STROKE REHABILITATION
by Sandeep Kumar Rajavelu Balachander, Registered Physiotherapist
Stroke Rehabilitation is defined as the progressive, dynamic, goal orientated process aimed at enabling a person with impairment to reach their optimal physical, cognitive, emotional, communicative, and social functional level. The overall aim of physical rehabilitation is to reduce stroke-related disability and help stroke survivors relearn skills that are lost when part of the brain is damaged. It also teaches survivors new ways of performing tasks to circumvent or compensate for any residual disabilities. For example, these skills can include coordinating leg movements in order to walk or carrying out the steps involved in any complex activity. Individuals may need to learn how to bathe and dress using only one hand, or how to communicate effectively when their ability to use language has been compromised. What disabilities can result from a stroke? The types and degrees of disability that follow a stroke depend upon which area of the brain is damaged. Generally, stroke can cause five types of disabilities as follows: 1. Paralysis or problems controlling movement (motor control). Paralysis is one of the most common disabilities resulting from stroke. 2. Sensory disturbances including pain. Stroke patients may lose the ability to feel touch, pain, temperature, or position. 3. Problems using or understanding language (aphasia). At least one-fourth of all stroke survivors experience language impairments, involving the ability to speak, write, and understand spoken and written language. 4. Problems with thinking and memory. Stroke can cause damage to parts of the brain responsible for memory, learning, and awareness. 5. Emotional disturbances. Many people who survive a stroke feel fear, anxiety, frustration, anger, sadness, and a sense of grief for their physical and mental losses. What medical professionals specialize in post-stroke rehabilitation? Post-stroke rehabilitation involves physicians; rehabilitation nurses; physical, occupational, recreational, speech-language, and vocational therapists; and mental health professionals. Physical therapists specialize in treating disabilities related to motor and sensory impairments. They are trained in all aspects of anatomy and physiology related to normal function, with an emphasis on movement. They assess the stroke survivor’s strength, endurance, range of motion, gait abnormalities, and sensory
deficits to design individualized rehabilitation programs aimed at regaining control over motor functions. When can a stroke patient begin rehabilitation? Rehabilitative therapy begins in the acute-care hospital after the person’s overall condition has been stabilized, often within 24 to 48 hours after the stroke. The first steps involve promoting independent movement because many individuals are paralyzed or seriously weakened. Patients are prompted to change positions frequently while lying in bed and to engage in passive or active range of motion exercises to strengthen their stroke-impaired limbs. “Passive” range-of-motion exercises are those in which the therapist actively helps the patient move a limb repeatedly, whereas “active” exercises are performed by the patient with no physical assistance from the therapist. Depending on many factors—including the extent of the initial injury—patients may progress from sitting up and being moved between the bed and a chair to standing, bearing their own weight, and walking, with or without assistance. Researchers found that functional improvements could be late as one year after the stroke, which goes against the conventional wisdom that most recovery is complete by 6 months. The trial showed that 52 percent of the participants made significant improvements in walking, everyday function and quality of life, regardless of how severe their impairment was, or whether they started the training at 2 or 6 months after the stroke. What’s involved in stroke rehabilitation? There are many approaches to stroke rehabilitation. Your rehabilitation plan will depend on the part of the body or type of ability affected by your stroke. Physical activities might include: • Motor-skill exercises: These exercises can help improve your muscle strength and coordination. You might have therapy to strengthen your swallowing. • Mobility training: Youmight learn tousemobility aids, such as a walker, canes, wheelchair or ankle brace. The ankle brace can stabilize and strengthen your ankle to help support your body’s weight while you relearn to walk. • Constraint-induced therapy: An unaffected limb is restrained while you practice moving the affected limb to help improve its function. This therapy is sometimes called forced-use therapy.
• Range-of-motion therapy: Certain exercises and treatments can ease muscle tension (spasticity) and help you regain range of motion. Technology-assisted physical activities might include: • Functional electrical stimulation: Electricity is applied to weakened muscles, causing them to contract. The electrical stimulation may help re-educate your muscles. • Robotic technology: Robotic devices can assist impaired limbs with performing repetitive motions, helping the limbs to regain strength and function. • Virtual reality: Theuseofvideogamesandother computer-based therapies involves interacting with a simulated, real-time environment. Cognitive and emotional activities might include: • Therapy for cognitive disorders. Occupational therapy and speech therapy can help you with lost cognitive abilities, such as memory, processing, problem-solving, social skills, judgment and safety awareness. • Therapy for communication disorders. Speech therapy can help you regain lost abilities in speaking, listening, writing and comprehension. • Psychological evaluation and treatment. Your emotional adjustment might be tested. You might also have counseling or participate in a support group. • Medication. Your doctor might recommend an antidepressant or a medication that affects alertness, agitation or movement. Experimental therapies include: • Noninvasive brain stimulation. Techniques such as transcranial magnetic stimulation have been used with some success in a research setting to help improve a variety of motor skills. • Biological therapies , such as stem cells, are being investigated, but should only be used as part of a clinical trial. • Alternative medicine. Treatments such as massage, herbal therapy, acupuncture and oxygen therapy are being evaluated. • Wireless technology: An activity monitor might help you increase post-stroke activity.
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