Stoke is the world’s second biggest killer. A stroke happens when the blood supply to the brain tissue is interrupted.

There are two main types of stroke

  • Ischemic strokes are caused by a clot in a blood vessel of the brain
  • Hemorrhagic strokes are caused by bleeding in or around the brain.

Both types of stroke can damage or destroy brain cells due to oxygen los. This is a medical emergency because brain cells are starting to die within a few minutes without oxygen. A Stroke can occur at any age, but stroke risk does increase as you get older.

A Stroke can affect everything –

  • the ability to move
  • communicate
  • learn and process actions
    – which all can and will influence activities of daily life

The amount and the impact of the damage depends on the affected area.

〉A third of the annual stroke victims are left with impairments of motor function, speech or vision.  20% of them are younger than 60. (1)

〉In western society, stroke is the leading cause for lasting disability. (2)

〉In 80% of all stroke incidence the risk can be foreseen. The risk of a stroke can be influenced by various factors(3,4).

〉Some of these factors can be can be effected, others can not. Around 90% of the population attributable risks can be reduced by our lifestyle. (5)

After a stroke you may have to deal with different kinds of symptoms, which all can and will influence your performance in your daily life. All together can be said, that the location of the stroke influences the impairment. A stroke in the left side of the brain will show the main symptoms on the right side of the body, and the other way around.

The most common impairments of a stroke are:

  • Hemiparesis and Hemiplegia
  • Sensory deficits
  • Spasticity
  • Vision problems
  • Aphasia
  • Pain
  • Cognitive deficits

〉Every stroke patient should be assessed for all necessary therapies and rehabilitation goals should be set. Using the available support systems in your country can help you with your recovery. (3)

USA
UK
Australia

〉According to the ASA (3), 42% of stroke patients in the U.S. are not referred to any post- acute care. In the UK over a third of stroke survivors are discharged to an Early Supported Discharge (ESD) or community rehabilitation team. Only 50% of the stroke survivors in the UK are assessed for further treatments. There are still areas in the UK with no access to speech and language therapy for stroke survivors. (4)

Stroke survivors may require:

  • Speech therapy
  • Physical therapy and strength training
  • Occupational therapy (relearning skills required for daily living)
  • Psychological counseling

〉Although the quantity of therapies can be overwhelming, the ASA provides an overview of therapy treatments that are recommended (3)

Generally speaking, any therapy is better than none.

The access to therapy and to an interdisciplinary team of experts for rehabilitation can help through the challenging process of regaining functionality and independency.

〉After a stroke, the biggest results in the rehabilitation process will occur in the first few weeks. Due to  neuroplasticity (the ability of our brain to reorganize) with ongoing therapy, continuous improvement can be expected. (6)

The success of the rehabilitation process depends on a high amount of active therapy time.

Often a variety of therapeutic approaches are necessary to achieve progress.

〉A combination of task-specific training, mental practice, mirror therapy, strategy training and “forced-use-therapy” or CIMT can improve function and performance in daily life. (3)

The complex functionality of our hands is a challenging aspect of the upper limb rehabilitation process. Activity limitation, reduced participation and the inability to us one’s arm and hand can lead to loss of independence in daily life.

Full recovery is not always possible, but improvement is.

Therapy doesn’t stop after an hour of OT or PT, it’s not only inpatient or outpatient therapy. Studies show that stroke patients need even more repetitions of a movement in order to re-learn it. Every activity, every challenge in daily life is part of therapy and can add to these repetitions.

〉Therapists also assign exercises to do at home in order to maximise the therapy time. The patient has to have a lot of internal motivation and self control to follow through with such a plan. (7)

〉The need to improve the effectiveness of rehabilitative training is ongoing. There are already new directions for therapy after stroke. In addition to conventional therapy, new technologies can provide patients with a way to independent training. (8)

〉Regardless of when a stroke occurred, therapy can always bring about improvements in some ways. Staying active and reducing the post-stroke complications is crucial to long term independence. (9)

Bibliography

    1. Katan, M., & Luft, A. (2018). Global Burden of Stroke. Seminars in Neurology, 38(2), 208–211. https://doi.org/10.1055/s-0038-1649503
    2. Wardlaw, J.M., Sandercock, P.A.G. & Murray, V. (2009). Should more patients with acute ischaemic stroke receive thrombolytic treatment? BMJ.
    3. Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., … Zorowitz, R. D. (2016). Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke (Vol. 47). https://doi.org/10.1161/STR.0000000000000098
    4. Stroke Association. (2018). State of the nation – stroke statistics. Stroke association. https://doi.org/10.1038/nj6943-1021a
    5. O’Donnell, M. J., Chin, S. L., Rangarajan, S., Xavier, D., Liu, L., Zhang, H., … Yusuf, S. (2016). Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. The Lancet, 388(10046), 761–775. https://doi.org/10.1016/S0140-6736(16)30506-2
    6. Robbins, J. (2008). Swallowing and Dysphagia Rehabilitation : Translating Principles of Neural Plasticity Into Clinically, 4388(March 2015). https://doi.org/10.1044/1092-4388(2008/021)
    7. Fleming, M. K., Newham, D. J., & Rothwell, J. C. (2018). Explicit motor sequence learning with the paretic arm after stroke. Disability and Rehabilitation, 40(3), 323–328. https://doi.org/10.1080/09638288.2016.1258091
    8. Widmer, M., Held, J. P., Wittmann, F., Lambercy, O., Lutz, K., & Luft, A. R. (2017). Does motivation matter in upper-limb rehabilitation after stroke? ArmeoSenso-Reward: Study protocol for a randomized controlled trial. Trials, 18(1), 1–9. https://doi.org/10.1186/s13063-017-2328-2
    9. Bustamante, A., García-Berrocoso, T., Rodriguez, N., Llombart, V., Ribó, M., Molina, C., & Montaner, J. (2016). Ischemic stroke outcome: A review of the influence of post-stroke complications within the different scenarios of stroke care. European Journal of Internal Medicine, 29, 9–21. https://doi.org/10.1016/J.EJIM.2015.11.030