Stroke Rehabilitation

Causes of Stroke

There are two main causes of stroke, a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause lasting symptoms.

1. Ischemic stroke

This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through the bloodstream, most often from the heart, and lodge in the blood vessels in the brain. Some initial research shows that COVID-19 infection may increase the risk of ischemic stroke.

2. Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect the blood vessels. Factors related to hemorrhagic stroke include:

•Uncontrolled high blood pressure

•Overtreatment with blood thinners (anticoagulants)

•Bulges at weak spots in your blood vessel walls (aneurysms)

•Trauma (such as a car accident)

•Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy)

A less common cause of bleeding in the brain is the rupture of an irregular tangle of thin-walled blood vessels (arteriovenous malformation).

3.Transient ischemic attack (TIA)

Sometimes known as a ministroke, is a temporary period of symptoms similar to those in a stroke. A TIA doesn't cause permanent damage. A TIA is caused by a temporary decrease in blood supply to part of the brain, which may last as little as five minutes. Like an ischemic stroke, a TIA occurs when a clot or debris reduces or blocks blood flow to part of the nervous system. Seek emergency care even if you think you've had a TIA because your symptoms got better. It's not possible to tell if you're having a stroke or TIA based only on the symptoms. If you've had a TIA, it means you may have a partially blocked or narrowed artery leading to the brain. Having a TIA increases your risk of having a full-blown stroke later.

What treatment for post stroke rehabilitation ?

The rehabilitation plan will change during the recovery process, depend which part of the body or abilities were affected and the type and severity of damage. A stroke rehabilitation team includes a variety of specialists:

Physicians have the primary responsibility for managing and coordinating the long-term care of stroke survivors, including recommending which rehabilitation programs will best address individual needs. These doctors often include physiatrists (specialists in physical medicine and rehabilitation), neurologists, internists, geriatricians (specialists in seniors), and family practice physicians. A physician also may recommend medicines to ease pain or treat a condition.
Rehabilitation nurses can help a stroke victim relearn the skills needed to carry out the basic activities of daily living. They also provide information about routine health care, such as how to follow a medication schedule, how to care for the skin and manage bladder and bowel issues, how to move out of a bed and into a wheelchair, and special needs for people with diabetes.
Physical therapists specialize in treating disabilities related to motor and sensory impairments. They help restore physical functioning by evaluating and treating problems with movement, balance, and coordination. A physical therapy program may include exercises to strengthen muscles, improve coordination, and regain range of motion and constraint-induced therapy, in which an unaffected limb is immobilized, causing the person to use the affected limb to regain movement and function.
Occupational therapists help to improve motor and sensory abilities while ensuring safety in the post-stroke period. They help a person relearn skills needed for performing self-directed activities (also called occupations) such as personal grooming, preparing meals, and housecleaning.
Therapeutic recreation specialists help people with a variety of disabilities to develop and use their leisure time to enhance their health, independence, and quality of life.
Speech-language pathologists help a person relearn how to use language or develop alternative means of communication and improve the ability to swallow. They teach problem-solving and social skills needed to cope with the aftereffects of a stroke.
Vocational therapists perform many of the same functions that ordinary career counselors do, in helping people with residual disabilities identify vocational strengths and develop résumés that highlight those strengths. They also can help to identify potential employers, assist in specific job searches, and provide referrals to vocational rehabilitation agencies.
Social workers can assist with making financial decisions and plan the return home or to a new living place. They also can help plan for care after being discharged from a rehabilitation facility.
Psychologists can help with the person’s mental and emotional health and assess cognitive skills.

Sign and symptom of stroke

If you having a stroke, pay particular attention to the time the symptoms began. Some treatment options are most effective when given soon after a stroke begins.

Signs and symptoms of stroke include:

•Trouble speaking and understanding what others are saying. You may experience confusion, slur words or have difficulty understanding speech.

•Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in the face, arm or leg. This often affects just one side of the body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile.

•Problems seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.

•Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate that you're having a stroke.

•Trouble walking. You may stumble or lose your balance. You may also have sudden dizziness or a loss of coordination.

What factors affect the outcome of stroke rehabilitation ?

The severity and degree of damage to the brain.
Age. The degree of recovery is often greater in children and young adults as compared to the elderly
Level of alertness. Some strokes depress a person’s ability to remain alert and follow instructions needed to engage in rehabilitation activities.
The intensity of the rehabilitation program.
The home environment. Additions such as stair rails and grab bars can increase independence and safety at home.
The work environment. Modifications to improve physical safety and modifications of work tasks may make return to work possible.
Cooperation of family and friends. Supportive family and social networks can be a very important factor in rehabilitation, which usually extends over many months.
Timing of the rehabilitation. Generally, the sooner it begins, the greater are the chances to regain lost skills and function and for a successful rehabilitation.