A stroke injures nerve cells in the brain. There are two types of strokes: ischemic and hemorrhagic.

Ischemic stroke:

• Caused by an obstruction of a blood vessel in the brain which denies necessary oxygen and nutrients to the affected brain tissue
• Accounts for almost 90% of strokes
• The main cause is atherosclerosis or the development of fatty deposits or plaques along the vessel walls
• A blood clot can form at the site of the fatty deposit within a blood vessel that supplies the brain (thrombosis) and occlude blood flow to brain structures supplied by that vessel
• A blood clot can also form elsewhere in the circulatory system (embolism), usually the heart or in the large arteries of the neck, then travel up to the vessels of the brain where it gets stuck in a narrowed artery causing blood flow obstruction. A main cause of embolism is a condition called atrial fibrillation wherein the heart beats irregularly

Hemorrhagic stroke

• Occurs when a weakened blood vessel in the brain ruptures allowing blood to spill into the brain tissue
• Blood accumulates around the area of the ruptured blood vessel and compresses the brain causing damage. The blood itself is also damaging to the brain tissue it contacts
• There are two main types of hemorrhagic stroke
• Intracerebral hemorrhage: occurs within the brain tissue
• Subarachnoid hemorrhage: occurs between the inner and outer layers of tissue that cover the brain
• The main causes of hemorrhagic stroke are an arteriovenous malformation or a cerebral aneurysm rupture
• In some cases only supportive treatment is needed while in other cases blood needs to be evacuated from the brain to reduce the pressure on the brain tissues

The signs and symptoms of a stroke differ based on the vessel which was injured and the areas of the brain that are affected. Strokes affecting the face, trunk or limbs will cause symptoms on the opposite side of the body from the location of the stroke. Some of the common signs and symptoms of a stroke, however, are as follows:

• Muscle weakness and loss of motor control in the arm, leg or trunk
• Facial drooping
• Pain
• Changes in sensation
• Changes in bowel and bladder control
• Clumsiness and loss of coordination
• Impaired balance
• Ataxia
• Foot drop
• Difficulty in walking
• Fatigue
• Vision changes
• Changes in cognition and concentration
• Dizziness
• Speech impairments
• Difficulty swallowing
• Muscle stiffness or spasticity
• Fine motor impairments

If you decide to work with a physical therapist to help with stroke rehabilitation related issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY INTERVENTIONS FOR STROKE

Physical therapists play a supportive and rehabilitative role in the management of stroke. The main goal of therapy is to promote neuroplasticity of the brain to help repair and replace injured synapses or connections in the brain and to promote reorganization of the brain to restore normal brain function. Intensive, specific and structured rehabilitation is the best method to promote recovery. Neuroplasticity is greatest within the first 3-6 months following the stroke though this does not mean recovery cannot happen after that time period. Where recovery of primary brain function is slow or incomplete, physical therapists will teach patients how to compensate for impairments like lasting muscle weakness, loss of motor control, balance or vision impairments to help restore their prior level of function or maximize functional independence.

Given that the symptoms of a stroke are unique to the vessels involved, your physical therapist will individualize a treatment plan to meet your needs. These are some of the physical therapy interventions and services you may receive when working with your PT.

Patient education: education on topics like energy conservation techniques, adaptive equipment, safety, fall reduction, exercise and more to help you improve daily function and quality of life.

Gait and transfer training: physical therapists can assist in improving gait mechanics, walking endurance and recommend assistive devices for walking. They can assist with learning how to move around in bed, transfer between surfaces, get in and out of the car, bed, shower and more.

Balance training: stroke can cause impairments in balance. Physical therapy can help train the balance systems for sitting, standing, walking and more.

Strength and endurance training: strength training and endurance training to improve muscle performance in the arms, legs and trunk can help with performing daily tasks, participating in exercise, work and recreational activities.

Pain management: physical therapists can help with the management of musculoskeletal pain related to stroke.

Equipment prescription: different types of adaptive equipment and assistive devices can improve mobility, energy conservation and quality of life and your physical therapist can help guide you on which devices are most appropriate.

Aerobic training: Your physical therapist can help you participate in an aerobic exercise program safely.

Experiencing a stroke can be overwhelming but physical therapy can help manage symptoms of this condition and improve function and quality of life. If you are ready to experience how physical therapy can help you, call Evolve today to schedule your initial evaluation.