Post-Stroke Physical Therapy and Rehabilitation

Stroke; It is one of the leading neurological diseases that cause high mortality and long-term disability all over the world, and that has a risk of recurrence. It is a disease that negatively affects not only the patient but also the whole patient’s family. It is the third most common cause of death after coronary heart disease and cancers worldwide. According to the definition of WHO (World Health Organization), stroke is a clinical syndrome characterized by the rapid establishment of signs and symptoms of focal cerebral function loss without an apparent cause other than vascular causes.

Although the brain constitutes 2% of the body weight, it is one of the most metabolically active organs in the body and needs a rich blood flow to provide this activity. About 20% of the blood pumped into the peripheral circulation with each heartbeat is used by the brain. The brain meets its metabolic needs with this blood. The brain’s own tissue does not have the ability to store oxygen and glucose. Therefore, the cerebral circulation

  • Stopping for 6-10 seconds causes reversible neuronal changes and loss of consciousness.

  • Within 2 minutes, all activities of the brain stop.

  • After 5 minutes, irreversible changes occur.

In other words, stroke is the inability of the arteries feeding the brain to transmit blood flow from the heart to the brain due to occlusion or bleeding, and as a result, the brain tissue undergoes necrosis.

WHAT ARE THE RISK FACTORS;

  • Age (about 70% of stroke survivors are over 65 years old.

  • Hypertension

  • Diabetes

  • Smoking and Alcohol Use

  • extreme stress

  • Sedentary (sedentary) lifestyle

  • Addictive substances

WHAT IS HEMIPLEGIA?

Hemiplegia is a vascular syndrome that develops as a result of pathological changes in cerebral circulation and is characterized by neuromuscular dysfunctions in one half of the body (right or left). Damage to the left side of the brain affects the right side of the body, while damage to the right side affects the left side of the body. Although hemiplegia, which is one of the most common brain and nervous system disorders worldwide, is mostly seen in middle age and above, every age group is at risk.

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Hemiplegia Symptoms;

  • Numbness, numbness, stiffness in tissue, loss of strength or loss of movement in the right or left side face, arms and legs, or decrease in movement functions,

  • Spasticity, combined reactions

  • Difficulty in walking and standing and balance disorders,

  • Sensory-perception disorders,

  • Difficulty speaking (aphasia)

  • Partial dependence on activities of daily living

  • memory loss,

  • Difficulty perceiving the concepts of place and time

HEMIPLEGIA REHABILITATION

Stroke requires a high level of health practice, good disciplinary coordination and rehabilitation from the first moment, as it causes sudden onset, important life-threatening dangers and a disability that will last a lifetime. It would be wrong to deal with stroke patients only with their physical problems. In addition to physical problems, mental problems, daily living activities, language and speech problems, and most importantly, psychological problems should be evaluated and handled by experts. For this reason, physiotherapists, physical therapists, neurologists, social workers, psychologists, occupational therapists and language-speech therapists should work in cooperation in hemiplegia rehabilitation.

PHYSICAL THERAPY AND REHABILITATION AFTER STROKE

There are various concepts created in the rehabilitation of hemiplegia and accepted worldwide (such as Bobath, Margaret Johnstone, Restrictive Intensified Movement Therapy, Robot-Assisted Therapy Approaches, Virtual Reality Therapy).

Although neurological recovery in stroke is mostly in the first 3 months, it is known that it can continue more slowly until the first 6 months, and very rarely up to 1 year. 80% of motor recovery occurs within the first 3 to 6 months. Studies have reported that 85% of stroke survivors develop hemiplegia, and 55-75% of stroke survivors develop upper extremity function limitation. The goal in stroke rehabilitation; It is to gain the highest level of functional independence and increase the quality of life of the individual despite the existing deficiencies. It is also important to initiate physical therapy and rehabilitation practices in hemiplegic patients at an early stage. Caused by hemiplegia in delayed treatments;

  • Osteoclasis

  • Orthostatic hypotension (caused by immobilization)

  • Edema

  • Joint limitations, contractures

  • Shoulder subluxations

  • pressure sores

  • Inflammations in veins

  • Different complications such as intestinal dysfunction may occur.

What does the physiotherapist do;

Each physiotherapist evaluates the patient with the concepts he/she uses and prepares the treatment plan appropriate to the patient’s level. But in the first place, the aim should be to prevent complications. Inhibition of spasticity and gaining normal movement patterns accompany this sequence.

  • POSITIONING:The correct positioning of the hemi (affected side) extremity must be done by a physiotherapist and these positions should be taught to the relatives of the patient. Positioning regulates blood flow while preventing pressure sores (bed sores) and 2. Reduces the risk of a stroke.

If the patient has a pressure sore, the position should be changed every half hour or every 2 hours.

  • INHIBITION OF SPASTICITY

  • MAINTAINING JOINT MOVEMENT

  • ACQUISITION OF NORMAL MOVEMENT PATTERNS

  • BALANCE STUDIES (static and dynamic balance)

  • WALKING TRAININGS

  • WHEELCHAIR, walking stick, walker etc. USE TRAINING

  • Personally, if necessary ORTHOSIS RECOMMENDATIONS

  • SENSORY GAIN

  • If there is loss of swallowing function SWALLOWING REHABILITATION

  • For Speech Problem SPEAK THERAPY

  • For memory effects COGNITIVE REHABILITATION

Just as every disease is personal, every treatment should be personal, no matter what concept it is based on. For this reason, people should start rehabilitation practices as soon as the specialist physician allows after they have had a stroke. Early intervention also increases the possibility of providing the best return in patients. You should also consult your physician and physiotherapist for your post-stroke physical therapy and rehabilitation services.

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