Stroke Physiotherapy: What is a stroke?
Strokes are life-threatening medical conditions. With all the scientific research and studies on this neurological and cardiovascular disease, we know that the sooner a patient starts stroke physiotherapy, the better the outcome.
Although strokes can leave you with long-lasting physical and mental problems, rehabilitation can help those recover to continue living a fully active life.
Types of stroke
There are two main types of stroke: haemorrhagic stroke and ischaemic stroke. An ischaemic stroke is caused by a clot that blocks the blood vessels leading to the brain. A haemorrhagic stroke is caused by a blood vessel in the brain bursting and bleeding into the surrounding tissue.
What is a Haemorrhagic Stroke?
Haemorrhagic strokes are caused by bleeding within or around the brain, and they are sometimes described as brain haemorrhages. The bleeding prevents vital oxygen getting to the brain cells, leading to cell death. Around 15% of all stokes are haemorrhagic strokes.
There are two kinds of haemorrhagic strokes. One is caused when blood leeks out of faulty or damaged vessels and into brain tissue (called an Intracerebral Haemorrhage), and the other is cause by bleeding from blood vessels on the surface of the brain (called a Subarachnoid Haemorrhage).
What is an Ischaemic Stroke?
Ischaemic strokes are the most common type of stroke, accounting for about 85% of all cases, and there are two kinds -thrombotic and embolic.
A thrombotic stroke is caused by a clot that forms within a blood vessel in the brain, while an embolic stroke is caused by a clot that forms elsewhere in the body (e.g. in the heart) and then travels to the brain. Thrombotic strokes are the commonest kind of ischaemic strokes. When blood flow in the brain is impeded, the brain tissue becomes starved of oxygen.
An ischaemic stroke causes cell death within the affected parts of the brain, which can impair the way you move, think, speak, smell and feel.
Depending on which artery is blocked, different symptoms develop but generally a blockage to an artery on one side of the brain will cause symptoms on the opposite side of the body. For example, a blockage to the Left Middle Cerebral Artery (MCA) will cause right-sided face and arm weakness, and sensory changes.
What Causes an Ischaemic Stroke?
Blockages within the blood vessels to the brain occur in those arteries that have been progressively narrowed by the process of atherosclerosis.
Atherosclerosis is the build up of fatty plaques within the walls of the arteries. This occurs naturally with age and is more common in males than females, however other lifestyle and environmental factors can speed up or worsen this process.
These factors include:
· Smoking
· Unhealthy/high-fat and cholesterol diets
· High blood pressure
· Lack of exercise
· Diabetes and obesity
· Increased consumption of alcohol
Mini Strokes
A mini stroke, also known as a transient ischaemic attack (TIA), is a temporary disruption of blood flow to the brain. It is similar to a stroke, but the symptoms resolve within a few hours or days and there is no permanent damage to the brain. Mini strokes are often called “warning strokes” because they can be a warning that a person is at risk for a more serious stroke in the future.
What are the symptoms of a stroke?
If you’ve experienced having a stroke, or have witnessed a family member having a stroke, it can be very frightening.
Common stroke symptoms include:
• Common stroke symptoms include:
• sudden numbness or weakness in the face, an arm, or a leg (that will typically affect one side of the body)
• difficulty walking, balancing, or moving in a coordinated way
• rapid confusion, trouble speaking or difficulty understanding speech (known as aphasia)
• visual loss
• memory loss (both short and long-term)
• difficulty swallowing
• severe headache
If you suspect you or a family member may be experiencing a stroke, remember to Think and act FAST
The signs of stroke are:
Face – has their face fallen on one side? Can they smile?
Arms – can they raise both their arms and keep them there?
Speech – is their speech slurred?
Time – time to call 999
Stroke after effects
Muscle weakness and paralysis
Around three-quarters of people who’ve had a stroke will experience leg weakness, and the majority of stroke sufferers will also experience arm weakness, often on the same side of the body. or difficulty moving a limb. You might find that your balance is affected, and you may even have experienced a fall, which is often one of the commonest concerns stroke patients have. If you have foot drop as a result of the stroke affecting the muscles that operate your ankle, you might find yourself having to raise your hip up higher, or swinging your leg outwards, to avoid tripping on your toes when you take a step. Physiotherapy can significantly improve mobility after a stroke.
Communication problems
Around one in three people will experience some difficulty with communication after a stroke, which might include speaking, reading, writing, and understanding what people are saying to them.
Aphasia is when a person has difficulty speaking, or understanding what other people are saying. It’s as if the person can’t find the right words to say, and their understanding of language is interrupted.
Dysarthria is when stroke has affected the mechanical production of speech, and the person has difficulty using their facial and throat muscles to make the correct sounds.
Thankfully, with speech and language therapy, aphasia typically improves quickly within the first 3 to 5 months, and a person with aphasia can continue to improve even years later.
Muscle spasticity (spasm)
About one in three people who have had a stroke will experience muscle spasticity, which is increased tone in the muscles – it’s as if the muscles can’t relax. The muscles become, and painful, and it often causes the arm or fingers in the hand to sit in a bent position. Sometimes the muscles can become permanently shortened, and the joints fix into a position and can’t be straightened. This is known as contracture, and one of the aims of physiotherapy after stroke is to prevent or limit the impact of this problem.
Shoulder pain
Shoulder pain after stroke is very common, affects over ¾ of patients.
When the muscles supporting the shoulder joint are affected during stroke, the shoulder can sublux (meaning that the shoulder becomes partially dislocated from the socket). This can put strain on the ligaments and the capsule surrounding the shoulder, particularly if there is poor positioning of the shoulder when sitting in a chair or lying in bed. In some people this can lead to the development of ‘frozen’ shoulder, particularly if the shoulder has been immobilised for a long time. Frozen shoulder is a condition that causes pain and profound stiffness of the shoulder and early physiotherapy is key to limiting the risk and impact of shoulder pain. Physiotherapy exercises, taping, and electrical stimulation treatments can help activate muscles, restore range of movement, and improve shoulder alignment.
Depression and anxiety
Many people who have suffered a stroke will experience symptoms of low mood, anxiety, or even depression, which is very understandable given the impact that a stroke may have on an individual’s and a family’s life. It’s very natural to have concerns about the recovery process, and what may be possible after a stroke. The good news is, much can be done to help along this journey, and sharing how you’re feeling with a healthcare professional will enable you to get the care you need in managing your mood and mental wellbeing.
Fatigue
Stroke can cause fatigue as the body and brain works to repair itself. It’s very common to experience feeling tired all the time, and you may need additional rest and sleep. We work with stroke patients to help them pace their activities at a level that enables good recovery, without pushing themselves into fatigue.
Can you recover from a stroke? (Using Neuroplasticity to recover from stroke quickly)
The brain is powerful, and it starts to undergo changes through a process called neuroplasticity, where the brain essentially re-wires itself, using different parts of the brain which are still functioning well, to carry out the processes that the stroke-affected parts used to perform.
The process of neuroplasticity is activated when you carry out rehabilitation activities, such as physiotherapy exercises.
Every person’s stroke is different, and whilst it’s not possible to predict with certainty the degree of recovery, much improvement takes places in the first few days and weeks after a stroke. It’s even possible to still make recovery gains years after a stroke.
Stroke physiotherapy and recovery
Stroke rehabilitation should begin as soon as possible. Once the stroke has been medically managed either through medication to help dissolve the blood clot or in some cases surgery (thrombectomy) to remove the clot, physiotherapy treatment should begin.
Depending on the severity of your stroke, your time in hospital may have been short (e.g. a couple of weeks), or many months. You’ll have been assessed to check your swallowing, how continent you are, whether you have any communication problems, and of course, your mobility.
The quicker the treatment, the quicker and easier the recovery. Speed is of the essence.
Physio is key to recovery, with treatments starting within 48 hours of the stroke. Many people who have suffered a stroke find they experience weakness, stiffness, joint pain and struggle to re-find their balance. Your physiotherapist will help you with your recovery of function and mobility. These simple tasks that we all take for granted are walking, sitting, laying down and standing.
Patients are often assessed in the hospital shortly after being admitted. Then, a treatment plan is put together, which will vary from patient to patient while under the hospital’s care.
Programs are tailored to suit the individual’s circumstances, stroke type and patient’s capabilities. Contact us today if you wish to know more or want to continue treatment privately after being discharged.
