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Post-Stroke Recovery

A Cerebrovascular Accident (CVA) , often referred to as “stroke” , is the medical definition of a disruptive event, obstructing blood vessel flow to the brain.CVA may occur if a blood clot forms, interrupting blood flow either by blockage or bleeding from a ruptured blood vessel.

Early action can minimize damage and complications to the brain.In stroke rehabilitation , depending on the severity of neurological impact, the brain must re-learn lost skills

Expectations of Stroke Rehabilitation

Post-stroke rehab consists of treatment programs designed to help patients recover lost function.

A typical program usually involves a specialized team of health professionals such as physicians, physiatrists,rehabilitation nurses,physical therapists, occupational therapists & speech language pathologists. Together, this multi - disciplinary rehab team can form a customized recovery program, incorporating feedback from a variety of inputs.

From a physiotherapist’s perspective, there are two main goals:
I) Enhancing Muscle Control & II) Reducing Spasticity

Programs that combine varied exercises and techniques are designed to stimulate gradual recovery.
Relative to points I & II (see above),contraction of muscle tissue should be closely observed to monitor effects on the patient (i.e. in the event of pain or other health related problems).

Stroke rehab includes passive movements or exercises to be performed with the help of a therapist. In contrast, active exercises may enable a patient to perform them with little or no assistance.

Stretching Exercises

Stretching is important for reducing spasticity. According to the Director of Rehabilitation Medicine Services & Chief Physiatrist at the Presbyterian Hospital (New York, USA),“Stretching should be used not as an alternative to medications, but as a foundation.”

A therapist can guide you on how to stretch. The objective is to gently stretch tighter muscles to a point of slight discomfort and hold it for at least 60 seconds.Range of motion (ROM) stretches help prevent muscle shortening and joint stiffness.

These types of activities are extremely helpful in preventing spasticity & other related health problems (although it doesn’t directly address the primary impairment ). For example, some of these stretches may involve using one arm to produce forces needed to move the other (i.e. affected arm - if disabled). These are called passive exercises.

Functional Arm Exercises

This technique is referred to as Constraint - Induced Movement Therapy (CIMT).

For example,CIMT may be applied to encourage use of an affected arm. In this case, it would consist of restricting use of an unaffected hand for several hours / day while performing tasks over and over with the affected arm. Research has shown that repeated action (i.e. involving forced use of an affected hand & fingers ) can cause the brain to reorganize while helping to move the hand.

Examples of daily activities :
• Place your fingers around a door knob / handle. Try to open and close the door
• Hold a plastic bag in your affected hand and carry it
• Pull laundry out of a dryer and carry it in a bag
• Carry light objects while supporting them against your body with upper and lower arms
• Place and hold a tube of toothpaste in your affected hand. Try to squeeze the toothpaste while manipulating a tooth brush with your unaffected hand
• Flip a light switch on & off with your affected hand

The sensory information gained from touching may lead to greater recovery. Furthermor e, activities of this nature can help one attain independence during recovery

Strengthening Exercises

In stroke patients with mild to moderate impairment, it has been found that strengthening of the affected hand(s) and/or leg(s) with small weights, resistance bands & pulley weights ; may be performed without increasing spasticity and pain.

Other Techniques

In addition to the aforementioned exercises, there are other techniques that may help with recovery following a stroke.

Active - Passive Bilateral Therapy involves performing a task by using the affected and non - affected hand(s) together. This may help stimulate both the left and right sides of the brain to work better together while restoring balance and possibly improving hand function.
Robotic Devices may assist movement to help achieve a more consistent movement repetition versus conventional therapy.
Functional Electrical Stimulation (FES) encourages nerve activity in limbs affected by stroke which strengthens weak or spastic muscles.
Biofeedback is a technique designed to increase awareness while relaxing muscles to coordinate hand movements. However, further studies are required to determine its benefits as the current available research is inconclusive.

Recovering from stroke is a gradual healing & learning process that takes time, patience and persistence.