Physical Therapy and Stroke Rehabilitation

Physical Therapy and Stroke Rehabilitation

Stroke Symptoms, Causes, Treatment and Physical Therapy Rehabilitation

Stroke, also called cerebrovascular accident or brain attack, occurs when blood does not reach the brain cells depriving them of nutrients and oxygen. As a result, brain cells die causing symptoms and disability.

Worldwide, stroke and other cerebrovascular diseases ranks as the second leading cause of death, according to the World Health Organization (WHO). In the United States, the condition is the third leading cause of death and is the leading cause of serious and long-term disability.

With the advancement in medical and physical therapy research, new treatment protocols have been developed, resulting in better patient outcomes. New treatments have been made that help limit the disability caused by a stroke. However, people should know the signs of stroke and act in time.

Causes

Common causes include blockage to the blood vessels supplying the brain by a clot and blood vessel narrowing such as that occurs in arteriosclerosis. If any of these happens, the condition is specifically called ischemic stroke. In some cases, the disorder results from a leaking blood vessel in the brain, a condition called hemorrhagic stroke.

Physical Therapy and Stroke Rehabilitation

Symptoms

There are warning signs people should know when one is experiencing stroke, which include:

  • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
  • Sudden severe headache with no known cause
  • Sudden confusion or trouble speaking or understanding
  • Sudden trouble walking, dizziness, or loss of balance or coordination
  • Sudden trouble seeing in one or both eyes

If you or someone you know experience any of these symptoms, you should call your local emergency hotline immediately. The earlier stroke is recognized, the better the chance of preventing further damage to the brain.

Treatment

With stroke, treatment depends on the stage of the disease. Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and rehabilitation after the stroke.

Medical therapy is probably the first line of treatment for acute stroke. The doctor would try to stop a stroke while it is happening by quickly dissolving the blood clot using drugs or stopping the bleeding if its hemorrhagic stroke. The most popular kinds of drugs to prevent or treat stroke are antithrombotics — which include antiplatelet agents and anticoagulants — and thrombolytics.

Physical Therapy and Rehabilitation of Stroke

For most stroke patients, rehabilitation involves not only physical therapy but also other health care professionals, such as the rehab doctor, nurses, occupational therapists and other providers. This multidisciplinary team is called the “Rehab Team.”

The aim of physical therapy is to help stroke survivors relearn skills that are lost when part of the brain is damaged. This includes relearning simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another.

Acute (In Hospital) Phase – Physical Therapy Treatment Options for Acute Phase of Stroke

Physical therapy usually begins while the patient is in the hospital when condition of the patient has stabilized, usually within 24 to 48 hours after the stroke. The physical therapist will conduct a thorough evaluation of the patient and develop an individualized plan of care.

PT treatment options may include:

Active Range of Motion Exercises (AROME) or Strengthening Exercises on the unaffected limbs.
Passive Range of Motion Exercises (PROME) on the paralyzed extremities or Active Assistive Range of Motion Exercises (AAROME) for weak muscle groups
Provide patient and family education
Education of patient’s family regarding stroke and what they can do to help with patient’s recovery.
Instruct patient or family members on how to properly perform and when to do “log-rolling” to prevent pressure sores.
Teach compensatory techniques or skills
Electrical Stimulation (ES) or Functional Electrical Stimulation (FES)
Stabilization/Mobilization
Progression: lying down to sitting → transferring between bed and chair → sitting to standing → bearing their own weight
Parallel bar exercises (Gait re-education)
Postural education
Acquire assistive device if necessary/Assistive device training

Outpatient Rehabilitation:

For some stroke survivors, physical therapy will be an ongoing process to maintain and refine skills and could involve working with physical therapists for months or years after the stroke.

Outpatient rehabilitation of stroke usually involves further strengthening of weak muscles; patient education; further refining of motor skills; and prevention of further problems associated with stroke and promoting the healthiest possible lifestyle.

Sometimes, full function or return to normal may not be fully achieved depending on the extent of brain damage. In this case, the aim of therapy is to achieve patient’s highest functional independence possible or to prevent complications.

NOTE: Treatment and rehabilitation protocols may vary in different institutions or countries. You should ask your physical therapist or doctor if you have questions about your rehabilitation.

Sources:
NIH Senior Health (August 2010). Stroke. Available at http://nihseniorhealth.gov/stroke/aboutstroke/01.html. Accessed on August 30, 2010.

National Institute of Neurological Disorders and Stroke (October 2008). Post-Stroke Rehabilitation Fact Sheet. Available at http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm. Accessed on August 30, 2010

World Health Organization – Fact sheet N°310 (October 2008). The Top 10 Causes of Death. Available at http://www.who.int/mediacentre/factsheets/fs310/en/index.html. Accessed on August 30, 2010.

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Author: Zaheer

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