STROKE

Stroke is a focal neurological disorder lasting more than 24

hours of sudden development due to a detect in cerebral
blood vessels. It remains one of the top tour causes of
death in the civilized world. Prevention has produced a
Significant reduction in its occurence in the United States
and the United Kingdom; the death rate from stroke has
now decreased in the last decade.
t is paradoxical, but as mortality due to stroke has
decreased due to better medical care, impairment and
disability due to it has actually increased, since
there are more survivors. Generally, the majority of stroke
patients regain ability to walk (with or without assistive
device) and up to half regain independence with their self-
care skills.
Cerebrovascular accident (CVA) is a broad term which
includes all types of occlusion or stenosing disease of
cerebral blood vessels as well as hemorrhagic disease of
brain. It is the name given to the clinical manifestation of
brain infarction causing weakness of one side of the body
orhemiparesis. There may be disturbances of voluntary
movement, sensation, language, emotional and intellectual
functioning. The descriptionof a patient with stroke must be
precise, and include mention of these disturbances.
ETIOPATHOGENESIS
Ihe cerebroOvascular event causing stroke may be
ischaemia or hemorrhage.
Ischemia, which deprives the tissue of O2 and nutrients,
may be caused by embolismm. Thrombotic emboli
phenomena account for most of all strokes.
Assessment
Assessment is also an important and integral part of
treatment. The physiatrist constantly assesses to see if his
treatment has reduced hypertonicity stimulated activity and
improved the general abilities of the patient.
He notes how the patient enters the examination room;
whether he is escorted, and if so whether held or
supported. If the patient is in awheelchair,
he notes how he is propelled, whether both hands are
used or whether it is a one arm propelled wheelchair. The
general appearance of the patient - how
he is sitting and whether he looks alert or less interested is
noted and compared with each subsequent visit for
prognosis.
Conscious Level Assessment
Hemiplegia must not be viewed as simply paralysis of one
side of the body; a stroke victim must be rehabilitated
holistically. During the acute stage the consciousness must
be evaluated.
Eye opening: whether spontaneous to speech or to pain.
Verbal response: whether oriented, confused, speaks
words or only makes SOunds
Motor response: Obeys commands like lifting up arms.
Does the patient localize, flex or extend limb in response to
pain
Cognitive skills: Orientation to time, place and person.