What Is a Stroke?
Stroke is caused when the blood supply to the brain is disrupted, either through a blockage (ischaemic stroke) or a rupture (haemorrhagic stroke). A stroke is a medical emergency and requires urgent medical attention in order to prevent damage that impacts physical and mental abilities.
The symptoms of stroke vary, depending on what part of the brain is affected but generally, the symptoms to look for can be summarised by FAST:
F – Face – Stroke can paralyse the facial muscles resulting in drooping of the face on one side and an inability to smile.
A – Arms – Weakness, heaviness and numbness in the upper body limbs may result in difficulty to lift one or both arms.
S – Speech – Speech may be slurred, garbled or in worse cases completely absent.
T – Time – Time is crucial in stroke cases. Immediate medical attention will reduce any risk of potentially serious consequences.
After a severe stroke, patients may display cognitive decline, which can possibly progress into dementia (usually vascular dementia). Patients may become paralysed on one side of the body and experience other symptoms such as confusion, language comprehension difficulties, poor eyesight, motor coordination and balance irregularities, dysphagia and sometimes an extremely sudden onset severe headache.
Recovering From a Stroke
Stroke contributes 9.8 per cent of total deaths in Malaysia affecting more than 13 799 people in 2018. Although nothing can truly prepare us in this unfortunate event, rehabilitation rates are encouraging. In less severe cases, brain cell damage may be temporary and may recover over time. For some stroke survivors, their brain can even reorganise its own functioning and a region of the brain “takes over” for a region damaged by the stroke.
Stroke recovery can be generally summarised by these divisions:
- Ten per cent of stroke survivors recover almost completely. Another 10 per cent require care in a nursing home or other long-term care facility.
- One-quarter per cent recover with minor impairments.
- Forty per cent experience moderate to severe impairments.
Importance of Effective Recovery Plan
Stroke rehabilitation helps stroke survivors to continue with their lives with what is left of their abilities after the attack. It is important to start the treatment and rehabilitation early on after a stroke as it will help to regain a lot of function. A lot of encouraging progress can be seen within the first six months after treatment and it can continue on steadily for years.
Purpose of rehabilitation after stroke
The type of rehabilitation needed by a stroke survivor will be decided based on how the function has been affected. Functional changes after a stroke will depend on which part of the brain was damaged and its severity. After a stroke, slightly more than one-third of people have a disability that has affected their daily activities.
Rehabilitation helps stroke survivors to:
- re-learn skills that were lost when their brain was damaged by the stroke
- learn new ways of performing tasks without letting the disabilities get in the way
Rehabilitation should begin as soon as the stroke survivor’s condition becomes stable. This may be as soon as 24 hours after the stroke. They can either choose to check into a rehabilitation facility or continue as an outpatient or use community healthcare professionals.
Stroke rehabilitation activities may vary with time along with the change of needs and progress in the skill levels. The stroke survivor’s needs should be central to the types of rehabilitation approaches chosen. Family members and carers can also be a part of the rehabilitation activities.
Physical therapy consists of muscle manoeuvres and exercises. Post-stroke physical therapy activities are designed to get the brain and the muscles to work simultaneously using an approach that builds muscle strength and maintains healthy muscle tone.
While there is no evidence to prove that one kind of physical therapy was better than the others, physical therapy has shown tremendous results in helping stroke survivors to improve mobility, walk at a faster pace, have better balance and function more independently.
The ideal dose of physical therapy is approximately 30-60 minutes five to seven days per week.
Occupational therapy is different from physical therapy as it involves a more task-focused type of training. Occupational therapists work with stroke survivors on practical, real-world, day-to-day tasks such as climbing stairs, getting in and out of bed and getting dressed.
There is an overlap between physical therapy and occupational therapy but physical therapy is more focused on strength while occupational therapy is more focused on coordination.
Speech and Swallow Therapy
Speech and swallowing require simultaneous thought and muscle coordination. Both skills use muscles of the face, mouth, tongue, and throat. Speech problems are not unusual after a stroke while swallowing problems are usually unexpected for stroke survivors and their loved ones.
A speech and swallow evaluation is normally done in the hospital within days after a stroke. Speech and swallowing abilities might improve as you recover from the stroke.
Speech therapy sessions aim to improve understanding of words as well as produce words that others can clearly understand. Sometimes, speech therapy requires visual aids such as flashcards, pictures, and, of course, practice and repetition with speaking.
Swallowing is important in order to continue providing the body with good nutrition. However, properly coordinated swallowing is important for other health issues in addition to nutrition. When swallowing muscles do not move as they should, choking on food is one of the dangerous consequences.
Choking can cause an infection known as aspiration pneumonia, which has greater risks on stroke survivors. Choking on food can also block oxygen from entering the system resulting in brain damage and even brain death. Swallow therapy helps stroke survivors avoid these severe complications of a stroke.
Visual therapy and balance therapy are often scheduled together in a combined session. Both therapies work concurrently in ways that vision partially relies on good balance and balance partially relies on good vision. The areas of the brain that control these two functions are separate, but they depend on each other as they interact.
Cognitive therapy is considered a new concept in stroke rehabilitation. Cognitive therapy involves interventions that are designed to improve thinking skills and problem-solving abilities.
The level of cognitive disability after a stroke is different for each person. Stroke survivors who are recovering from a large cortical stroke often have more cognitive issues than stroke survivors recovering from a small vessel subcortical stroke. Left-sided cortical strokes cause somewhat different cognitive deficits than right-sided cortical strokes, and this can impact the process of recovery.
Cognitive therapy uses video games, virtual reality techniques, and computer-generated rehabilitation therapy as ways to improve cognitive function after a stroke. The best type of cognitive therapy has not yet been established. However, so far, it has been found that stroke survivors who participate in cognitive therapy recover better than those who did not.
Recovery activities for stroke patients
In addition to direct therapy at medical and rehabilitation centres, patients should beware of becoming isolated and try to engage in a handful of home-based and social activities throughout the week.
Get some exercise
Exercise in any form is important for rehabilitation. The coordination of movements brings about positive emotions thanks to endorphins. Even swaying side-to-side or rocking mobile parts of the body helps increase blood flow and is likely to make patients feel better.
The brain is a muscle and when its language centres are down you can stimulate it through colour, texture and movement. If the fine motor skills required to hold a paintbrush are lacking, rethink your approach to art. Just arranging objects into collages and patterns or drawing in the sand with fingertips can be helpful.
Learn something new
You don’t have to go back to school, it might be you pick up a hobby like gardening or bird watching. You may also want to acquire a new skill—particularly one that helps with language recoveries, such as practising sign language or typing. Stimulating new areas of the brain gets things moving.
Satisfy your senses
Learning is enhanced through multi-sensory approaches in which you hear, see and feel material at the same time. Go to a greenhouse and smell the flowers, visit a museum or get a neck and shoulder massage. All of these activities stimulate your sensory systems.
Turn up the music
Hearing a rhythm can improve the attitude and outlook of stroke patients. It’s also a great way to maximise the potential for re-learning coordinated movements and to work on balance. Express yourself in whatever way is possible, whether it be through syncopated tapping and conducting to the radio, or even just deep breathing in time to the music. Language and music are stored in different areas of the brain and someone who struggles with the spoken word may have no difficulty with singing a song. Singing is good exercise.
When writing by hand is too hard and speaking ability is inhibited, it can sometimes be easier to type messages on a computer or tablet. That’s because keyboarding trains muscle memory in the fingers to remember the spelling and help with word recovery. Repetitive drills reinforce learning and it is particularly helpful when the approach taken is multi-sensory – such as with Touch-type Read and Spell.
Innovative Physical Therapy
New types of therapy have also been put into practice including music therapy, electrical therapy and mirror therapy. Stroke survivors who participate in research studies that use new and innovative rehabilitative therapies tend to test better on measures of stroke outcomes and usually do not experience negative effects caused by experimental rehabilitation.
The outcomes of these new types of therapy have shown promises but researchers do not outlaw the possibility of a placebo effect. But there could still be a degree of the placebo effect and a degree of usefulness when it comes to most of the innovative rehabilitation techniques that are currently under research.
Since function and mobility can be difficult for a person recovering from a stroke, some modifications may be needed around the home. To ensure safety for the stroke survivor, Physical and Occupational Therapists may be able to evaluate your home prior to your loved one getting home to set up optimal operation in your house. Check with your insurance company to see if this service is available to you.
Make a list as you go along of things around the house that work well for you, and things that are a problem for you. This can help you come up with ways to fix the problem. Here are some suggestions:
- All throw rugs should be picked up from the floor to reduce the chance of tripping.
- A shower chair may be used during bathing.
- Shower chairs may be rented or purchased from medical equipment or your local drug store.
- A bathroom and sleep area may need to be on one level or floor for ease of use.
- Beds may be placed in other rooms for sleeping on the first floor.
- Move furniture to get a walker or wheelchair in certain places.
- Adjust the lighting in the house to assist in clear visibility.
- Keep a telephone within reach.
- Wear non-stick shoes around the home to prevent slip and falls.
- Install handrails in bathroom and stairwells.
- Move or reorganize clothing and personal items so they are within reach.
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Stroke rehabilitation. Stroke Foundation website. Available at: https://strokefoundation.org.au/About-Stroke/Learn/Treatment-for-stroke/Stroke-rehabilitation Accessed Sept 18, 2021
6 Post-Stroke Rehabilitation Programs You May Need. Verywell Health website. Available at: https://www.verywellhealth.com/therapies-for-post-stroke-rehabilitation-4068638. Updated: Apr 20, 2021. Accessed Sept 18, 2021.
Rehab Therapy After a Stroke. American Heart Association, website. Available at: https://www.stroke.org/en/life-after-stroke/stroke-rehab/rehab-therapy-after-a-stroke Updated: May 14, 2019. Accessed Sept 18, 2021.
What is a Stroke? News-Medical website. Available at: https://www.news-medical.net/health/What-is-a-Stroke.aspx Accessed Sept 18, 2021
7 Activities for stroke patients. Touch-type Read & Spell website. Available at: https://www.readandspell.com/activities-for-stroke-patients Accessed Sept 18, 2021
Rehabilitation after stroke. Better Health website. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rehabilitation-after-stroke Accessed Sept 18, 2021
Arriving Home After a Stroke. University of Toledo website. Available at: https://www.utoledo.edu/depts/csa/caringweb/arrivinghome.html Accessed Sept 18, 2021