STROKE REHABILITATION

A stroke is a sudden interruption in the blood supply of the brain. Stroke also known as brain attack occurs rapidly and requires immediate treatment.. When the symptoms of a stroke last only a short time (less than an hour), it is called a transient ischemic attack (TIA) or mini-stroke. The effects of a stroke depend on which part of the brain is injured, and how severely it is injured. Strokes may cause sudden weakness, loss of sensation, or difficulty with speaking, seeing, or walking. Since different parts of the brain control different areas and functions, it is usually the area immediately surrounding the stroke that is affected. According to the World Health Organization (WHO), 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are left permanently disabled.

The 2010 Global Burden of Disease Study suggested Stroke is the second leading cause of death globally and the third leading cause of premature death and disability as measured in Disability Adjusted Life Years (DALY) Types of Stroke

Ischemic Stroke

The most common type of stroke, accounting for almost 80 percent of all strokes, is caused by a clot or other blockage within an artery leading to the brain. Intracerebral Hemorrhage An intracerebral hemorrhage is a type of stroke caused by the sudden rupture of an artery within the brain. Blood is then released into the brain compressing brain structures. Subarachnoid Hemorrhage A subarachnoid hemorrhage is also a type of stroke caused by the sudden rupture of an artery. A subarachnoid hemorrhage differs from an intracerebral hemorrhage in that the location of the rupture leads to blood filling the space surrounding the brain rather than inside of it. Causes of stroke

The different types of stroke have different causes. However, stroke is more likely to affect people if they have the following risk factors:

• being overweight
• being aged 55 years or older
• a personal or family history of stroke
• an inactive lifestyle
• a tendency to drink heavily, smoke, or use illicit drugs
• hypertension
• diabetes

  • confusion, including trouble with speaking and understanding
  • A headache, possibly with altered consciousness or vomiting
  • Numbness or inability to move parts of the face, arm, or leg, particularly on one side of the body
  • Vision problems in one or both eyes
  • Trouble walking, including dizziness and lack of co-ordination
  • Face drooping: If the person tries to smile, does one side of the face droop?
  • Arm weakness: If the person tries to raise both their arms, does one arm drift downward?
  • Speech difficulty: If the person tries to repeat a simple phrase, is their speech slurred or strange?
  • Time to call for medical help: If any of these signs are observed, contact the emergency services.

The faster a person with suspected stroke receives medical attention, the better their prognosis will be, and the less likely they will be to experience permanent damage or death.

Early medical intervention of acute stroke: The goal for the acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within a short time frame. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.

Physiotherapy is very effective and key to better outcomes for patients with stroke. Research suggests that early mobilization within 24 hours of stroke improves the outcome of patients. Early mobilization is associated with better outcomes – even after taking account of the potential confounding influence of disease severity.

After stoke, the brain cannot grow new cells to replace the ones that has been damaged. Recovery depends on the brain’s ability to re-organize its damaged cells and make up for what has been lost. Physiotherapy therefore can provide expert practical guidance to help but the earlier you start physiotherapy; the better it is for the damaged cells to re-organize. Also, recovery is faster with consistency of therapy.

Stroke often causes paralysis on one side of the body, which means patients lose function in one arm and one leg. In the first weeks and months of recovery, physiotherapists work with stroke survivors to keep these muscles toned and stimulated – even before they regain voluntary movements. If and when function does return, physiotherapy allows patients to relearn everyday skills and retrain their healthy brain cells to control the affected body parts.

Your physiotherapy regimen will revolve around specific goals, which you and your therapist will work together to set and work toward.

Our Primary goals of rehabilitation are to:

  1. Prevent complications
  2. Minimise impairments

Maximise function

Optimising post stroke rehabilitation:

  1. early assessment with standardised evaluations and validated assessment tools
  2. early employment od evidence based interventions relevant to individual patient needs
  3. patient access to an experienced multidisciplinary rehabilitation team
  4. ongoing medical management of risk factors and co-morbidities

 

Interventions

At Nadkof Physiotherapy and Wellness Centre, we use different evidenced base interventions for stroke rehabilitation. These interventions include;

Positioning

Ability to change position and posture is affected in many individuals post stroke as a result of varying degrees of physical impairments. At Nadkof, our aim of positioning is to try to promote optimal recovery and comfort by modulating muscle tone, providing appropriate sensory information, increasing spatial awareness, improved ability to interact with the environment and prevention of complications such as pressure sores, and contracture

Early Mobilization

Immobility is associated with a number of post stroke complications such as deep vein thrombosis etc. We do early mobilization to reduce the time that elapses between stroke and the first time the patient leaves the bed, increasing the amount of physical activity that the patient engages in outside of bed.

Balance training

Balance difficulties are common for many individuals post stroke usually due to a combination of reduced limb and trunk motor control, altered sensation and sometimes centrally determined alteration in body representation such that the person misperceives their posture in relation to the upright. Nadkof Physiotherapy and Wellness Centre focuses also on balance training to improve confidence level of client since balance difficulties reduces one’s confidence level.

Standing

Practice of standing balance is provided for individuals who have difficulty with standing. We help in practicing functional task-specific training while standing, walking training that includes challenge to standing balance (e.g. over ground walking, obstacle courses) and also providing visual or auditory feedback.

Gait & Mobility

The highest priority for many people with limited mobility after stroke is to walk independently. This section focuses on treatments and equipment aimed at improving walking and includes exercise. Individuals post stroke benefit from time spent in task-specific, walking-orientated leg exercises which have a cardiorespiratory focus both early and late after stroke. This is also one of our main focuses at Nadkof Physiotherapy and Wellness Centre.

Treadmill Training

Treadmill training can be utilized for both Gait Re-education / Training but also to aid improvements in aerobic function. Therapists here facilitate alternating stepping and weight-bearing, and as many as three therapists may assist with the complete gait cycle.

Overground Walking

Overground walking involves walking and walking-related activities on a solid surface, where the physiotherapist observes the patient’s gait, usually on a level surface, and has the patient do a range of different activities and exercises to influence their gait. The benefit is that over- ground gait training can be used in almost any setting or location without requiring a great deal of high-tech equipment. Nadkof Physiotherapy and Wellness Centre incorporate this intervention in order to make it easy for clients to practice at home with supervision of their guardians.

Bilateral Arm Training

Bilateral Arm Training provides intensive training of bilateral coordination to enable practice of bimanual skills. During bilateral arm training, movement patterns or activities are performed with both hands simultaneously but independent from each other and can also be cyclic.

Constraint Induced Movement Therapy

Constraint-induced movement therapy (CIMT) involves intensive targeted practice with the affected limb while restraining the non-affected limb, which means that during task-specific practice, individuals with hemiplegic stroke are forced to use their affected limb.

Spasticity Management

 Spasticity can cause discomfort or pain for the and can be associated with activity limitation. Spasticity is common, especially in a non-functional arm with close association between spasticity and other impairments of arm function and mobility

Proprioceptive neuromuscular facilitation (PNF) stretches

PNF is more advanced is a more advanced form of flexibility training that involves both the stretching and contraction of muscle group being targeted. PNF stretching was originally developed as a form of rehabilitation and to that effect, it is very effective. It is excellent for targeting specific muscle groups and as well as increasing flexibility and improves muscle strength.

Contracture Management

A muscle contracture is a permanent shortening of a muscle or joint. It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area. Contractures are not uncommon in limbs affected by spasticity. Contractures can impede activities such as washing or putting on clothes, and may also be uncomfortable or painful and limit the ability to sit in a wheelchair or mobilize

Fatigue Management

Fatigue is common complaint post-stroke, and is evident even in those individuals who have made an otherwise complete recovery. Fatigue has also been associated with depression, and may be a predictor of shorter survival. Therefore Nadkof Physiotherapy and Wellness Centre also focus on fatigue management for our stroke clients.

 

 

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