Hello again and welcome back once again to the ThreeSpiresPhysiotherapy blog. This time we shall have a look at a common and often extremely debilitating condition that our physiotherapy service helps patients to recover from, namely a stroke. This is something that our physiotherapists help patients recover from on a daily basis and I thought it might be a nice idea to have a look in a bit more detail at what a stroke is and how it affects patients.

What is a Stroke?

Stroke is the common name for a cerebro-vascular accident (CVA), which occurs when there is a disruption of the blood supply to areas of the brain which causes the death of the cells in that area and can cause significant loss of function. Commonly it affects one side of the body and often patients will have a facial droop, slurred speech, difficulty with swallowing and weakness in the limbs on one side of the body. Access to regular physiotherapy to aid recovery from a stroke and promote normal movement patterns is essential and often patients find it much easier if the physiotherapist is able to visit them rather than having to travel to a clinic.

 Medical Warning Alert

Just to be clear - obviously if you suspect that you or someone else is having a stroke - then please remember this is a medical emergency and you should call the emergency services immediately - the sooner a person receives medical attention the better are the chances of recovery. This article is concerned with recovery and rehabilitation after the person has been to hospital and has been discharged back home.

Types of Stroke:

There are two types of stroke - ischaemic and hemorrhagic; an ischaemic stroke is by far the most common type (approximately 87% of all strokes) and happens when there is a blockage of one of the cerebral arteries (blood vessels that supply the brain). This causes blood to stop flowing to parts of the brain and then causes subsequent damage to the brain. A hemorrhagic stroke is generally more serious and the effects tend to be more severe - in this case a bleed occurs in a blood vessel in the brain which causes pressure to build up in the skull and brain and causes compression of blood vessels in that area and a secondary loss of blood flow to areas of the brain. For some people the effects of a stroke will be very minor and will quickly resolve - these are often called mini-strokes, the medical terminology is Transient Ischaemic Attack (TIA), but for many the effects are catastrophic with large losses of movement, strength, co-ordination and there can also be cognitive changes.

Causes of Stroke:

So what causes a stroke and what are the major risk factors for having a stroke? Well, an ischaemic stroke is caused by a blockage of one of the arteries that supply blood to the brain, these blockages often happen when part of a plaque deposit that has formed in one of the arteries around the heart breaks off and floats upwards to the brain and eventually gets stuck in a narrow part of the artery. Hemorrhagic (bleeds) strokes happen when a blood vessel bursts in the brain, sometimes this is a congenital disorder (the person is born with it) but often it is associated with high blood pressure. There are many factors that increase the risk of having a stroke: high blood pressure, smoking, obesity, diabetes, heart disease, atherosclerosis, high cholesterol and lack of exercises have all been shown to have a link to increased risk of stroke. Basically anything that increases the likelihood of plaques forming in your arteries will increase the likelihood of having a stroke. The risk of stroke increases as we age (due mainly to the effect of all the lifestyle factors listed earlier) and also tends to affect more men than women. General advice to reduce the risks of having a stroke would be to try and live a healthy lifestyle, by eating a balanced diet and exercising regularly.  

How Does A Stroke Affect People?

Next we will look at how a stroke commonly affects people but please be aware that the effects of a stroke, as mentioned earlier, can be extremely variable with some people only experiencing minor disturbances and others suffering catastrophic effects. How a stroke affects each patient will be different and will depend upon which cerebral artery was blocked and the specific area of the brain damaged. 

Firstly a stroke will commonly only affect one side of the body - this is due to the fact that each side of the brain controls the opposite side of the body e.g. the left side of the brain is predominantly responsible for motor control of the right side of the body and so damage to the left side of the brain will affect the right side of the body. Hemiparesis (a weakness of one side of the body) is a common effect of a stroke and in its most severe form of hemiplegia can be extremely debilitating. This one sided weakness tends to affect one of the limbs more than others (for some this will be the arm/hand and in others it will be the leg), one problem that is often difficult to see but is extremely debilitating is a reduction in trunk control on the affected side. This will cause difficulty with sitting, balance and standing - patients will often slump to one side due to a lack of strength on that side.

Some patients may have increased muscle tone in some areas of the body (sometimes called spasticity) - this is commonly found in the arm and the wrist and the patient will tend to struggle to straighten their elbow, wrist and fingers. It tends to vary throughout a 24 hour period and is a common side effect of a stroke. Shoulder subluxation is also a common problem on the side of the body affected by the stroke - subluxation is a form of dislocation and means that the head of humerus (ball part of the shoulder joint) has slumped downwards away from the socket. This is caused by a loss of strength in the muscles of the shoulder, it can be extremely painful and can sometimes be felt as a gap at the top of the shoulder joint.

Strokes do not just affect the muscles of the body, their effects depend upon which areas of the brain have been affected and they can cause difficulties with speech, understanding, swallowing and droop of the muscles of the face.

How Can Physiotherapy Help After A Stroke?

So, how can physiotherapy help with recovery and rehabilitation from the effects of a stroke? Recovering from a stroke can be a long and arduous process and physiotherapy is well established as a key part of this recovery process. Early access to regular physiotherapy can help establish normal movement patterns, improve balance, co-ordination and improve range of motion at any affected joints. To understand this process in more detail it is worth looking at a typical patient from initial assessment through to discharge and self-management and examine the ways in which physiotherapy can help them improve their function and quality of life.

Firstly, each patient needs a comprehensive neurological examination and assessment by a neurological physiotherapist who will look at a variety of factors including balance, core stability, muscle tone, reflexes, co-ordination and how each limb has been affected. The results of this neurological assessment are then used to determine the best approach to use to maximise results for the patient, the greater the effect of the stroke the more there will be to address. Treatment in each session involves working on improving the tasks that the patient finds difficulty, this may be standing, sitting up straight, reaching for objects, walking, improving co-ordination and grasping objects. At the end of each session the physiotherapist gives the patient a series of exercises and tasks to complete in between sessions. Typically in the initial period of rehabilitation a patient may need 2 to 3 sessions per week to maximise recovery and function but then as progress slows this will generally reduce to one session every few weeks and finally only once every month or so until eventually the patient is able to self manage their condition.

Okay, I hope you have found this blog to be useful and has helped improve your understanding of stroke, how it can affect people and the importance of physiotherapy. Should you or anyone you know need neurological physiotherapy then please do not hesitate to get in touch, we provide a home visit physiotherapy service anywhere within 25 minutes drive of Lichfield and can be contacted on 0788 428 1623 or via email at enquiries@threespiresphysiotherapy.co.uk.