Did you know that around 15 million people in the world experience a stroke each year? Out of those 15 million, almost 10 million either pass away or are disabled.
A stroke is something that many people have to readjust their lives for. Depending on the severity of the stroke, it can even lead to permanent residence in a care facility.
Physiotherapy is critical during all stages of stroke rehabilitation. Through coordinated care from a physiotherapist, you or your loved one can start the process of recovery.
Are you interested in learning more about a physiotherapist’s role in post-stroke rehabilitation? Keep reading on to learn more about recovery from a stroke.
What Is Post-Stroke Rehabilitation?
To understand post-stroke rehabilitation, it is crucial to understand better what a stroke is and what causes it. The technical term for a stroke is a cerebrovascular accident (CVA).
In the brain, you have many blood vessels that deliver nutrients and oxygen to various parts. When one of these blood vessels becomes blocked, certain parts of the brain are deprived of vital nutrition.
Depending on what area of the brain received the damage will usually determine what regions of deficit someone has. Strokes typically have two causes – a blockage or burst blood vessel. When a blood vessel bursts – otherwise known as a ruptured aneurysm – the person has a higher likelihood of more widespread damage.
Post-stroke rehabilitation emphasizes recovery following a CVA. The body has its own healing methods, and the brain is no exception. It is going to try and rewire broken signals following this damage.
A physiotherapist helps someone relearn motor tasks and teach adaptation skills in the home. They also retrain fine or gross motor tasks, coordination, and balance.
Depending on the severity of the stroke, a person could remain in a hospital or care facility before returning home. This means that rehabilitation includes a multi-disciplinary approach. You can read more about this later on.
The Goal of Physiotherapy and Stroke Rehabilitation
Because the brain has its own way of healing, the ultimate goal of physiotherapy is to essentially promote a rewiring of the brain. Stroke patients need a delicate balance of mental and physical stimulation each day.
The amount of stimulation will vary – and hopefully, increase – as the patient progresses in their recovery. The ultimate goal of a physiotherapist is improved independence and safety in the home environment. They want to try and get people back as close to their prior level of functioning as possible.
If the stroke is severe, a patient will likely learn adjustment tools and strategies to live safely at home with supervision. A physiotherapist is trained to educate family members and patients on safety and mobility in a facility or at home.
In the early stages of a stroke, the physiotherapist will primarily work on assessing the extent of the damage. They can also work on early mobility skills such as light strengthening, stretching, or positioning.
As the patient progresses, the rehab goals will adjust to include higher functioning activities. The main focus of this session is to prevent further complications and treat active issues.
Once the patient is discharged home, physiotherapy continues. The goal in this setting is to promote safety and independence in the home environment. Physiotherapists also work closely with the patient towards preventing a loss of skills or further complications.
From a multi-disciplinary approach, stroke rehabilitation encompasses more than just the physiotherapist. You or your loved one will have multiple health professionals that specialize in different areas.
To Recover Motor Skills
Often, stroke patients have impaired motor function on one side of the body. This leads to difficulties performing everyday tasks such as walking, standing, dressing, and even getting in and out of bed.
Sometimes, people eventually recover partial or total use of all of their extremities. Almost 85% of stroke patients lose at least partial motor use in one of their arms. Around 40% have long-term impairments.
This condition, known as hemiplegia, is common to see. When one side is affected, the physiotherapist teaches strategies that overcome the deficits using someone’s stronger side.
Research recommends that motor skills and tasks focus on repetitive, functional movements. Even if it takes more time, the patient should use their affected extremity as much as possible. This helps in the rewiring of the brain.
What are functional tasks? These are things that everyone frequently does throughout the day and usually without a second thought. Some examples are reaching, standing, dressing, brushing our teeth, etc.
Task-specific exercises are critical to the rehab process. These exercises let patients focus on one thing at a time. It also gives them a chance to work on a task repetitively. If needed, the physiotherapist provides physical assistance or teaches compensatory strategies.
To Recover Mobility
Mobility falls in line many times with motor function. A person’s mobility is negatively affected after a stroke. This is due for many reasons, some of them are:
- Weakness or hemiplegia
- Coordination problems
- Abnormally high or low muscle tone
- Muscle contractures or extreme tightness
- Sensation problems
What are the first steps to regaining mobility?
In a severe stroke, the first step is learning how to roll in bed. Then, it progresses to sitting up at the edge of the bed. Once someone is sitting, they can have balance issues that require support to remain upright.
Often, the goal of treatment is to get someone sitting up before working on other tasks.
There are a lot of mobility exercises someone can do in a sitting position, including reaching, leg or arm exercises, and core strengthening. Once a person is safe, the physiotherapist helps them work on standing and taking steps.
Depending on where the stroke was and how significant the damage is, this process takes longer or shorter.
To Recover Cognitive Abilities
Cognitive deficits after a stroke cause safety risks for trying to return home. If a patient is unaware of their deficits, this can lead to falls or other burdens placed on caregivers.
One study looked at multiple research journals to see what type of rehabilitation led to cognitive improvements. They found that aerobic and strength training had some of the best results. This was even noted in patients who had a stroke almost three years prior.
Ultimately, any form of physical activity led to improvements in cognition. Why is this important? Over 80% of stroke victims suffer from cognitive impairments. Reducing long-term deficits is essential to someone’s overall well-being and health.
To Regain Communication
Communication is an integral part of post-stroke rehabilitation. Usually, when people think of communication, they think of speech therapists or other types of therapy.
However, a physiotherapist plays an essential part in all of this. A skilled physiotherapist will provide clear instructions and eliminate any external stimuli limiting their ability to focus.
During this time, background noise should be non-existent, and distractions should be kept to a minimum. They should keep tasks focused on one thing at a time. This gives the patient plenty of time and reasoning to work through it.
It also provides patients with a better opportunity to express questions or frustrations.
Early Physiotherapy Helps People Relearn Vital Abilities
Early mobility guidelines are sometimes challenging to determine. One study focused on the benefits of physiotherapy with stroke patients 24 to 72 hours after the injury. They found that there were several positive benefits to starting movement and rehab early on.
Some of the benefits were:
- Reduced complications
- Improved neuroplasticity
- Reduced mortality
What is neuroplasticity, and how does early physiotherapy help? Neuroplasticity is how your brain rewires itself. It includes the building of new pathways or restructuring around damaged ones.
Typically, the younger and healthier you are – the more neuroplasticity you have. If you are older or have other comorbidities, you might have less neuroplasticity. Physiotherapy is showing evidence of helping spark neuroplasticity immediately after someone has had a stroke.
This is extremely important to note because, after a short period, neuroplasticity starts to decline.
After completing an inpatient stay for stroke rehabilitation, your physiotherapist and physician might suggest in-home physiotherapy. A physiotherapist will arrive on certain days and help with exercises and other mobility tasks when you discharge home.
This is sometimes called mobile physiotherapy, and it is beneficial for patients to carry over their rehab program in a home environment. The physiotherapist can better determine safety risks and hazards in the home as well.
Daily Stroke Rehabilitation Exercises
Stroke rehabilitation exercises should focus on strengthening and mobility activities. Physiotherapists can also help you or your loved one work through other types of activities such as:
- Pain management
- Avoiding future injuries
- Improving flexibility
- Improving coordination and balance
Additionally, your physiotherapist provides a home exercise program that patients work through on their own or with a loved one. Daily mental and physical stimulation through activity is vital to a person’s overall health and well-being.
A study in Canada looked at the benefits of exercise in post-stroke patients. They followed a large group of individuals for five years following the incident. They found that there was a 54% lower risk of death with people who walked up to four hours per week or biked up to 3 hours per week.
This number was higher for those under the age of 75. Almost 80% of patients in this age group had lower mortality rates with exercise. It doesn’t have to be just walking or biking either; the researchers found the same benefit with those who liked gardening.
However, not everyone can participate in more vigorous activity. For that reason, it is necessary to have your physiotherapist design an exercise program that best fits you or your loved one’s needs.
Multi-Disciplinary Team To Help in the Process
Having a qualified, multi-disciplinary team on your side is greatly important to positive outcomes. The goal of a multi-disciplinary team approach is to treat the patient as a whole.
In a hospital setting, this includes the rehab team, social workers, recreational therapists, and physicians. As a patient progresses to in-home rehabilitation or outpatient rehabilitation, your team dynamic may shift.
It is more important to have higher amounts of rehab during this stage due to improved medical stability. Some other members of the rehabilitation team that lead to positive outcomes are:
Occupational therapists work hand-in-hand with physiotherapists. Some of their goals with post-stroke patients could be:
- Improving activities of daily living
- Helping with a return to work
- Teaching coping strategies
- Teaching compensatory strategies
It is vital that you have a whole team to work with you since each individual discipline is specialized in different areas. As noted earlier, physiotherapists indirectly help with occupational therapy tasks by teaching early mobilization skills.
Early mobility and movement are essential to developing strategies for dressing and other self-care tasks. An occupational therapist is specialized in further addressing these functional tasks. You want to make sure you go through a trusted and professional rehab clinic to receive expertise through multiple disciplines.
Take the Next Step
Having a stroke is a life-changing event. Physiotherapists use stroke rehabilitation to help you or your loved one during every recovery step. During the early stages of a stroke, it is crucial to start mobility as soon as possible to reduce long-term deficits.
Not only have these activities shown a positive benefit in the early stages, but it is important to retain carry-over at home.