Stroke

stroke
Stroke might be defined as the abrupt start of the neurological disorder that could .occur due to some vascular cause. It happens if an area of brain tissue is missing out on its blood supply, causing cognitive abilities to lose their way to obtain oxygen. Without oxygen, cognitive abilities can become irreversibly damaged in a few minutes. Stroke is mainly brought on by disruption of blood circulation to the brain due to blockage or leakage inside a blood vessel. The effects of stroke vary with respect to the severity of the blockage or leakage.
Stroke commonly causes a leg and leg weakness, facial weakness and speech problems. This  may result in decreased mobility, balance problems and difficulty in performing everyday tasks. Unlike other cells within the body, if brain cells are irreversibly damaged they are unable to heal themselves. The mind, however is capable of learning new tasks to pay for the areas that have been damaged and physiotherapy thus encourages the training and help the body relearn normal movement patterns.
 Kinds of strokes
Stroke is principally of two types
a)      Ischemic stroke
b)      Haemorrhagic stroke
 Ischemic stroke
 Ischemic stroke is generally caused by a blockage inside an artery. This blockage  results in decreased blood circulation to an area of brain and then the brain cells in that area are damaged because of the lack of oxygen.
 Haemorrhagic stroke
 It's also called as “brain haemorrhage”. This occurs when  blood vessels within the brain ruptures causing bleeding in to the area of brain. This will cause a build up of pressure and damages the fragile tissues of the brain. Blood circulation to the neighbouring cognitive abilities also reduced which cells get damaged because of lack of oxygen and results in stroke.
 Effects of stroke
The results of stroke is determined by the type of stroke suffered, its severity and also the area of brain affected and also the extent of damage towards the brain tissue. The results are classified as:
Physical
Non-physical
 Physical effects :
1) Reduce  mobility
2)Weakness or Paralysis (usually of 1 side)
3) Reduced sensation
4) Don't one side of the body
5) Speech/ language difficulty
6)Swallowing  problem
7) Incontinence
8)Fatigue
9)Foot drop
 Non-physical effects :
1)      Mood change
2)      Perceptual problems
3)      Cognitive difficulty
4)      Behavioural changes.
Common impairments occur during stroke
a)      Arm/hand/leg weakness
b)      Facial weakness
c)      Sensory loss
d)     Dysarthria(difficulty in speech)
e)      Aphasia(difficulty in comprehension)
f)       Visual field defect
g)      Cognitive impairments
h)      Balance problem
 Common physical limitations
a)      stair climbing
b)      bathing
c)      walking
d)     feeding
e)      urinary/faecal incontinence
 Common complications
a)      Medical problems like heart problems, G.I haemorrhage
b)      Confusion
c)      General pain
d)      Falls
e)      Other infections
f)       Depression
g)      Anxiety
h)      Shoulder pain
i)       Urinary tract infection
j)       Pressure sores
k)      Recurrent stroke
l)       Seizure

Goals of Physiotherapy
Control over stroke patients begins because the acute care during acute hospitalization and continues as rehabilitative care when patient’s medical & neurological status has stabilized. Moreover, community reintegration of patients continues throughout the community care stage.
1. Acute Care
Aims :
1) Prevent recurrent stroke
2) Monitor vital signs, dysphasia adequate nutrition, bladder & bowel function.
3) Prevent complications
4) Mobilize the individual
5) Encourage resumption of self-care activities
6) Provide emotional support & education for patient & family
7)Screen for rehabilitation and selection of settings
2. Rehabilitation care
Aims :
1) Set rehabilitation goals; develop rehabilitation plan and monitor progress
2) Manage sensori-motor deficits
3) Improve functional mobility & independence
4) Prevent & treat complications
5) Monitor functional health conditions
6) Discharge planning (safe residence recommendation, patient & caregivers education & continuityof care)
7) Community - reintegration
3. Community care
Aims :
1) Assist patient to reintegrate into community
2) Enhance family and caregivers functioning
3) Co-ordinate continuity of patient care
4) Promote health and safety and stop further hospitalization
5) Give suggestions about community supports, valued activities and vocational reintegrate
In Stroke Physiotherapy assessment includes:
a) Patient characteristics
• Demographics (age, gender).
• History of illness.
• Prior activity level (low to high).
• Prior socialization (isolated to outgoing).
• Expectations regarding stroke outcomes and want for assistance.
b) Family and caregiver characteristics
• Members of household and relationship to patient.
• Other potential caregivers.
• Capacity to supply physical, emotional, instrumental support.
c) Impairments
e.g. speech, seeing, tone, muscle strength, balance, and co-ordination.
d) Activities
e.g. communication, movement, utilization of assistive devices and technical aids.
e) Participation
e.g. mobility, personal maintenance, social relationships, work, leisure, hobby, economic life
f) Environment factors
e.g. personal support and assistance, social and economic institutions, physical environment for example access to building and key facilities within living quarters, safety considerations, use of resources and activities in community.
Special consideration
Shoulder assessment
Shoulder subluxation and pain is really a major and frequent complication in patients with hemiplegia. (Joynt, 1992; Grossen-Sils, and Schenkman, 1985). As much as 80% of patients with cerebrovascular accident continues to be reported to show shoulder subluxation. Clinical study of shoulder should include thorough evaluation of pain , selection of movement, motor control, and shoulder subluxation.
Setting rehabilitation goals
In Stroke Physical rehabilitation both short-term and long- term goals have to be realistic in terms of current amounts of disability and the potential for recovery. Goals ought to be mutually agreed to by the patient, family, and rehabilitation team and really should be documented within the medical record in explicit, measurable terms.
Developing the rehabilitation management plan
In Stroke Physical rehabilitation the rehabilitation management plan should indicate the particular treatments planned as well as their sequence, intensity, frequency, and expected duration. Measures to avoid complications of stroke and recurrent strokes ought to be continued.