Physiotherapy Treatment for Stroke - Success Rate

What Is a Stroke?

A stroke or a cerebrovascular accident is characterized by a sudden loss of neurological function caused by an interruption of blood flow to the brain. Stroke is one of the leading causes of long-term disability around the globe. Ischemic stroke is the most common type of stroke and occurs when a clot blocks or impairs blood flow to the brain, depriving oxygen and nutrients. Hemorrhagic stroke occurs when blood vessels rupture, causing leakage in and around the brain.

What Is the Cause?

Sudden cessation of blood flow and oxygen-glucose deprivation to the brain sets a series of pathological events causing a stroke. Within a few minutes, the majority of the neurons die. Atherosclerosis is a major contributory factor to stroke. It is characterized by plaque formation that is formed due to the accumulation of lipids, fibrin, complex carbohydrates, and calcium deposits on the arterial wall that will lead to progressive narrowing of the blood vessels. This narrowing will affect the blood circulation to the brain.

What Are the Risk Factors for Developing Stroke?

• Hypertension.

• Heart diseases such as congestive heart failure, rheumatic heart disease, and endocarditis.

• Disorders of heart rhythm.

• Hypercholesterolemia (excess cholesterol).

• Sleep apnea.

• Women with early menopause.

• Preeclampsia is a pregnancy complication characterized by high blood pressure during pregnancy.

• Cigarette smoking, physical inactivity, obesity, and poor diet are modifiable risk factors.

What Are the Early Warning Signs of Stroke?

• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.

• Sudden confusion, trouble speaking, or understanding.

• Sudden trouble in seeing in one or both eyes.

• Sudden trouble walking and dizziness.

• Sudden loss of balance or coordination.

• Sudden severe headache with no reason.

• Urinary incontinence.

• Slowness, delay, lack of spontaneity, and motor inaction.

• Speech impairments like aphasia with poor comprehension.

What Are the Complications and Associated Conditions?

1. Altered Consciousness: Coma and decreased arousal levels may occur with extensive brain damage.

2. Disorders of Speech and Language: Aphasia is the term used to describe an acquired communication disorder caused by brain damage and is characterized by an impairment in language formulation, comprehension, and usage. Respiration, phonation, and resonance are also affected.

3. Dysphagia: Dysphagia is defined as the inability to swallow or difficulty swallowing. Patients will have reduced tongue control, poor head control, poor jaw and lip closure, and delayed swallowing. Patients will have difficulty ingesting food, and complications like drooling, and dehydration.

4. Cognitive Dysfunction: The patient will be unaware of what is going on in the external environment and will have a problem with impaired alertness. The patient appears disoriented and unable to provide information about themself, time of day, and geographical location. Attention and memory are impaired with complications like confusion and delirium.

5. Altered Emotional Status: The patient will have mood inconsistencies that may exhibit exaggerated outbursts of laughing or crying. Apathy, euphoria, and depression are some examples of altered mental status in stroke-affected patients.

6. Behavioral Differences: Patients having left hemisphere lesions will have difficulties in communication and processing information. They are described as cautious, anxious, and disorganized. Patients with right hemisphere lesions will demonstrate difficulty in perceptual tasks like grasping the idea of the activity and are described as quick and impulsive.

7. Perceptual Dysfunction: Patients will have disorders of body scheme, spatial relation, and agnosias. Body scheme refers to a postural model of the body, including the relationship of body parts within each other and the environment. Agnosia refers to the inability to process incoming information like visual, audio, and tactile information.

8. Bladder and Bowel Dysfunction: Urinary incontinence can occur from stroke and lead to urinary tract infections. Bowel function disturbances include incontinence, diarrhea, constipation, and impaction.

9. Seizures: Seizures can occur in minimal cases but can be life-threatening if it occurs.

10. Cardiovascular and Pulmonary Dysfunction: Patients demonstrate impaired cardiac output, cardiac decompensation, and rhythm disorders.

11. Deep Venous Thrombosis and Pulmonary Embolus: This can occur in immobilized patients due to clot formation.

12. Osteoporosis and Fracture Risk: This occurs from decreased physical activity, protein, and calcium deficiency.

How Is It Diagnosed?

A CT (computed tomography), MRI (magnetic resonance imaging), and MRA (magnetic resonance angiography) are taken to get a clear picture of the extent of the lesion. Doppler ultrasound and arteriography are other diagnostic tools used to diagnose stroke.

How Is It Managed?

Medical Management: Improving cerebral perfusion by re-establishing circulation and oxygenation, maintaining adequate blood pressure and cardiac output, and restoring and maintaining blood glucose levels and electrolytes. Controlling seizures, infections, and edema, if any, and decreasing the risk of complications should be done by the medical team.

Pharmacological Management:

1. Thrombolytics: Also known as fibrinolytic drugs and they dissolve clots and improve blood flow. For example - Alteplase.

2. Anticoagulants: Anticoagulants are given to people at high risk of getting clots. They act as blood thinners and are used in deep vein thrombosis prophylaxis. For example, Heparin, and Warfarin.

3. Antiplatelets: These medications prevent platelet aggregation. Some examples of antiplatelets are Aspirin and Plavix.

4. Antihypertensives: This class of drugs is given to control hypertension. Some examples are diuretics and calcium channel blockers.

5. Angiotensin II Receptor Antagonists: These drugs enlarge blood vessels and reduce blood pressure. Examples are Telmisartan, and Losartan potassium.

6. Statins: These drugs are used in the management of hypercholesterolemia. Some examples of statins are Atorvastatin calcium and Mevacor.

7. Antispasmodics: They help relax skeletal muscles and decrease spasms. Examples are Carisoprodol and Methocarbamol.

8. Antispastics: They also relax skeletal muscles and decrease spasms. Examples are Baclofen and Diazepam.

9. Anticonvulsants: These drugs are used to control seizures, and some of the anticonvulsants prescribed are Carbamazepine and Clonozepam.

10. Antidepressants: These help in managing depression and related symptoms. Prozac and Fluoxetine are some examples.

Physical Therapy Intervention:

1. Motor Learning Strategies: Activities that are meaningful and important to the patient are selected. The therapist helps the patient learn the desired task. Surface electromyography is used as a feedback mechanism to improve proprioception. Mirror therapy is also beneficial for the patient for progress. The patient performs certain tasks by seeing the mirror, and the affected hand will progressively learn to do that task. Thermal stimulation is used for recovering sensation.

2. Flexibility and Joint Integrity Strategies: Soft tissue and joint mobilization and range of motion exercises are included. Activities like arm cradling, tabletop polishing, sitting, and standing are taught.

3. Strength Improvement: Progressive resistive strength training is incorporated to improve muscle strength. Spasticity is treated through sustained stretching activities.

4. Movement Control: The therapist includes postural control and movement training. Neuromuscular electrical stimulation is used to reduce spasticity and prevent violation movements. Supportive devices such as wheelchairs, canes, and walkers are given to the patient, and the patient is given instructions to use them without falling or tripping.

5. Functional Status: Patients are trained to improve bed mobility, sit, stand, and bed transfers.

6. Postural Balance: The patient is taught to exercise correct posture during sitting, standing, and sleeping. Balance training is given to the patients.

7. Gait Pattern: Functional electrical stimulation can be used to improve gait patterns and improve the strength of the muscles of the upper and lower extremities.

8. Aerobic Capacity: Aerobic training and endurance training are given to the patients. Due to prolonged immobilization, the patient feels fatigued soon. So, endurance is brought back by the therapist through various aerobic exercises.

Conclusion

Stroke results from several factors and can disable the patients at various levels and alter almost various functions of the patient. Effective rehabilitation should be done for a quick recovery of the patient. Through rehabilitation, the motor and sensory functions of the individual are brought back, and the independence of the patient in performing various tasks is restored.