Physiotherapy for Strokes
Strokes are a very commonly occurring medical condition that can, if not treated properly, have a terrible impact on quality of life and functionality. This is an issue of increasing concern in the UK today, particularly because of the growing aging community. At present strokes are the second most common cause of death in the world and the number one cause of disability in the US and Europe.
What is a stroke?
A stroke is a cerebrovascular accident (CVA) in which blood flow to the brain is disrupted. The brain is the most metabolically active organ in the body and requires a constant supply of oxygen and nutrients to function correctly. What happens in a stroke is that this supply becomes disrupted and a region of the brain begins to suffer damage and loss of function which increases the longer it is deprived of blood.
The disruption in blood flow can be caused by due to blockage (thrombosis) of vessels causing ischemia, or blood leaking from vessels into surrounding tissue in what is called a haemorrhage. Regardless of its cause, a stroke is always a medical emergency that can cause permanent brain damage and, if untreated, death. The likelihood of a stroke occurring is dependent on a number of risk factors which include age, high blood pressure, long term smoking, high cholesterol levels (increasing the likelihood of thrombosis as cholesterol can break off from the arterial wall forming a blockage), and TIAs (transient ischemic attacks, partial blockages).
Strokes typically present with a set of symptoms that occur sequentially. It is this presentation which gave rise to the FAST acronym and initiate in the UK. FAST lists the typical symptoms of a stroke and the order in which they present. The first being facial weakness, usually on one side of the face, leaving the victim unable to smile. This is followed by a weakness in the limbs which is easily assessed if the person can’t raise their arms. The final symptom is in speech, stroke victims often have difficulty understanding speech or articulating themselves as the stroke occurs. Upon the presentation of these three symptoms it is essential to call the emergency services immediately as a stroke is always a medical emergency. By acting quickly you decrease the risk and extent of brain damage.
Because of its prevalence in the population many hospitals have, or are in the process of developing, a stroke unit dedicated to administering rapid and efficient care to stroke victims as they come in. This unit is staffed by stroke experts who are able to respond quickly to symptoms and complications. Stroke treatment is an issue of time, the more quickly treatment can be administered, the better the patient’s chance of recovery.
The first stage in treatment is determining the cause of stroke as the nature of a stroke determines which treatment is best. A CT scan is used to discern between the two main categories of stroke, haemorrhagic or ischemic, in the absence of bleeding on the scan the latter is inferred. Distinguishing between the two is absolutely critical as the treatment for ischemic stroke can potentially be fatal in a patient with hemorrhagic stroke
In the event of an ischemic stroke the focus of treatment is either to remove the blockage mechanically or to bust the clot using thrombolytic drugs. At the same time other treatments are administered to keep other clots from developing. During hemorrhagic strokes a surgical assessment is needed to determine the cause of bleeding and whether or not the patient needs surgical intervention.
Stroke rehabilitation and the importance of physiotherapy
Despite advances in stroke care and in getting people to a dedicated stroke unit as quickly as possible, many stroke victims still suffer disability to some extent. The rehabilitation phase begins once a patient is stable and able to commit to their recovery. Physiotherapists are a key part of the rehabilitation process, involved in improving mobility and independence as much as possible.
Depending on where a stroke strikes and how quickly it’s treated, the event can limit mobility, fine motor function, sensation, and balance. A typical stroke affects one part of the body, so part of the physio’s role is teaching the patient how to adapt to the weakness on the affected side. The physio will conduct an examination prior to implementing a rehabilitation plan to determine the best way to proceed and aid in recovery.
A major issue with one side of the body losing functionality while the other does not is balance and postural misalignment. The extent and nature of treatment is hugely dependent on the patient and the extent of their stroke. In some the stroke has been mild and any adjustments needed are relatively minor, for example compensating for a slight deviation in gait. In others however, the issues can be considerably more severe and treatment geared towards improving mobility to the extent that the patient can use the toilet without support.
The techniques used to achieve stroke rehabilitation are again hugely variable. For patients with minor strokes resistance training, full body exercises, and even running exercises can be recommended. While patients with more severe stroke may need to have smaller muscle groups, like those in their hands, rehabilitated by such tools as therapeutic putty.
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