Stroke is a medical condition in which blood flow to the brain is interrupted. It can be because of blockage or hemorrhage in the brain, due to which blood flow is restricted and there is a lack of oxygen in brain cells. It requires immediate attention and hospital admission.
Neurological rehabilitation is started as soon as possible during the hospitalization phase itself. It involves different approaches in order to get different targeted outcomes to help patients achieve functional independence. Major aims and approaches are explained below-
Early Mobilization
Activities involving full range of motion- active or passive movements of joints through their full range to prevent joint stiffness and secondary complications such as frozen shoulder. This helps maintain joint and muscle integrity.
Positioning
The patient is positioned in different positions such as lying on the affected side, lying on the unaffected side, lying on the back, and sitting up on the bed or on a chair for the prevention of secondary complications such as pressure sores which happen due to lying on the same side for long duration. It also helps in improving circulation and patient comfort.
Motor Control and Relearning
Motor control has to be gained to initiate and complete purposeful voluntary actions.
Appropriate ways of icing, stretches and passive movements are effective in motor relearning.
Functional electrical stimulation is commonly practiced by physiotherapists for initiating motor control.
Consistent practice of available active movements.
Sensory Function
Commonly seen sensory impairments are-
Proprioceptive deficits: The patient loses the ability to recognize body movements and positions. Such patients show difficulty in balance and coordination activities.
Altered sensations: 2 types- hyposensitivity and hypersensitivity. Hyposensitive patients are given re-sensitization procedures such as brushing, and appropriate exposure to different temperatures and textures. Hypersensitive patients are treated using desensitization methods using soft fabrics, and graded exposure of stimulants.
Sensory neglect: The patient may not respond to stimulus from one side of the body as brain fails to recognize sensations of that side. In such cases, mirror therapy is used to retrain the brain.
Reduce Spasticity
The management of spasticity involves prolonged stretching, icing, and the usage of splints. In severe spastic cases, often muscle-relaxing medication such as botulinum toxin is administered.
Strength Training
Strength training begins in the early stages once the patient is able to actively perform the action against gravity. Weighted cuffs, dumbbells, and resistance bands are to aid the resistance exercises. The resistance/intensity progresses gradually according to the patient’s ability.
Upper Limb Functions/ Hand Rehab
Upper limb rehabilitation aims to improve movement and strength of the affected limb and make it functional for daily life activities like eating, personal hygiene, dressing, etc. Rehabilitation involves -
Activities involving usage of both arms: such as throwing, lifting, passing, catching, etc. It helps in improving bilateral hand coordination.
Constraint-induced movement therapy: it involves restricting the unaffected extremity and using the affected extremity for doing each task.
Mirror therapy: it involves performing activities in front of a mirror, thereby getting visual feedback.
Mental imagery: it involves practicing an activity imagining the object without really having it in hand. It can help in improving motor control.
Gait Training
The ability to walk independently is the highest priority for majority of the stroke survivors.
Walking: Walking on a solid surface with or without walking aids, under supervision.
Treadmill training: The treadmill is used commonly in the rehabilitation of stroke patients. In the initial stages, the patient is held by a harness, which can be withdrawn gradually as the patient gains confidence and stability.
Rhythmic Cueing: The patient is asked to perform the movements in a rhythmic manner according to the auditory stimulus. This helps in coordination and timing of stepping.
Robot-assisted training: A robotic exoskeleton is attached to the patient, and it imitates the phases of gait along with required trunk movements. Though it requires no or less effort from the physiotherapist, it is done under proper supervision.
VR training: Virtual reality and other video games offer a task-oriented approach to training patients, which is comparatively more engaging than the traditional methods.
Orthosis: Orthosis is used in certain cases to support and stabilize the extremity.
Balance and Coordination Training
Reaching Activities: The patient is made to reach for things placed slightly beyond reach in all possible directions.
Perturbation: The patient is exposed to sudden perturbations in all directions which is helpful for maintaining balance during disturbances and preventing falls.
Walking: Short obstacle courses and walking over different surfaces/grounds can help in improving spatial awareness.
Cardiac Function
Treadmill training
Sports activities: Slowly reintroducing stroke patients to their preferred sports activities
Respiratory Function
Deep breathing exercises: maintain lung volume and relax the patient
Aerobic exercises: Walking, jogging, running, swimming and other sports help the patient to improve respiratory capacity.
Cardiac functions: Aerobic exercises help in improving cardiovascular functions, leading to increased endurance and delaying the onset of fatigue.
Functional Independence
Training and enabling patients for daily life activities such as eating, bathing, grooming, toileting, moving from bed to chair, etc.
Tailoring rehabilitation protocols according to the activity goals of the patient.
Patient and Family Education
Patients and family members are made aware of the present situation and its probable secondary complications. Family members are asked about the emotional triggers and likes of the patient therefore exercise duration and methods can be tailored accordingly. Necessary architectural modifications, lifestyle changes, and other habits are suggested. They are made aware of the pacing of treatment and encouraged to support emotionally and psychologically throughout the treatment.
The ultimate goal of rehabilitation is to prioritize the patient’s desires, paving the way for a gradual return to their preferred activities and maximizing their functional independence.
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