Stroke and Its Rehabilitation
Stroke is a clinical condition that consists of a wide range from loss of movement, sensation, balance and speech, loss of consciousness to coma due to blockage or rupture of cerebral veins. It is popularly known as hemiplegia. 85% of stroke occurs due to obstruction and 15% due to cerebral hemorrhage. Stroke is the most common and serious neurological disease. It is the third most common cause of death after heart disease and cancer. Stroke is more common in men than in women. It is mainly an elderly disease; most patients are older than 65 years. With advances in medicine, the chance of survival after stroke is increasing. Approximately 80% of patients survive. High blood pressure is the most important risk factor. The second common risk factor is heart diseases. Diabetes doubles the risk of stroke. Smoking is also one of the important risk factors.
Clinical process changes depending on the location the disorder in the brain. Body half (arm and leg) on the opposite side of the brain half in which bleeding and obstruction is paralyzed. Sensation may decrease and vision may be impaired on the paralyzed body side. Urinating and speech disorders, and memory loss may occur.
Exercises should be started in the first days of the disease. Because early mobilization (movement) prevents complications and affects the patient's relationship with those around him and mental status in a positive manner.
The patient’s position on the bed should be taken care of. Pillow is placed under the shoulder and elbow, and a rolled towel is put into the palm. The leg is extended, supported by a sandbag to prevent it from rolling out. The ankle is held vertically at 90°. The position is changed every two hours. The patient is occasionally lied face down for a short time.
In the acute period, the exercises are performed passively, and the patient's participation is encouraged as soon as possible. Rotating and changing positions on the bed, sitting on the bed, getting into a wheelchair, standing and walking should be done gradually and the patient should be encouraged.
There are many clinical studies showing that most stroke patients recover significantly over time. Recovery time varies from patient to patient. Improvement even in patients with extensive damage to the motor areas of the brain indicates that adjacent or distant brain regions gain new functions and assume the function of the damaged region. Structural and functional reorganization (neuroplasticity) in the brain forms the basis of healing and may last for months. Functional training and use are effective in healing. The patient's participation in active physical therapy programs has a positive effect on functional reorganization in the brain and accelerates neurological recovery.
Motor recovery is rapid in the early period. It usually occurs in the first 3 months and can last up to 6 months. Approximately one-third of stroke patients have aphasia (inability to speak), which decreases to 15% by the end of the 6th month. Aphasia can take a year to heal.
After the acute period, exercises are performed to maintain the range of motion and strengthen the muscles. The patient is encouraged to mobilize.
Neuromuscular reeducation techniques and therapeutic exercises aim to restore lost motor abilities. Functional electrical stimulation is used to increase muscle strength, improve active movements, dissolve edema, and gain the patient's lost senses. Biofeedback regulates events that the patient cannot normally control. Devices such as walking sticks and crutches can be provided for the patient to use her/his arms and walk, and the patient is taught to use them.
Occupational therapy starts. The purpose of this therapy is to make the patient independent in daily life activities such as washing hands and face, shaving and bathing.
Improvements in stroke rehabilitation accelerate the patient's recovery and improve the quality of recovery. One of these improvements is the robots that assist walking, arms and hands. Robots facilitate the repetition of the patient's movements and made the activities fun. The movements that the patient cannot perform can be done with the help of the robot, so that the brain can reorganize itself (neuroplasticity) by the signals sent to the brain and the lost functions can be recovered.
The earlier the rehabilitation starts, the higher the success rate. However, stroke rehabilitation is often a long and challenging process that requires patience. At each stage, the patient should receive adequate training. If there is a hurry in this process, bad gait patterns may develop.