Stroke is a sudden loss of neurological function i.e. sudden onset of weakness on one side of the body, caused by interruption of blood flow to brain. It is the most common cause of chronic disability. Nowadays stroke affects people from all age groups due to unhealthy lifestyles such as smoking, alcohol consumption, obesity, lack of exercise and sedentary lifestyle which lead to heart ailments and hypertension which in turn might result in a stroke.
Stroke leads to paralysis of one side of body. Patient is unable to move the affected side with increased stiffness (tone) & tightness of muscles and slurred speech. Patients are unable to balance themselves and walk independently. Stroke affects sensory perception, memory and cognition. The activities of daily living are affected resulting in dependence on other members of the family and a poor quality of life.
The goal of stroke rehabilitation is to help patients to re learn skills which are lost and to help them to regain independence and improve quality of life. Rehabilitation depends on the severity of stroke. Rehabilitation starts in hospital as soon as possible following a stroke and is continued on a long term basis. Rehabilitation doesn’t reverse the effects of stroke but helps build capacity and confidence so that the patient can continue with activities of daily living with no or minimal help and thus improve the quality of life.
There are many approaches in stroke rehabilitation.
1. Strategies to improve bed mobility – Teaching to roll and move in bed, come to sit independently
2. Strategies to improve motor function – Exercises to improve voluntary control and ability to use affected limbs
3. Strategies to manage spasticity (Muscle stiffness) – Icing, sustained stretching, splinting and positioning.
4. Motor control training – Patients are given advanced neurotherapeutic techniques such as Neurodevelopmental therapy, Proprioceptive neuromuscular facilitation and Motor relearning programme for enhancing motor control and functional recovery.
5. Hand rehabilitation exercises using Neuromuscular electrical stimulation, Constraint induced movement therapy, Mirror therapy using mirror box, various functional training equipments and peg boards
6. Gait and mobility training includes training in parallel bars, treadmill training, simulation of community ambulation and staircase training using appropriate orthosis and walking aids as required.
7. Postural control and balance training includes Fall prevention strategies, Equilibrium board training, Swiss ball exercises, Stability training and exercises on Balance manager system.
8. Group exercises: Group exercises to encourage peer participation, motivation and to make therapy sessions interactive and function based.
9. Regular counselling & motivation of patient & caregivers to maintain dignity.
Thus neurorehabilitation helps affected persons to regain mobility, functionality, balance, confidence and helps them to reintegrate into the society.
Dr Priti Nisheet Agni (PT),
Assistant Professor, Department of Neuro Physiotherapy,
K. J. Somaiya College of Physiotherapy.