Stroke

Pathophysiology & Epidemiology

Stroke, also known as a cerebrovascular accident, is a condition characterized by a sudden interruption
of blood flow to the brain due to either a blockage (ischemic stroke) or a rupture of a blood vessel
(haemorrhagic stroke). This deprivation of oxygen and nutrients results in the rapid death of brain cells,
leading to immediate loss of function. Stroke primarily affects older adults, though it can occur at any
age. Risk factors include: hypertension, smoking, diabetes, high cholesterol, obesity, cardiovascular
diseases, heavy alcohol use, family history, and certain genetic disorders.

Causes
Ischemic strokes occur when a clot or plaque obstructs an artery, while haemorrhagic strokes occur
when a blood vessel bursts. Contributions include: atherosclerosis, hypertension or aneurysms.

Clinical Presentation Differential Diagnosis & Red Flags

Signs and Symptoms: Red Flags:
Acute Stroke: • Sudden onset of symptoms
• Remember *FAST* • A change in the level of consciousness or
-Facial Drooping unresponsiveness
-Arm weakness • Seizures
-Speech difficulties • Difficulty breathing
-Time to call emergency services and check incident time
•Sudden confusion, trouble speaking or understanding Differential Diagnosis:
• Sudden severe headache with no known cause • Migraine
Post-Stroke: • Seizure
• Weakness, or paralysis on one side of the body • Brain tumour
• Trouble speaking or understanding speech (aphasia) • Multiple sclerosis
• Cognitive changes: memory, attention, or reasoning • Hypoglycaemia
• Difficulty Swallowing (Dysphagia)

Multidisciplinary Team & Their Roles

Neurologist: Diagnoses, plans treatment, and monitors the progression of the stroke.
Physiotherapist: Helps with the recovery of physical activities like walking and balance.
Occupational Therapist: Assists with regaining everyday skills such as dressing, cooking, and writing.
Speech and Language Therapist: Works on problems with speech and swallowing.

Physiotherapy Management
Physiotherapy management for Stroke involves:

Movement Skills: Physiotherapists strengthen weakened body parts and improve balance and
coordination to improve mobility.
Motor Skills: Work to regain fine motor skills like grip strength and hand-eye coordination.
Range of Motion Exercises: Stretching exercises to maintain muscle flexibility and reduce stiffness.
Gait Training: To improve walking, therapists provide training exercises, often initially with assistive
devices, interventions can include weight shifting, stepping drills, and obstacle courses.
Use of Assistive Devices: Physiotherapists train patients on the safe use of aids such as walkers, canes,
or wheelchairs as needed.
Pain Management: Therapists provide techniques to manage pain, including exercises and various
therapies such as positioning techniques, heat/cold therapy, massage and/or TENS.
Family Education: Education on recovery support and manual handling techniques for transferring, at-
home exercise instruction and potentially adapting home environment for safety and accessibility.

www.learningphysiotherapy.com ÓLearning Physiotherapy Pty Ltd. 2023 Built for Students & New Grads.