STROKE REHABILITATION

By Dr. Ayesha and Dr. Vivian Consultant Physiotherapists Spectrum Physio Centre.

Introduction

  • Stroke is a medical condition in which poor blood flow to the brain causes cell death.
  • There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.
  • Both cause parts of the brain to stop functioning properly.
  • If symptoms last less than one or two hours, the stroke is a transient ischemic attack (TIA), also called a mini-stroke.
  • Many etiologies can lead to a stroke. Some of the most common risk factors include; Hypertension, diabetes mellitus, hypercholesterolemia, physical inactivity, obesity, genetics, and smoking.
  • Signs and symptoms often appear soon after the stroke has occurred.
  • Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, dizziness, or loss of vision to one side.

Ischaemic stroke

  • Ischaemic strokes are the most common, accounting for up to 80% of strokes, and occur when there is an occlusion of a blood vessel impairing the flow of blood to the brain.
  • Ischaemic Strokes are divided into: - Thrombotic, Embolic and Systemic hypoperfusion.
  • Thrombotic means a blood clot within the main brain artery, Embolic means a blood clot that has dislodged from other area and lodged into the brain artery.
  • Systemic Hypoperfusion means a general decrease in blood supply, eg. 1. in shock 2.occurring in small vessels(lacunar infarcts) caused by chronic, uncontrolled hypertension.

Hemorrhagic stroke

  • Haemorrhagic Strokes occur when a blood vessel in the brain ruptures and bleeds.
  • This leads to increased intracranial pressure which can further cause damage to the healthy/other parts of the brain.
  • The main cause of hemorrhagic stroke is high blood pressure, followed by traumatic head injury.

Presentation based on affected side

  • The terms Left Brain Stroke and Right Brain Stroke refer to the side of the brain where the obstruction causing the stroke occurs.
  • There is not a worse or better side to have a stroke on as both sides control many important functions, but a more severe stroke will result in amplified effects.
  • For any survivor to begin seeing positive changes after a stroke, the rehabilitation process must start right away, regardless of which side of the brain the stroke occurred.
  • Although the effects of a stroke can be severe, the brain has an incredible ability to adjust and even reconnect neurological pathways. This is called Neuroplasticity.

Left brain stroke

  • Possible paralysis on the right side of the body
    Speech/language problems
    Slow, cautious behavior
    Impairment of organizational abilities
    Facial weakness or problems with swallowing
    Memory loss

Right brain stroke

  • Possible paralysis on the left side of the body
    Vision problems
    Quick, overly curious behavior
    Poor decision making
    Facial weakness or problems swallowing
    Memory loss

Management/Interventions

  • Initial acute stage management mainly involves to stabilize the patient.
  • Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
  • Patients presenting with Glasgow Coma Scale scores of 8 require emergent airway control via intubation.

For the Physiotherapists

  • Physiotherapists should be involved early and should make their own assessment of how much they can work with a patient.
  • Early mobilisation is associated with better outcomes, even though the early presentation of the disease may look confounding.
  • Physical exercise acts as preconditioning stimuli that offer brain protection effects and are safe and workable treatment options for providing increased neuroplasticity.

Primary Goals of Rehabilitation

  • Prevent complications
  • Minimize impairments
  • Maximize function

Upper Limb Impairments:

  • Subluxation
    Changes in Sensation
    Contracture
    Swelling
    Coordination Problems
    Weakness
    Altered Muscle Power
    Changes in Muscle Tone
    Hand Dysfunction

Treatment options

  • There is evidence that strength train improve upper-limb strength and function without increasing tone or pain in individuals with stroke.
  • Balance training has also showed positive results to improve static, dynamic and gait balance in patients with stroke.
  • Modified Constraint-Induced Movement Therapy.
  • Gaming and Virtual reality training

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