Stroke Management: Physiotherapy for Paralysis

There are several different approaches to physiotherapy treatment after stroke. These can broadly be divided into approaches that are based on neurophysiological, motor learning, or orthopedic principles.

Some physiotherapists base their treatment on a single approach, whereas others use a mixture of components from a number of different approaches.

Paralysis is the result of damage to the nervous system especially the spinal cord. Paralysis can be due to many reasons that can range from injury, accidents and diseases. The most common reason for paralysis is the stroke which has the ability to injure the brain and obstruct the relationship with the spinal cord.

The main causes of paralysis are

• Spinal cord injury
• Multiple sclerosis
• Cerebral palsy
• Post-polio syndrome
• Neurofibromatosis
• Traumatic brain injury
• Birth defects

Our sense of movement is controlled by the communication between the sensory nerves and the central nervous system. Disruption of the communication of nerve impulses anywhere along the pathway from the brain to the muscle can impair control of muscle movement and cause muscle weakness and loss of coordination. Muscle weakness can progress to paralysis. Paralysis symptoms can occur anywhere in the body.

Some of the symptoms of paralysis attack are:

• Loss of consciousness
• Clumsiness and numbness
• A Severe headache
• Difficulty breathing
• Drooling
• Cognitive difficulties, difficulty writing or speaking
• Changes in mood or behaviour
• Loss of bladder or bowel control
• Loss or changes in vision and/or hearing
• Nausea with or without vomiting

It comes in many forms, and the extent to which a person is immobilised may change over time as physiotherapy, changes in health and sheer luck alter the way the body responds to physical damage. Typically paralysis is divided into four categories, though there are uncountable ways that the body can be injured. The four types of paralysis are:

1. Monoplegia – paralysis accompanied with involuntary tremors.
2. Hemiplagia – paralysis of the one side of the body – face, arms and legs.
3. Paraplegia – paralysis of the lower half of the body.
4. Quadriplegia – paralysis of the arms and legs.

1. MONOPLEGIA:

Monoplegia is a paralysis that denotes partial or complete loss of voluntary motor function in one limb. Monoplegia affected people retain control over the rest of their body, but cannot move or feel sensations in the affected limb.

2. HEMIPLEGIA:

Hemiplegia affects an arm and a leg on the same side of the body. Hemiplegia often begins with a sensation of pins and needles, progresses to muscle weakness, and then to complete paralysis.

3. PARAPLEGIA:

Paraplegia is a spinal cord injury that paralyses the lower limbs. It is a result of severe damage to the spinal cord and the nervous system. It mainly affects the trunk, legs, and the pelvic region, resulting in loss of movement. The affected people cannot walk, move their legs, or feel anything below the waist. Paraplegics are able to regain some functioning with physiotherapy, which works to retrain the brain and spinal cord to work around limitations while strengthening muscles and nerve connections.

4. QUADRIPLEGIA:

Quadriplegia or Tetraplegia is a medical condition in which the lower extremities, upper extremities, and almost the entire trunk/torso get paralysed. Some people with quadriplegia spontaneously regain some or all functioning, while others slowly retrain their brains and bodies through dedicated physiotherapy and exercise.

The physiotherapy treatment provided for paralysis will be dependent upon the cause and severity of the symptoms. This will be established by a thorough subjective and objective neurological assessment in the clinic or in the home environment.

Following the assessment, there will be the opportunity to discuss your goals and expectations of physiotherapy treatment.

Physiotherapy treatment for paralysis may focus on:

• Muscle strengthening
• Stretches to maintain muscle length and joint range of motion
• Core stability exercises
• Dynamic balance work
• Transfer practice
• Re-education of walking pattern
• Sensory stimulation
• Facilitation of return to hobbies/driving/work
• Use of gymnasium facilities
• Use of hydrotherapy pool
• Functional electrical stimulation
• Provision of walking aids and equipment
• Carer education

The benefits of physiotherapy are:

• Increased muscle strength
• Maintain range of movement and muscle length
• Improved core stability
• Improved sitting/standing balance
• Improved coordination and sensation
• Improved posture

Improved walking pattern and stamina

• Improved ability to carry out day to day activities
• Exercises to complete at home independently or with family

To book an appointment at PCA for your stroke care call 0813 028 0496