PT Weekly: Stroke Rehab and Physiotherapy

A stroke is caused by the interruption of blood supply to the brain, usually because a blood vessel rupture/bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue. There are two types of stroke, hemorrhagic and ischemic. A hemorrhagic stroke occurs when brain arteries rupture. An ischemic stroke occurs when blood supply to part of the brain is cut off.

Hemorrhagic stroke

The term hemorrhagic means flow (or torrent) of blood, referring to bleeding into or around the brain. Symptoms of this type of stroke are similar to those of an ischemic stroke. The major subtypes of hemorrhagic stroke depending on the affected areas in the brain are:

1. Subarachnoid

2. Parenchymal

3. Intraventricular

In hemorrhagic strokes, brain arteries rupture from high blood pressure, abnormal blood vessel walls, or from an aneurysm (an abnormal outpouching of a blood vessel). The rupture causes blood to flood the brain, creating pressure that leads to significant brain injury.

Ischemic stroke

An ischemic stroke occurs when the blood supply is cut off from part of the brain, often related to a clot or a plaque. When this happens, the blood-deprived brain tissue loses its supply of oxygen and nutrients. When brain tissue is deprived of blood for more than a few minutes, the brain tissue begins to die. Brief losses of neurological functions often occur before a full-blown stroke.

Transient ischemic attacks(TIAs) occurs when blood flow to a certain part of the brain is cut off for a short period of time, usually 15 minutes or less. Although TIA is a painless episode, it is an important warning sign. TIA warning signs are similar to those of strokes, even though TIAs does resolve within 24 to 48 hours. These include symptoms like loss of speech, vision problems, weakness of muscles, and severe headaches. Ischemic strokes tend to result from either clotting of an already narrowed vessel, much like in a typical heart attack, or from clots that form elsewhere and then lodge in the vessels that supply the brain.

Signs and Symptoms

Many warning signs indicate one may be suffering a possible stroke. Depending on the function of the part of the brain that is under attack. The signs are:

• Sudden loss of speech
• Slurred speech
• Sudden loss of vision
• Blurry or double vision
• Sudden paralysis
• Sudden weakness
• Sudden dizziness
• Sudden severe headache, often with neck stiffness and vomiting

Irrespective of the type, a full blown stroke is certain to leave an individual affected with a long lasting effects. These effects of a stroke now depend on the extent and the location of damage in the brain. Among the many types of disabilities that can result from a stroke are:

• Inability to move part of the body (paralysis)
• Weakness in part of the body
• Numbness in part of the body
• Inability to speak or understand words
• difficulty communicating
• Difficulty swallowing
• Vision loss
• Memory loss, confusion or poor judgment
• Change in personality; emotional problems

Stroke Rehabilitation

Stroke rehabilitation programs are critical in helping patients regain lost skills, relearn tasks, and work to be independent again. The severity of stroke complications and each person’s ability to recover vary widely. Researchers have found that people who participate in a focused stroke rehabilitation program perform better than most people who don’t have stroke rehabilitation.

After hospitalization for stroke, many patients still have problems with physical, speech, and mental functions. In many cases, there is great potential for the brain to recover itself. With diligent rehabilitation, these prospects can get even better. Even if major neurological deficits do not improve, the patients’ functioning can improve as they learn ways to compensate for their problems. Some factors that play a role in success of stroke rehabilitation are:

• The extent of the brain injury: The less severe the injury, the better the chances for recovery.
• The stroke survivor’s attitude: A survivor’s positive attitude can help him or her cope with difficult times and focus on getting better.
• Family support. A stroke survivor’s family can be the most important form of support during rehabilitation. Family members can reassure stroke survivors that they’re wanted, needed, and still important to the family.
• Time of commencement of rehabilitation: Rehabilitation should begin as soon as a stroke patient is stable, sometimes within 24 to 48 hours after a stroke. This first stage of rehabilitation can occur within an acute-care hospital; however, it is very dependent on the unique circumstances of the individual patient.

Stroke rehabilitation is most successful when it is a team effort. The stroke survivor and his or her family must work together with the team of specialists involve in the rehabilitation. The team includes and not limited to;

1. Physician(Doctors)
2. Rehabilitation nurse
3. Physiotherapist
4. Occupational Therapist
5. Speech and language Therapist
6. Psychologist
7. Social workers

Role of Physiotherapy in Stroke Rehabilitation

Physiotherapy focuses on restoring physical function following stroke. Rehabilitation services for stroke survivors, including physiotherapy, are provided in specialized stroke units, inpatient hospital wards, Outpatient unit and home base or domiciliary units. Physiotherapy has a positive impact in the prevention of subsequent acute events and supports the individual’s ability to live independently through targeted interventions aimed at improving balance, strength, coordination and function. Physiotherapy is a key component in the continuum of care by providing support for the transition from hospital to home.

Physiotherapists specialize in treating disabilities related to motor and sensory impairments. They assess the stroke survivor’s strength, endurance, range of motion, gait abnormalities, and sensory deficits to design individualized rehabilitation programs aimed at regaining control over motor functions.

Physiotherapists help survivors regain the use of stroke-impaired limbs, teach compensatory strategies to reduce the effect of remaining deficits, and establish ongoing exercise programs to help people retain their newly learned skills. Disabled people tend to avoid using impaired limbs. However, the repetitive use of impaired limbs encourages brain plasticity and helps reduce disabilities.

Strategies used by physiotherapists to encourage the use of impaired limbs include selective sensory stimulation such as tapping or stroking, active and passive range-of-motion exercises, and temporary restraint of healthy limbs while practicing motor tasks.

For more information and appointment, contact PCA on 0813 028 0496