Causes of stroke
In neurorehabilitation, a branch of the physical therapy and rehabilitation, strokes has an important place. Stroke constitutes the most common group of diseases in neurological diseases. In stroke the clinical picture due to power loss in hand – arm – legs is paralysis. But in our society, paralysis is more frequently preferred than stroke to name the disorder.
Stroke can occur as a result of blockage of the brain vessels or brain hemorrhage. Approximately 80-85% of the strokes are caused by vascular occlusion, while 15-20% is caused by cerebral hemorrhages.
In stroke caused by vascular occlusion or brain hemorrhage patients may develop loss of movement, loss of power in hands, arms and legs – paralysis, abnormal gait, sensory disturbances, loss of balance, speech impairment and cognitive problems – impaired brain function. In developed countries stroke is the most common cause of death after cardiovascular diseases and cancer. Stroke is also at the forefront of diseases that cause disability, so the physical therapy and rehabilitation branch plays a crucial role in preventing disabilities.
Stroke Risk Factors
Noncontrollable Stroke Risk Factors: Advanced age, male gender, black race, family history, and previous stroke history
Controllable Stroke Risk Factors: High blood pressure, diabetes, elevated cholesterol, heart valve diseases and rhythm disturbances, closure of jugular veins, coagulation disorders, use of smoking and alcohol, sedentary lifestyle. In these matters, the physiotherapist makes necessary treatment and direction.
Clinical course of stroke
Clinical course in stroke patients varies according to the area of the brain involved, its prevalence, and the cause. Paralysis of arm and legs in the opposite side of the stroke brain area, walking and balance loss, neglect of the paralyzed side of the body, sensory disturbances, visual problems, swallowing and speech disorders, cognitive problems, urinary incontinence are frequent early stage clinical conditions. Undesirable conditions such as side arm and leg contractions, shoulder pain, depression, infection, epilepsy, neuropathic pain (nerve tissue – brain-derived pain) may occur during the later stages of strokes. In stroke patients, the fastest healing occurs in the first 3 to 6 months and the neurological recovery lasts for about 2 years, depending on the severity of the disease. For this reason, patients who develop stroke and paralysis should be assessed by a physical therapist as soon as possible and neurorehabilitation processes should be planned.
Treatment of stroke
In stroke patients, the neurorehabilitation process should start as early as possible and patients should be monitored lifelong at certain periods. In terms of physical therapy in patients with stroke, it is important to position the patient appropriately at an early stage and to change position at regular intervals in terms of not developing pressure sore. In addition, passive range of joint motion exercises, respiratory exercises, evaluation of swallowing, skin care, provision of appropriate nutrition, regulation of sleep periods, psychological and social support are other important issues to be considered during rehabilitation of stroke in the early stages.
If the patient is in a state of neurological stability, the patient should be evaluated by the physical therapist and active mobilization activities should be started within 24-48 hours after the stroke. Robotic rehabilitation – robotic physical therapy (robotic bed, robotic walking and hand-arm robotic rehabilitation) to be done by the physiotherapy and rehabilitation clinic in this period makes a great contribution to the patient. Functional deficits of the patient after stroke and other health problems accompanying the stroke should be assessed by the physical therapist and taken to comprehensive rehabilitation program while the patient is still in the neurology service. After stroke, usually if the medical condition allows, the patient should be transferred to the physiotherapy and rehabilitation clinic to start the neurorehabilitation program after a mean of 3 to 7 days.
Comprehensive rehabilitation program in stroke treatment includes physical therapy activities such as walking, hand and arm use, self-care, nutrition, toileting, speech, occupational therapy. Robotic rehabilitation provides great contributions to the development of the patient at this stage. The treatment aims finally to return the patient to the family, professional and social life. For this purpose, neurological rehabilitation techniques, robotic rehabilitation, speech therapy, botulinum toxin (botox) injections for spasticity can be applied in physical therapy and rehabilitation clinic.
It is also important from the earliest days that physical therapists prescribe appropriate orthoses for reduced functioning limbs of stroke patients.
In this regard for a successful stroke treatment a neurorehabilitation-robotic rehabilitation center under control of a physiotherapy rehabilitation specialist with sufficient experience will be an appropriate option. In such a clinic, rehabilitation team consisting of a wide range of staff such as physiotherapy and rehabilitation specialist, physiotherapist, rehabilitation nurse, physical therapy technician, robotic rehabilitation technician, occupational therapist can provide important contributions to stroke rehabilitation.
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