REHABILITATION IN

CEREBROVASCULAR
DISEASE INFARCT
.
• Effective rehabilitation intervention initiated early after stroke can enhance the
recovery process and minimize functional disability.
• Improved functional outcomes for patients also contribute to patient satisfaction
and reduce potential costly long term care expenditures
The focus of rehabilitation is to in improving the following
• Mobility
• Activity of Daily Living(ADL)
• Communication
• Swallowing
• Shoulder pain
• Spasticity
ASSESSMENT OF REHABILITATION
NEEDS
1. Prevention of complications:
• Swallowing problems(Dysphagia)
• Skin breakdown
• Risk for Deep vein thrombosis(DVT)
• Bowel and Bladder Dysfunction
• Malnutrition
• Pain
2. Assessment of impairment
• Communication impairment
• Motor impairment
• Cognitive deficit
• Visual and spatial deficiency
• Psychological/Emotional deficit
• Sensory deficit

3. Psychosocial assessment and Family/ Caregivers support

4. Assessment of functions
SPECIFIC STROKE IMPAIRMENTS AND THEIR
REHABILITATION
• Walking:
• The standard rehabilitation technique for gait training after stroke is to
walk overground.
• A very common gait training system is body weight–supported
treadmill training (BWSTT)
• Superior for gait training to neurodevelopmental techniques that use
• Practice of balance and weight bearing before stepping and walking
Spasticity
• Motor disorder characterized by a velocity-dependent
increase in tonic stretch reflexes and can contribute to
motor impairment, pain, and disability after stroke.
• Managed with exercise therapy, anti-spastic medication or
by focal management with botulinum toxin or phenol
injections.
• Use of static resting splint for hand and ankle can help
prevent contractures and reduce tone.
 COGNITION, LANGUAGE, AND
COMMUNICATION DISORDERS:
• Approximately one third to half of stroke survivors experience speech and
language disorders.
• Recovery from aphasia usually occurs at slower rate and over more prolonged
time course than does motor recovery.
• Goal of speech therapy is to improve the patient’s ability to speak, understand,
read, and write, and to assist patients to develop strategies that compensate for
or circumvent speech and language problems that are not directly remediable
• Selected Treatment Methods for Aphasia
₋ Language-oriented treatment
₋ Direct stimulus–response treatment
₋ Treatment of aphasic perseveration
₋ Visual action therapy
₋ Oral reading for aphasia
₋ Conversational coaching
 SWALLOWING AND
NUTRITION

• Dysphagia, occurs in approximately one third to half of

all stroke survivors and places the stroke patient at risk
for aspiration and pneumonia, malnutrition, and
dehydration
• Compensatory treatments for disordered swallowing
function include changing posture and positioning for
swallowing, learning new swallowing maneuvers, and
changing food amounts and textures
 SHOULDER PAIN
• Shoulder pain is common complication after stroke that
can inhibit recovery and reduce the quality of life
• Prevalence of shoulder pain in post stroke hemiplegia
ranges from 34% to
84%
 BOWEL AND BLADDER CONTROL
• Incontinence of bowel and bladder occurs in one third to
two thirds of patients after stroke and, if it persists, can
pose a challenge to preparing family caregivers for
patient’s return to home
• Most common reason for incontinence after stroke is
uninhibited evacuation of bladder or bowel
• Timed voiding is primary treatment strategy for patients
with persistent uninhibited bladder
• Bladder ultrasound post void estimates with good
accuracy the residual volume
• The use of intermittent catheterization or indwelling
catheter is also an option, depending on the goals of
the patient and caregiver
 DEPRESSION AND
PSYCHOSOCIAL
• New onsetCONSIDERATIONS
and persistence of disability can give rise to
variety of psychologic reactions in patients who have
sustained a stroke, including sadness, grief, anxiety,
depression, despair, anger, frustration, and confusion
• Treatment consists of psychotherapy, psychosocial
support, milieu therapy, and medications
• Antidepressant medication Escitalopram to treat
poststroke depression demonstrated improvement in
cognitive functioning
• Serotonin-specific reuptake inhibitor medications are
now widely accepted as effective treatment
interventions for poststroke depression
 CONCLUSIONS
• Stroke rehabilitation requires a sustained and coordinated effort
• Communication and coordination among these team members are
paramount in maximizing the effectiveness and efficiency of
rehabilitation
• Investigate multimodal interventions (eg, drug and therapy, brain
stimulation, and therapy)
• Consider including multiple outcomes such as patient centered, self-
report outcomes in future intervention
• Consider computer-adapted assessments for personalized and tailored
interventions
• Explore effective models of care that consider stroke as a chronic
condition rather than simply a single acute event