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All about the stroke different stroke types ischemic stroke thrombotic stroke embolic stroke transient ischemic attack (TIA) or mini stroke hemorrhagic stroke intracerebral hemorrhage subarachnoid hemorrhage causes of stroke stroke symptoms stroke risk factors diagnosis of stroke treatment for stroke stroke medications stroke prevention surgical treatments for stroke recovery from stroke stroke rehabilitation

What is stroke rehabilitation?

Stroke rehabilitation is a very important part of recovery for many people who have had a stroke. It helps build your strength, coordination, endurance and confidence. In stroke rehabilitation, you may learn how to move, talk, think and care for yourself. The goal of stroke rehabilitation is to help you learn how to do things that you did before the stroke.

A stroke occurs when one of the vessels supplying blood to the brain tissue becomes damaged or blocked. When the brain tissue is cut off from its supply of oxygen for more than three to four minutes, it begins to die. Nerve cells in the brain tissue communicate with other cells to control such functions as memory, speech and movement. When a stroke happens, nerve cells in the brain tissue become injured. As a result, they cannot communicate with other cells and certain functions are impaired.

About 20% of patients die in the first month after stroke, and more than half of the survivors will require specialist rehabilitation. Once the patient's condition stabilises medically, there is less need for the facilities of the acute hospital, and the focus of the rehabilitation program moves to improving function and independence, and preparing the stroke survivor and his or her carers for life after discharge in the context of their previous health, home and family situation, avocational and vocational needs.

Despite the best care, a stroke can cause some degree of disability such as weakness, partial paralysis, memory loss, inability to speak or understand words, change in personality or confusion.

However, there are several key factors to a successful rehabilitation which can help people resume their normal lives as much as possible:

  • The extent of the brain injury - the less severe the injury, the better the chances for recovery.
  • The stroke survivor's attitude - a survivor's positive attitude can help him or her cope with difficult times and focus on getting better.
  • Family support - a stroke survivor's family can be the most important form of support during rehabilitation. Family members can reassure stroke survivors that they're wanted, needed and still important to the family.
  • Immediate rehabilitation - rehabilitation must begin as soon after the stroke as possible. Even simple tasks such as exercising paralyzed muscles and turning the person in bed should begin very soon after the stroke. Stroke rehabilitation is most successful when it's a team effort. The stroke survivor and his or her family must work together with the doctor, nurse and other rehabilitation specialists.

The stroke rehabilitation team is a group of specialists and allied health professionals who work together to provide stroke survivors with the comprehensive medical care, therapy, counseling and family training needed to recover from a stroke. Team members strive to restore a patient's ability to perform the daily activities of life.

Team members usually include:

  • Physiotherapists may focus on limb weakness, abnormal tone (flaccid or spastic) and balance, to meet the agreed aim of independent mobility, but need to work closely with occupational therapists to achieve this.
  • Occupational therapists may take the lead in teaching independence in activities of daily living, guiding the patient (if improvement allows) through personal hygiene to domestic and community activities, but success in these domains will demand input from physiotherapists as well.
  • Speech therapists deal with communication and motor production of speech, as well as chewing and swallowing.
  • Nurses have specific expertise in bladder and bowel function, and have a critical role in consolidating rehabilitation gains. They spend many more hours with the patients and family than any other team members.
  • A neuropsychologist is an important member of a specialised stroke rehabilitation team, as cognitive deficits are common. These often include impaired memory and concentration, as well as difficulties in planning and problem solving. Personality changes are frequent. Damage to specific areas of the brain can lead to distinctive clinical syndromes, and their accurate definition is helpful to the team (eg, a frontal haemorrhage will often affect learned social inhibitions, emotional responses and control, while lesions of the parietal lobe, particularly in the non-dominant hemisphere, tend to impair perception and planning). A particularly formidable task, often delegated to neuropsychologists, is assessment of a patient's capacity to make a will, and there are few guidelines on which to base this difficult decision.
  • All team members work together to deal with other important sequelae of stroke, often ignored by those without rehabilitation expertise. These include perceptual impairment, reduced attention and awareness of body parts or the environment, and visual field loss.
  • Social workers play an important role in evaluating a patient's premorbid state within his or her social network and society as a whole, and in determining what aspects were previously determinants of the patient's quality of life. Social workers often take on a critically important counselling role with the patient and next-of-kin, and link professionals in arranging and coordinating community resources before and after discharge. This task can be a complex nightmare for uninitiated family members.
  • A rehabilitation physician usually leads the team and works closely with the nurses to deal with comorbidities, such as hypertension and diabetes, and to treat or prevent secondary complications, such as pressure areas and seizures (about 5% of patients will have a seizure in the first year after stroke).
  • The end of the formal rehabilitation program is usually signalled by a functional plateau after which little or no recovery occurs. This may be hard to pinpoint, but if no improvement occurs over a period of more than 3 weeks then further significant improvement of brain function is unlikely, although patients may still learn further compensatory techniques. However (as mentioned above), some patients show "late" functional improvement, even two years after the initial stroke.

In recent years, clinicians have been pressured (militated by a combination of political, financial and clinical determinants) towards discharging stroke patients from the hospital environment as early as possible. However, this is only possible, or safe, when community resources and infrastructure are adequate, and the timing depends as much on such resources as the patient's degree of functional recovery. Successful discharge depends on accurate assessment of the domestic environment, and the establishment of networks to meet critical needs (eg, personal care, domestic help, home modifications and carer respite).

More information on the stroke

What is a stroke? - Stroke (cerebrovascular accident) is a sudden loss of consciousness resulting when the rupture or occlusion of a blood vessel leads to oxygen lack in the brain.
What're the different types of strokes? - There are two main types of stroke. Ischemic stroke is the most common type of stroke. Hemorrhagic stroke is caused by bleeding.
What is ischemic stroke? - Ischemic stroke is the most common type. Ischemic stroke can further be divided into two main types: thrombotic and embolic.
What is a thrombotic stroke? - Thrombotic strokes are strokes caused by a thrombus (blood clot) that develops in the arteries supplying blood to the brain.
What is an embolic stroke? - Embolic strokes often result from heart disease or heart surgery and occur rapidly and without any warning signs.
What's transient ischemic attack (TIA) or mini stroke? - A transient ischemic attack (TIA) is often called a mini stroke. A transient ischemic attack (TIA) is a transient stroke that lasts only a few minutes.
What is hemorrhagic stroke? - In hemorrhagic stroke, bleeding in the brain itself or between the brain and the skull (subarachnoid hemorrhage) disrupts brain function.
What is an intracerebral hemorrhage? - Intracerebral hemorrhage is usually caused by hypertension (high blood pressure), and bleeding occurs suddenly and rapidly.
What is a subarachnoid hemorrhage? - Subarachnoid hemorrhage results when bleeding occurs between the brain and the meninges in the subarachnoid space.
What causes a stroke? - Stroke caused by damage to blood vessels in the brain. The ischemic stroke is usually caused by atherosclerosis (hardening) of blood vessels.
What are the symptoms of a stroke? - The symptoms of a stroke depend on what part of the brain and how much of the brain tissue is affected. Stroke symptoms usually come on suddenly.
What are the risk factors for a stroke? - Risk factors for a stroke include high blood pressure (hypertension), atherosclerosis, cigarette smoking, atrial fibrillation, diabetes.
How is a stroke diagnosed? - Stroke is diagnosed through several techniques: a short neurological examination, blood tests, CT scans or MRI scans, Doppler ultrasound, and arteriography.
What's the treatment for a stroke? - The aim of the therapy is to minimise the size of the stroke and therefore minimise subsequent disability by restoring blood flow to the area of the brain affected quickly.
What medications can be used for stroke treatment? - Intravenous thrombolytics. clot-busting, or thrombolytic drugs are now administered intravenously for ischemic (not hemorrhagic) stroke.
What can be done to prevent a stroke? - Prevention of stoke is an important public health concern. Medication or drug therapy is the most common method of stroke prevention.
What're the surgical treatments for stroke? - Surgical treatments for stroke include carotid endarterectomy, angioplasty, clipping. Clipping involves clamping off the aneurysm.
How to recover from a stroke? - Spontaneous recovery accounts for most improvements in the first month after a stroke. Successful recovery after a stroke depends on the extent of brain damage.
What is stroke rehabilitation? - Stroke rehabilitation is the process by which patients with disabling strokes undergo treatment to help them return to normal life.
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