Stroke is a sudden loss of consciousness resulting when the rupture or occlusion of a blood vessel leads to oxygen lack in the brain. After a stroke it badly affects one's life physically, mentally and as well as quality of life.
Physiotherapy is very much important to get rid from these bad effects.
Positioning the patient to prevent complications-spasms/ injuries
Positioning the patient is very important in acute stage. The aim of this is to promote optimal recovery by modulating muscle tone, providing appropriate sensory information, increasing spatial awareness and prevention of complications such as pressure sores, contracture, pain, respiratory problems and assist safer eating.
Correct positioning can help to reduce the risk of,
Pressure areas
Aspiration
Contracture
Swelling of the extremities
It helps to,
Normalise tone or decrease abnormal influence on the body.
Maintain skeletal alignment.
Promote increased tolerance of desired position.
Increased stimulation to affected side.
Promote patient comfort.
Facilitate normal movement patterns.
Control abnormal movement patterns.
Decrease fatigue.
Enhance autonomic nervous system function. (Cardiac, digestive and respiratory function)
Keep the lungs clear with the removal of secretions
After a stroke immobilization leads to reduce lung volumes, increase work of breathing and it increases the risk of lung collapse. These conditions can leads to post-stroke aspiration pneumonia. Because of that chest physiotherapy is more important to remove secretions that accumulate in lungs. There are proper interventions that are used by physiotherapists to remove secretions from lungs. Some of them are promoting normal coughing, vibration, percussion, and mechanical suctioning.
Help to keep a good respiration
After a stroke immobilization leads to reduce lung volumes, accumulation of the secretions in lungs. Because of that the patients cannot maintain a proper respiration. Recognizing breathing patterns and help to correct them by the use of breathing exercises, manual breathing techniques, and with the use of spirometers.
Improve muscle strength
After a stroke hemiparesis or hemiplegia can be occurred. With muscle weakness and reduced gait performance, is a leading cause of long-term disability. To improve lower limb muscle strength and mobility post stroke, there is a need for effective training. Physiotherapists properly assess the strength, endurance, range of motion of the affected muscle groups and make exercise programme to increase the muscle strength gradually.
Take the patient from immobile to mobile-gradually sitting, standing and walking
Once you are medically stable, the aim will be to get you moving as soon as possible. This will include moving around your bed, then from bed to chair, sitting to standing, walking with and without support and finally climbing stairs. This is likely to be a gradual process, and it is important to get each step right, so that you will end up with a balanced way of moving.
It is more difficult to sit up safely in bed than in a chair, so you may soon find yourself sitting in a suitable bedside chair with your affected side supported by pillows. This will help re-establish your balance. When you are ready, the physiotherapist will get you onto your feet using a hoist or two or three extra helpers. This will give you a chance to support your own weight and encourage you to use the muscles of your trunk, hips and legs. Your physiotherapist may not encourage you to walk straightaway if you need time to recover your strength and flexibility.
As mentioned step by step the physiotherapist improves you to walking.
Improve walking through proper gait training
Gait training is a very important part in stroke rehabilitation. Muscle weakness and paralysis, poor motor control and soft tissue contracture are major contributors to walking dysfunction after stroke.
Intervention aims to optimize walking performance by,
Preventing adaptive changes in lower limb soft tissues.
Eliciting voluntary activation in key muscle groups in lower limbs.
Increasing muscle strength and coordination.
Increasing walking velocity and endurance.
Increasing cardiovascular fitness.
The major emphasis in walking training is on,
Support of the body mass over the lower limbs.
Propulsion of the body mass.
Balance of the body mass as it progresses over one or both lower limbs.
Controlling knee and toe paths for toe clearance and foot placement.
Optimizing rhythm and coordination.
Some gait problems result from muscle strength, motor control, and balance. After a stroke, it’s important both neurologically and physically to regain your walking abilities. Gait training is a type of physical therapy that helps you stand and walk, and prevent falls. It addresses your needs and gets you walking and active again so you can complete your rehabilitation and get back into life.
Physiotherapy and Neuroplasticity
After a stroke, our brains cannot grow new cells to replace the ones that have been damaged, so your recovery depends on your brain’s ability to reorganise its undamaged cells and make up for what has been lost. This is called neuroplasticity. Physiotherapy can provide expert practical guidance to help. This ability to manipulate specific neuronal pathways and synapses has important implications for physiotherapeutic clinical interventions that will improve health. Promising therapies like specific exercise training, cognitive training and neuropharmacology are all based on our current understanding of brain plasticity (currently the subject of intense research for different pathologies). A better understanding of the mechanisms governing neuroplasticity after brain damage or nerve lesion will help improve the patient's quality of life.
Improve balance and coordination
Physiotherapist can improve your balance step by step. Treatments include both static and dynamic balance exercises. Sitting balance, standing balance, and lastly the risk of falls when walking is decreased by the balance training.
There are many interventions that can be utilised to improve coordination, such as,
Tai Chi
Pilates
Yoga
Otago Exercise Program and use of Balance Boards
Neuromuscular coordination exercises
Proprioceptive Neuromuscular Facilitation
Frenkel’s Exercises
Maximize each person’s functional abilities and level of independence
This approach is based on the simple idea that in order to improve our ability to perform tasks we need to practice doing that particular task numerous times, like when we first learned to write. Patients who receive Repetitive Tasks Training may be more likely to improve upper and lower limb function after treatment. And also this helps the patients to do their work independently.
Rebuild the person’s quality of life
Physiotherapy can help stroke survivors incorporate the physical activity recommendations into their daily routine to reduce the risk of another stroke by up to 35%.
Physiotherapists can provide circuit training, involving intensive repetition of everyday activities, to help people walk further, faster, with more independence and confidence.
Rebuild the person’s quality of life is the overall benefit that gain from physiotherapy. After a stoke the person may not achieve the previous life. But a physiotherapist can help him to achieve a better life with minimal disabilities.
Dimuthu Kumarasinghe
References
https://www.stroke.org.uk/life-after-stroke/physiotherapy-after-stroke.
Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PloS one. 2014 Feb 4;9(2):e87987.
https://www.northboulderpt.com/blog/gait-training-can-help-stroke-recovery.
Lexell J, Flansbjer UB. Muscle strength training, gait performance and physiotherapy after stroke. Minerva Med. 2008;99(4):353-368.
https://blog.rehabselect.net/benefits-of-physio-for-stroke-patients
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