STROKE REHABILITATION

By Dr. Ayesha and Dr. Vivian

Consultant Physiotherapists
Spectrum Physio Centre.
Introduction

 Stroke is a medical condition in which poor blood flow to the brain causes cell
death.

 There are two main types of stroke: ischemic, due to lack of blood flow, and
hemorrhagic, due to bleeding.

 Both cause parts of the brain to stop functioning properly.

 If symptoms last less than one or two hours, the stroke is a transient ischemic
attack (TIA), also called a mini-stroke.
 Many etiologies can lead to a stroke. Some of the most common risk factors include;
Hypertension, diabetes mellitus, hypercholesterolemia, physical inactivity, obesity, genetics,
and smoking.

 Signs and symptoms often appear soon after the stroke has occurred.

 Signs and symptoms of a stroke may include an inability to move or feel on one side of the body,
problems understanding or speaking, dizziness, or loss of vision to one side.
Ischaemic stroke

 Ischaemic strokes are the most common, accounting for up to 80% of strokes, and occur when
there is an occlusion of a blood vessel impairing the flow of blood to the brain.

 Ischaemic Strokes are divided into: - Thrombotic, Embolic and Systemic hypoperfusion.

 Thrombotic means a blood clot within the main brain artery, Embolic means a blood clot that
has dislodged from other area and lodged into the brain artery.

 Systemic Hypoperfusion means a general decrease in blood supply, eg. 1. in shock 2.occurring in
small vessels(lacunar infarcts) caused by chronic, uncontrolled hypertension.
Hemorrhagic stroke

 Haemorrhagic Strokes occur when a blood vessel in the brain ruptures and
bleeds.

 This leads to increased intracranial pressure which can further cause damage
to the healthy/other parts of the brain.

 The main cause of hemorrhagic stroke is high blood pressure, followed by

traumatic head injury.
Presentation based on affected side

 The terms Left Brain Stroke and Right Brain Stroke refer to the side of the brain
where the obstruction causing the stroke occurs.

 There is not a worse or better side to have a stroke on as both sides control many
important functions, but a more severe stroke will result in amplified effects.

 For any survivor to begin seeing positive changes after a stroke, the rehabilitation
process must start right away, regardless of which side of the brain the stroke
occurred.

 Although the effects of a stroke can be severe, the brain has an incredible ability to
adjust and even reconnect neurological pathways. This is called Neuroplasticity.
 Left brain stroke Right brain stroke

Possible paralysis on the left side of the body

Possible paralysis on the right side of
the body Vision problems

Speech/language problems Quick, overly curious behavior

Slow, cautious behavior Poor decision making

Impairment of organizational abilities Facial weakness or problems swallowing

Facial weakness or problems with

 Memory loss
swallowing
 Memory loss
Management/Interventions

 Initial acute stage management mainly involves to stabilize the patient.

 Critical decisions focus on the need for intubation, blood pressure control,
and determination of risk/benefit for thrombolytic intervention.

 Patients presenting with Glasgow Coma Scale scores of 8 require emergent

airway control via intubation.
For the Physiotherapists
 Physiotherapists should be involved early and should make their own assessment of how much
they can work with a patient.

 Early mobilisation is associated with better outcomes, even though the early presentation of the
disease may look confounding.

 Physical exercise acts as preconditioning stimuli that offer brain protection effects and are safe
and workable treatment options for providing increased neuroplasticity.
Primary Goals of Rehabilitation

 Prevent complications

 Minimize impairments

 Maximize function
Upper Limb Impairments:

Subluxation
Changes in Sensation
Contracture
Swelling
Coordination Problems
Weakness
Altered Muscle Power
Changes in Muscle Tone
 Hand Dysfunction
Treatment options

 There is evidence that strength train improve upper-limb strength and

function without increasing tone or pain in individuals with stroke.

 Balance training has also showed positive results to improve static, dynamic
and gait balance in patients with stroke.

 Modified Constraint-Induced Movement Therapy.

 Gaming and Virtual reality training