Stroke rehabilitation

What is a Stroke?

A stroke occurs if an area of brain tissue is deprived of its blood supply causing brain cells to lose their supply of oxygen. This is usually caused by a blockage or burst blood vessel. Without oxygen, brain cells can become irreversibly damaged within minutes. A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications.

Unlike other cells in the body, if brain cells are irreversibly damaged then they are unable to heal themselves. The brain, however, is very adaptable and areas of the brain are capable of learning new tasks to compensate for the areas that have been damaged. Physiotherapy encourages this learning and to help the body re-learn normal movement patterns.

Causes

There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (haemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause lasting symptoms.

Ischaemic strokes

This is the most common type of stroke. These are caused by a blockage within an artery. This blockage restricts the blood flow to an area of the brain, and therefore, brain cells in this area are damaged due to a lack of oxygen.

Haemorrhagic strokes (also known as brain haemorrhages)

These are caused when a blood vessel in the brain ruptures causing bleeding into an area of the brain. This causes a build-up of pressure and damages the delicate brain tissue. Blood flow to neighbouring brain cells is restricted and these cells can also become damaged due to a lack of oxygen.

 Factors related to hemorrhagic stroke include:

• Uncontrolled high blood pressure
• Overtreatment with blood thinners (anticoagulants)
• Bulges at weak spots in your blood vessel walls (aneurysms)
• Trauma (such as a car accident)
• Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy)
• Ischemic stroke leading to hemorrhage

A less common cause of bleeding in the brain is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation).

Transient ischemic attack (TIA)

A transient ischemic attack (TIA) —ministroke — is a temporary period of symptoms similar to those you'd have in a stroke. A TIA doesn't cause permanent damage. They're caused by a temporary decrease in blood supply to part of your brain, which may last as little as five minutes.

Like an ischemic stroke, a TIA occurs when a clot or debris reduces or blocks blood flow to part of your nervous system.

Risk factors

Many factors can increase your stroke risk. Potentially treatable stroke risk factors include:

Lifestyle risk factors

• Being overweight or obese
• Physical inactivity
• Heavy or binge drinking
• Use of illegal drugs such as cocaine and methamphetamine

Medical risk factors

• High blood pressure
• Cigarette smoking or secondhand smoke exposure
• Diabetes
• Obstructive sleep apnea
• Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm, such as atrial fibrillation
• Personal or family history of stroke, heart attack or transient ischemic attack
• COVID-19 infection

Other factors associated with a higher risk of stroke include:

• Age — People age 55 or older have a higher risk of stroke than do younger people.
• Sex — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men.
• Hormones — Use of birth control pills or hormone therapies that include estrogen increases risk.

TREATMENT

Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage.

Medication or drug therapy is the most common treatment for stroke. If you've had an ischemic stroke or TIA, your doctor may advise you to take medications to lower your risk of having another stroke. These are some examples: Antithrombotics (antiplatelet agents and anticoagulants). Platelets are blood cells that form clots. Antiplatelet medications make these cells less sticky and thus less likely to clot. Aspirin is the most commonly used anti-platelet medication. Your doctor can advise you on the appropriate aspirin dose for you.

Recurrent stroke is frequent; about 25 percent of people who  recover from their first stroke will have another stroke within 5 years.

How Neuro physiotherapy helps 

Improve balance and walking and reduce the risk of falls, increase ability to roll / move in bed / sit / stand, reduce muscle spasms, pain and stiffness, increase strength and function of affected arm and leg, retrain normal patterns of movement, increase energy levels, increase independence and quality of life.

Manual Therapy

Manual Therapy encompasses the treatment of muscular ailments of various etiologies through 'hands-on', physical intrusion. This form of physical treatment usually refers to hands-on techniques and includes:  

Soft tissue mobilization,  Myofascial release, Craniosacral techniques, Movement with Mobilization, Movement with Mobilization, Joint manipulation, Mobilization of neural tissue, Visceral mobilization Strain and counter strain, Integrative Manual Therapy.

Roods Sensorimotor Approach

Involves superficial cutaneous stimulation using stroking brushing icing or muscle stimulation with vibration to evoke voluntary activation.

TENS (transcutaneous electrical nerve stimulation) - a small extractable device that delivers electric impulses to nerve endings to stop pain.

Bioelectric treatment- a precise dose of bioelectric currents (electroceuticals), is administered through electrodes placed on the skin to cause a biological change and interrupt pain signals. It can treat chronic and acute pain conditions including complex regional pain syndrome, back pain, muscle pain and headaches.

 Muscle Re-education Approach

Ultimate goal of this approach is the development of co-ordinated movement patterns training begin with learning the control of individual muscles on a cognitive level.

Neuro Development treatment- Bobath technique

Neuro development treatment aims to inhibit spasticity and synergies using inhibitory postures and movements and to facilitate normal autonomic responses that are involved in voluntary movement. The treatment process includes the gradual withdrawal of the direct input of the practitioner leading to increased independence.

Alexander Technique  

The Alexander Technique is a method that works to change (movement) habits in our everyday activities. It is a simple and practical method for improving ease and freedom of movement balance support and coordination. The technique teaches the use of the appropriate amount of effort for a particular activity giving you more energy for all your activities.

Rolfing

Rolfing involves the manipulation of the soft tissues or myofacial system to allow for proper alignment and organization of the whole body in gravity. It helps loosen up spastic muscles and smoothes out gait patterns and helps keep the spine alignment

Complications

A stroke can cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include:

• Paralysis/ loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm.
• Struggle talking or swallowing. A stroke might affect control of the muscles in your mouth and throat, making it difficult for you to talk clearly, swallow or eat. You also may have difficulty with language, including speaking or understanding speech, reading, or writing.
• Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, reasoning, making judgments and understanding concepts.
• Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression.
• Pain. Pain, numbness or other unusual sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm.
• Changes in behavior and self-care ability. People who have had strokes may become more withdrawn. They may need help with grooming and daily chores.