SUBMITTED BY:

AMAAN KHAN
RIDHIMA BHALLA
 Definition
 Causes
 Types
 Clinical features
 Assessment
 FIM Scale
 Treatment
 According to WHO, “Stroke is a neurological
deficit of cerebrovascular cause that persists
beyond 24 hours or is interrupted by death
within 24 hours.”
OR
Stroke is defined as the interruption of blood
supply to part of the brain, depriving brain
tissue of oxygen and nutrients.
 Thrombus – Obstruction of a blood vessel by
a blood clot forming locally.
 Emboli – These are free flowing bodies in the
cerebral blood stream in the form of
dislodged thrombus, fats, tissue particles,
etc.
 Arterial Spasm – Artery contraction.
 Ischemia – Low blood supply in any part of
brain.
 1. Ischemic Stroke
In this blood supply to the part of the brain is
decreased, leading to dysfunction of the brain
tissue in that area.
There are 4 reasons why this might happen:
a) Thrombosis
b) Embolism
c) Systemic hypoperfusion
d) Cerebral venous sinus thrombosis
  2. Hemorrhagic Stroke
 It comprises of 10 – 15% of all strokes.
 There are mainly 2 types of hemorrhagic
stroke:
a) Intracerebral hemorrhage – Bleeding within
the brain itself due to bursting of artery.
b) Subarachnoid hemorrhage – Bleeding which
occurs outside the brain tissue but still the
skull between arachnoid mater and pia
mater.
 Headache
 Weakness
 Reflex changes
 Motor Impairment
 Numbness
 Language Disorder
 Sexual Dysfunction
 Bowel and Bladder impairment
 Cardiac and Respiratory problems
 Pain and Stiffness in the joint
 Face drooping
 1. Demographic Details:-
 2. History
-Paralysis before the stroke
- Patients which work during the stroke
3. Medication History
4. Personal History
SMOKING-
ALCOHOLIC-
DIABETES-
5. Vitals
BLOOD PRESSURE
PULSE RATE
HEART RATE
TEMPERATURE
ON OBSERVTION
Body Built-
Posture-
Contracture-
Scar-
Deformity-
Vision-
Gait-
Edema-
5. Examination
Higher Mental Function Examination:-
- Memory
- Intelligence
- Behaviour
- Orientation and Speech
- Arousal and Attension

Sensory Examination:-
- Superficial sensation
- Deep sensation
- Cortical sensation
6. Motor Examination:-
-ROM
-Limb length measurement
-MMT
-Spasticity
Functional
Independent Mobility
Scale
 1:- *Strategies to improve sensory function*
 Stroking
 Stretch
 Icing
 Vibration
 Brushing
 Superficial and deep pressure
 2:- *Strategies to improve flexibility and joint inte
 Joint mobilisation
 Stretching and hotpack
 PROM &AROM
 3:- *Strategies to manage spasticity*
 Mobilisation
 Pnf
 Spint
 Positioning in weight bearing
 Stretching
4:- *Strategies to improve movement control*
 Ecentric and cocentric exercises
 Posture change to siting and finally standing
 Pnf
 5:- *Strategies to improve posture*
 Bridging
 Supine to sit and sit to supine
 Rolling
 6:- *Home management*
 Open air
 Calling bell
 Stair climbing
 Memory book
 Colour cards
 Mats
 Carpets
 7:- *Gait training*
 PNF
 mat exercises
 Parallel bar walking
 quadripud-----kneeling-----half kneeling-----standing
Aim: Physiotherapeutic management after
stroke aims at improving motor control,
upper
extremity functions, gait and activities of
daily living, facilitating self care and societal
participation.

GENERAL RECOMMENDATIONS
1. All stroke patients must be attended and
assessed by a physiotherapist within first 48
hours of admission. The assessment needs to
be reviewed biweekly till the time of
discharge, weekly in first month, monthly till
first 6 months and s maximal functional
recovery.
2. Patient and caregivers should be involved
throughout the process of recovery in
deciding the goals and choice of treatment.
3. Functional use of affected side should be
encouraged as much as possible at all stages
of recovery.
4. Patients along with the caregivers should be
educated and motivated to ensure the
practice of the skills acquired during therapy
sessions at home as well.
5. Aggressive stretching should be avoided
around vulnerable joints (shoulder, knee,
wrist and hand) and flaccid muscles.
6. Duration and frequency of therapy
session should be planned when patient is
most
alert to avoid fatigue and ensure maximal
participation.
7. All stroke patients should get a
minimum of 45 minutes of supervised
physiotherapy 5
days per week till the patient achieves
preset goals as per the assessment.
 Patients with retention of secretions or
consolidation should be managed with
airways
clearances techniques like active cycle of
breathing technique, huffing, coughing
(ifcough reflex is good) or percussion,
vibration and assisted coughing (if cough
reflex is impaired). Head down postural
drainage position should be avoided.

5. Positioning (in bed): Therapeutic positioning

with pillows and bolsters are recommended
to maintain normal joint alignment.
 Early mobility (Mobility between 24-48 hours
of stroke) has been associated with improved
functional outcomes. To mobilize stroke
patients following actions should be taken
considering contraindications.
 a. Active and passive range of motion (ROM)
exercise should be initiated within 24 hours of
onset of stroke.
 b. ROM exercises should be limited to point of
resistance in unconscious patients and range of
comfort in conscious patients.
 c. Bedside sitting and standing can be initiated
within first 48 hours of stroke.
 d. In patients who have undergone angiography
through femoral artery, range of motion
 e. Functional retraining (i.e. participation in
bedside mobility, transfers, and activities of
daily living) and active participation in self
care should be initiated as soon as patient is
able to participate.
 h. Vital parameters (Heart rate, Blood
pressure, Respiratory rate, Temperature).
 THANK YOU....