A stroke is the damage caused to brain cells by a lack of oxygen when the blood supply to an area of the brain stops. It is the second cause of death and one of the leading causes of disability in adults in the Western world.
Strokes can be classified into two broad categories: ischaemic and haemorrhagic. Ischaemic strokes are caused by an interruption in the blood supply to the brain, whereas haemorrhagic strokes result from the rupture of a blood vessel or an abnormality in the vascular structure (e.g. aneurysm). A stroke can be mild or quite severe and the symptoms temporary or permanent, depending on the extent of the damage to the brain. Ischaemic ones occur at a higher rate than haemorrhagic ones.
Prognostic signs and symptoms of a stroke may include, but are not limited to, an inability to move or feeling numb, paralysis and pain on one side of the body, problems understanding or speaking, feeling dizzy, loss of balance, difficulty seeing and headache. These symptoms often occur immediately after the stroke. If the symptoms last less than an hour or two it may be a transient ischaemic attack. Hemorrhagic strokes are usually associated with a severe headache.
The main risk factor for a stroke is high blood pressure. Other risk factors include smoking, obesity, high blood cholesterol, diabetes mellitus and atrial fibrillation. An ischaemic stroke is usually caused by a blockage of a blood vessel after a blood clot forms either in the brain area or elsewhere in the body, most commonly in the heart. A haemorrhagic stroke is caused by bleeding, either directly into the brain or within the space surrounding the brain. Diagnosis is usually made by imaging methods, such as computed tomography (CT) or magnetic resonance imaging (MRI), along with a physical examination of clinical symptoms. Other methods such as an electrocardiogram (ECG) and blood tests are done to determine risk factors and to rule out other possible causes.
Prevention involves reducing risk factors, and possibly giving medication or surgery for problems with a narrowing of an artery, and whatever else the doctor deems necessary. Many times, a simple aspirin can solve many problems.
The primary goals of managing a stroke are to reduce brain damage and symptoms for maximum recovery of the patient. Once the patient’s condition has stabilized, rehabilitation begins. When necessary, a multidisciplinary team is recommended which may include the physician, physiotherapist, occupational therapist, speech and language therapist and a psychologist or social worker. The patient and his/her family or carers have a very important role in this team. The primary goals of this sub-acute phase include preventing secondary health complications, minimizing harm, and achieving functional goals that promote independence of the patient’s activities of daily living. Loss of functional capacity and performance of skills is often seen after a stroke.
Rehabilitation should be started as soon as possible to ensure the most effective recovery of the patient’s functional capacity. A prompt and appropriate approach optimises the results of rehabilitation, which also depend on the patient. Age, response during treatment, learning ability and general health status are key factors in shaping and progressing the treatment. The latest evidence shows that the most significant gains in a rehabilitation occur in the first 12 weeks after stroke.
People with impaired abilities have a lot of potential.
The purpose of physiotherapy intervention is to adapt to daily life and maximise the patient’s potential. We assess needs, evaluate abilities and maximize potential. The methods used retrain patients in activities to improve their functional abilities, health and independence (e.g. personal hygiene, dressing). In recent years, studies have advocated for specialized therapy oriented to the patients’ functionality with the help of multiple activities. This approach interacts with many brain systems and is organised around a goal.
In any form of goal-oriented activity training, diversity in exercise is needed, with specific skills and accommodations tailored to the patient’s goals and capabilities. Therapy associated with multiple activities is far more helpful in improving balance and reducing falls than any other approach. Training should be based on the practice of daily functional skills, directly related to the patient and his/her environment, and not so much as a focused treatment on impairment or strengthening.
A well-coordinated rehabilitation programme, meaningful and useful for the patient, organised by a qualified physiotherapist, starting as soon as possible after the stroke, leads to an improvement in the patient’s quality of life.
