diving doctor will need to assess the potential risks and benefits of these medications for divers.

Baseline Function Evaluation

It is crucial to establish the individual's baseline function through a comprehensive neurological evaluation. This includes assessing the strength and weakness of major muscle groups, the degree of cerebral injury, and comparing the function of the left and right sides of the body. By establishing a baseline, the diving doctor can more easily distinguish new symptoms from old ones in the event of a diving accident or post-dive health issues.

Diving Restrictions and Adaptations

In some cases, individuals may be able to return to diving with restrictions on the type of diving they can do. This could involve implementing an adaptive diving programme to accommodate any residual weaknesses or limitations. The diving doctor will need to assess the individual's specific needs and make recommendations for diving adaptations or restrictions.

Case-by-Case Decision

Ultimately, the decision to allow an individual to scuba dive after a stroke is a complex and case-by-case determination. The diving doctor will consider all the above factors and seek input from the individual's treating physician, family, and diving partners. Consulting a neurologist familiar with diving medicine is also highly advisable. The goal is to balance the risks and rewards of returning to diving while prioritising the individual's safety and well-being.

Residual symptoms and long-term effects

If a person has residual weakness or paralysis after a stroke, they may require further training with specially trained dive buddies or an adaptive diving programme. Agencies such as Diveheart and the Handicapped Scuba Association can help divers with limited mobility to enjoy scuba diving.

In addition to physical deficits, cognitive problems such as poor memory or difficulty processing information may also impact a person's ability to scuba dive safely. These issues can make it difficult for a person to make quick decisions or respond appropriately in an emergency situation.

The risk of having another stroke is also an important consideration for divers. A stroke underwater could be fatal, so it is crucial to assess the risk of recurrence before returning to diving. This assessment should include an evaluation of risk factors such as high blood pressure, diabetes, high cholesterol, and smoking. Addressing and effectively managing these underlying problems can help reduce the risk of recurrence and make it more likely for a person to safely return to diving.

It is important to consult with a doctor, preferably one familiar with diving medicine, to assess the individual's specific residual symptoms and long-term effects of their stroke and determine their fitness to dive.

Safe diving practices

Diving after a stroke requires careful consideration and assessment of the risks involved. Here are some essential safe diving practices to consider:

Medical Assessment and Clearance:

It is crucial to consult a qualified medical professional, such as a diving doctor or a neurologist familiar with diving medicine, to assess your fitness for diving after a stroke. They will evaluate your risk of having another stroke and determine if it is safe for you to return to diving. Ensure you provide them with all relevant medical information, including hospital letters, test results, and details of any medications you are taking.

Address Underlying Health Conditions:

Strokes are often associated with underlying health problems such as high blood pressure, diabetes, and high cholesterol. By effectively managing these conditions, you can lower your risk of having another stroke and potentially increase your chances of returning to diving safely. Work closely with your healthcare team to address these issues.

Assess Residual Symptoms and Limitations:

After a stroke, you may experience lasting symptoms such as paralysis, weakness, or cognitive problems. It is important to understand how these symptoms may impact your ability to dive safely. Some symptoms may be incompatible with diving, such as cognitive issues or severe physical limitations. However, for problems like residual weakness, an adaptive diving program can be considered.

Case-by-Case Evaluation:

The decision to return to diving after a stroke should be made on a case-by-case basis, taking into account the individual's specific circumstances, the severity of the stroke, the extent of any disabilities, and the likelihood of recurrence. The advice of the treating physician, family, and diving partners is crucial in this decision-making process.

Consider Specialised Training:

If you have lasting mobility and movement limitations due to the stroke, you may require further training with specially trained dive buddies. Agencies such as DiveHeart and the Handicapped Scuba Association specialize in helping divers with limited mobility safely enjoy scuba diving. They can provide the necessary support and adaptations to ensure a safe diving experience.

Manage Risk Factors:

Since diving does carry an increased risk for someone who has experienced a stroke, it is essential to carefully manage risk factors. This includes controlling high blood pressure, treating diabetes and high cholesterol, and addressing lifestyle factors such as smoking. Additionally, certain exercises and techniques, such as vigorous exercise, lifting heavy weights, and using the Valsalva method for ear-clearing, may increase the likelihood of a recurrent stroke and should be approached with caution.

Alternative options for diving

If you are unable to scuba dive due to health reasons, there are several alternative options for diving that you can consider. These alternatives vary in terms of required skills, equipment, and depth reached. Here are some options to explore:

Helmet Diving

Helmet diving is a great option for those who don't know how to swim or have difficulty using a snorkel breathing tube. It involves wearing a bell-shaped helmet that covers your head and shoulders, keeping you dry underwater. The helmet has a panoramic glass window, allowing you to explore the ocean with a clear view. Air is supplied through a hose connected to a raft above, ensuring a constant supply of fresh air. Helmet diving typically occurs at a depth of 9 to 10 feet, and you can expect to spend about 30 minutes submerged. It's important to note that helmet diving may not be suitable for those who are claustrophobic or sensitive to pressure changes.

Breathing Observation Submersible Scooter (B.O.S.S.)

The B.O.S.S. is a unique alternative that combines underwater exploration with scooter mobility. Similar to helmet diving, it utilizes a helmet instead of a scuba tank and snorkel mask. The key difference is that the B.O.S.S. includes a "Vespa"-style scooter, with your air tank mounted on it, allowing you to zip around underwater. With the B.O.S.S., you'll be able to move freely and explore the ocean at your leisure. Like helmet diving, it doesn't require swimming skills, and you'll breathe normally within the helmet. However, the B.O.S.S. offers 360-degree views, providing a more immersive experience.

Snuba

Snuba is a combination of snorkeling and scuba diving that offers a deeper exploration option for those with basic swimming skills. It doesn't require scuba certification, and you won't need to carry heavy air tanks on your back. Instead, the air is supplied by a raft on the surface, connected to your regulator via a hose. This setup allows for greater freedom of movement and exploration. Snuba provides a similar experience to scuba diving but with less cumbersome equipment and more agility underwater.

Tourist Submarine

For those seeking a more relaxed and comfortable underwater experience, tourist submarines are an excellent option. These small submarines can accommodate up to 50 people and offer a dry and easy way to explore the depths. You'll need to be fit enough to climb down a short ladder into the submarine and manage any feelings of claustrophobia. Once inside, you'll be treated to a 45-minute dive at a depth of approximately 115 feet. Through the portholes, you'll be able to observe a diverse range of sea life, including scuba divers, all while remaining dry and comfortable.

Freediving

Freediving is a challenging and rewarding activity that involves diving underwater with a single breath. It requires training and practice to master the necessary breath-holding skills and techniques. Freediving offers a sense of calm and control, promoting self-discovery and a unique connection with the ocean. While you won't have as much bottom time as scuba diving, you'll be more agile and able to get closer to marine life without the bubbles of scuba gear scaring them away.

These alternative options for diving provide opportunities for individuals with varying abilities and interests to explore the underwater world. Each option has its own unique advantages and considerations, so be sure to choose the one that best suits your needs and always prioritize your safety.

Frequently asked questions