What is a stroke: A Stroke, sometimes called a brain attack, occurs when the blood supply to an area in the brain is suddenly disrupted or blocked either due to narrowing of a blood vessel or due to a haemorrhage. In patients who survive a stroke, it leaves a permanent damage to the nerve cells of the brain causing loss of control over perception, movement, speech or other bodily functions.
A transient ischemic attack is like a stroke, producing similar symptoms, but usually lasting a few minutes and causing no permanent damage. However, this could be a warning sign of an eventual stroke. Stroke is a medical emergency, and seeking early treatment is crucial to ensure that the risks of brain damage and potential complications are minimized.
Impact of stroke: Stroke leads to weakness or paralysis of usually one side of the body (hemiplegia) along with some neuromuscular (spasticity) and sensory impairments. Loss of control over basic body movements leads to an inability to use the hand in functional activities, stand, walk and balance themselves. Significant limitations in and dependence on others for activities of daily living cause a social handicap. With over one million stroke cases in India annually, stroke is the leading cause of long-term disability.
Recovery after stroke: After stroke, brain cannot grow nerve cells or replace the damaged cells, but can retrain or reorganize them in order to minimize the deficit. This neurophysiological mechanism, along with similar other mechanisms, is called as neuroplasticity which drives the neurological recovery.
Role of Rehabilitation:
Neurological rehabilitation is an important part of recovery after stroke. Physiotherapists play a key role in the multidisciplinary healthcare team while the patients are in the hospital and afterwards. The goal of Physiotherapy is to promote active recovery by retraining their healthy brain cells to control the affected body part/s and relearn the skills lost due to brain damage. Physiotherapy employs an exercise-based intervention to regain movement control and functional mobility. As and when movement abilities improve, Physiotherapy helps patients relearn everyday skills to regain functional independence and improve quality of life.
When to begin?
Rehabilitative therapy begins in the acute-care hospital after the patient’s overall medical condition has been stabilized, often within 24 to 48 hours after the stroke. It continues on a long-term basis till optimum neurological and functional recovery is achieved.
How Physiotherapy can help?
During the initial phase of stroke, Physiotherapy aims to minimize the risk of medical complications arising due to impaired mobility; however during the further course, Physiotherapy targets to remediate the individual impairments. Depending on the severity of the stroke, a Physiotherapist designs a treatment program tailored to meet patient’s specific needs. Intensive Physiotherapy focused on functional goals and repetition is the key to recovery through exercise. When the patient repeats a movement over and over it helps create new pathways in the brain, and thereby aid in regaining the lost movement control.
A wide range of treatment techniques and approaches from different philosophical backgrounds are utilized in stroke rehabilitation.
Specialized neurotherapeutic techniques such as Proprioceptive Neuromuscular Facilitation, Neurodevelopmental technique, Rood’s approach, Brunnstrom’s Movement therapy, etc and strategies such as Constraint-induced movement therapy are used to promote and relearn normal movement in the affected body parts.
Postural control and mobility training form the mainstay in the therapy. Training is provided during functional activities, under various sensory environmental conditions and with the use of augmented feedback with the help of advanced instruments such as a balance manager system.
Along with hands-on approach, the use of various tools such as Functional Electrical stimulation, Mirror therapy, Treadmill training etc is widely incorporated in therapy.
Use of mobility devices like orthosis, canes, and walkers during some part of recovery help Physiotherapists to improve their treatment strategies and enable stroke patients to navigate safely and live more independent lives.
Patient and family education regarding safety including fall prevention techniques and independence measure at home and in the community is an essential part of stroke rehabilitation. Retraining functional mobility skills required for everyday life as well as vocational and recreational skills is another aspect of neurorehabilitation.
Recently, technological developments in the field of neurorehabilitation have greatly enhanced the scope and outcome of rehabilitation. Now, Physiotherapists are using technology to provide cutting-edge improvements to therapies for patients with stroke. In particular, the use of interventions like electromechanical-assisted gait training, virtual reality training and robot-assisted arm training is becoming more and more common. This emerging trend seems to be promising, offering more opportunities and hope for the recovery.
Holistic and Integrated care:
Physiotherapy aims to promote overall health by ensuring continuity of care all the way. This includes improving aerobic capacity; prevention of complications with minimizing risk factors, such as controlling high blood pressure, diabetes, obesity, etc and lifestyle modifications as appropriate. Neurological rehabilitation, thus, helps the stroke survivors return to the highest level of function and independence possible, while improving patients’ overall quality of life- physically, emotionally and socially through an integrated holistic approach. It encourages them to rebuild self-esteem and become empowered for successful and committed community reintegration.
By Dr Isha Tajane Associate Professor Neurosciences Physiotherapy K. J. Somaiya College of Physiotherapy