Hope for stroke – time is of the essence!
"My friend was driving me to the lab, to get my blood tested. Suddenly, my entire left side went dead. I screamed and turned to him. He exclaimed, when he saw my twisted face, that I was having a stroke! He immediately took me to the hospital. That was more than a year ago. I couldn't believe this had happened to me. I was only 45 years old."
These are true words from Mary who was not able to move her entire left side but now walks again after receiving intensive physiotherapy.
Stroke may be one of the major causes of disability in Jamaica. Typically the most obvious symptoms present is one-sided weakness. This weakness can affect the face, arm and leg on one side. It can result in difficulty with speech and functional activities such as reaching and holding objects, as well as standing, balancing and walking. Loss varies from person to person and is dependent on the degree of involvement of the brain.
Physical therapy is a key aspect of the multidisciplinary approach to rehabilitation in stroke. There is established research supporting this. Health professionals, including physiotherapists, who have specialised in this area bring additional expertise to the rehabilitation of the stroke survivor.
An early start is crucial in the recovery of stroke. Ideally, physical therapy should begin once the patient is medically stable, as the critical recovery phase is within the first three months after the stroke. However, all is not lost as there is evidence that there can be continued recovery beyond this time.
There are several approaches to the management of the physical rehabilitation of the stroke survivor. One such approach sees specialist physical therapists using movement science to evaluate and identify functional inadequacies and compensations of the patient. Once identified, training is primarily focused on the performance of functional activities such as walking.
In my own experience, in retraining functional activities, I break down and teach each part of the movement to the patient, eventually putting it back together to recreate the original activity. Other components
that can be used in conjunction include aquatic therapy,
robotics, video games and electrical therapy.
Aquatic therapy can be beneficial, as water partially 'carries' the person's body weight. Use of robotics and video games take advantage of the evolution of technology such as virtual reality. Electrical therapy can facilitate muscle movement when the person is unable to perform a movement. Manual therapy, stretching and strengthening activities also facilitate functional training and are commonly used.
Physical therapists caring for stroke survivors tend to advocate intensive and repetitious practice. It's all about 'practice, practice, practice', which is especially crucial at home with the assistance of trained relatives and caregivers.
During the recovery phase, involuntary movements may begin to surface. Physical therapists also play a role in supporting and educating the individual and their relatives or caregivers about the appropriate management of such occurrences as well as educating them in other areas of stroke care such as positioning.
Stroke survivors can suffer devastating insult to the body, hindering functional abilities. Fortunately, physiotherapy can bring hope to stroke survivors and their families. Together we aim at improving function in order to ultimately facilitate independence.
Remember, time is of the essence so let's get started for there is hope for stroke!
n Kathryn Fletcher, RPT, MSc (Neurorehabilitation), recently returned from the United Kingdom where she was awarded a Masters in Neurophysiotherapy at the University of Nottingham. She is currently practising at Physical Therapy Solutions.