Dr. Amresh Jamwal
Stroke has become one of the leading causes of neurological disability these days. Stroke occurs when the blood supply of an area of the brain is blocked which stops the oxygen supply to that area leading to damage to the affected cells. Without oxygen, the brain cells of the effected area can become irreversibly damaged within minutes. The irreversibly damaged brain cells are unable to heal themselves, however the cells of the brain are very adaptive & the uneffected cells of the brain are able to learn new tasks to compensate for the lost cells. People having history of hypertension, diabetes, smoking, alcoholism are more at risk of having Stroke. Stroke can be classified into two types: Ischaemic & Haemorrhagic. In Ischaemic stroke, the blood supply to the effected brain cells is stopped due to a blockage within the artery thus stopping the supply of oxygen to the brain cells while in Haemorrhagic stroke, there is a rupture in the blood vessel in the brain causing bleeding into an area of the brain which leads to an increase in the pressure & damages the brain tissues. Ischaemic stroke is more common as compared to Haemorrhagic stroke.
Physical problems commonly faced following Stroke are:
* Weakness of one side of the body (Hemiparesis). The upper limb is usually more effected than the lower limb.
* Weakness / drooping of the face.
* Changes in sensation such as numbness or pins & needle sensation.
* Balance problems.
* Fatigue.
* Loss of field of vision on effected side.
* Co-ordination difficulties.
* Difficulty in judging depth and distance.
Role of Physiotherapy in Stroke:
Physiotherapy is a form of therapy in which the Physiotherapist treats pain, muscular & joint problems or neurological problems by using manual techniques such as resisted exercises, stretching & relaxation along with suitable equipments which can stimulate or relax muscles or inhibit the sensation of pain. Physiotherapy in post Stroke patient contributes to improved functional outcomes for patient, such as patient’s ability to perform activities of daily living. Many physiotherapy techniques, including task-oriented training, gait training, balance training and constraint-induced movement therapy are crucial for the rehabilitation of Stroke patients. The treatment to be given is based upon the patient’s needs, level of functional independence & current condition of the patient. The overall recovery of the patient depends on various factors such as age of patient, previous condition of patient, patient’s motivation, degree of disability, other diseases, etc.
The role of Physiotherapy in a Stroke patient is to:
* Prevent or treat any contractures which may develop because of loss of movement.
* Clearance of airways by using postural drainage techniques.
* Re educate the effected muscles by using various muscle stimulation techniques so that they are able to perform normal movements.
* Balance training for improving balance while sitting, standing & walking so as to decrease the chances of falling.
* Strengthen the weakened muscles by using various strengthening exercises.
* Teach the patient the proper method of using any walking aid according to the patient’s ability to use it.
* Control of pain.
* Advice the patient & his/ her family members on any changes required in the house (such as bedroom & bathroom arrangement) so as to make the patient able to carry out activities of daily life as easily as possible.
* Advice the patient’s family member or attendant on how to help the patient move around, get in/out of bed & proper positioning of the patient in bed.
Some useful tips:
* Exercise is very important, exercises should be part of daily routine to maximize recovery following Stroke. Take advice of a Physiotherapist regarding which exercises are best for the patient.
* Never allow the arm to hang by the patient’s side. Always support the arm with a pillow.
* Never pull on the weak arm or use it to help the patient to move.
* Walking is a great form of exercise. Assistance & guidance should be provided while walking until the patient is sufficiently independent to walk alone.
* Proper posture should be maintained.
* Weak arm and leg should be used as much as possible even if it takes more time.
* Shoes should be comfortable, secure and firm. Slippers should not be worn.
* If the patient is medically unstable, the condition of the patient may deteriorate if the intensity of exercise is beyond patient’s ability. Exercises should be postponed until the patient is medically fit to perform exercises.
* Diet should contain less oil & salt.
* Regular Follow up with the Doctor should be done as reoccurrence of Stroke is common.
Always remember that a Stroke patient may have to be given constant motivation as recovery in a Stroke patient takes time & the patient may get frustrated or depressed because of dependence on others.
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