Physiotherapy after a stroke: Intervening to recover

Cerebral Vascular Disease is the most frequent cause of neurological disability in western countries. According to the World Health Organisation, a stroke is defined as “the rapid development of clinical signs of focal (or global) disorders of brain function, with symptoms that persist for more than 24 hours or lead to death, with no other apparent cause other than of vascular origin”.

The most common strokes are ischemic (when an obstruction of a cerebral artery causes a stroke due to the lack of necessary oxygen and nutrients not reaching the brain) and haemorrhagic (when an excessive amount of blood is pumped to the brain injuring the brain tissue, due to the rupture of a blood vessel).

Strokes are one of the major causes of disability, in which approximately two-thirds of the affected individuals are close to 65 years. However, a stroke can occur at any age, even in young people. Most of the survivors present a combination of sensory, motor, cognitive and emotional alterations, resulting in functional restrictions when performing daily activities.

Risk factors can be non-modifiable (personal) and modifiable (environmental). Age, sex and ethnic group are personal; hypertension, smoking, alcoholism, hyperlipidemia, diabetes mellitus, obesity and sedentary lifestyle are modifiable.

In spite of the numerous advances in the prevention and intervention of strokes, it remains the most prevalent neurological condition with a great impact on society. Strokes are classified as the most disabling chronic disease.

However, it is now possible for these patients to recover much of their functionality, if subjected shortly after the acute phase of a stroke, to a multidisciplinary rehabilitation programme which includes physiotherapy.

Physiotherapy in an individual who has suffered a stroke should be a continuous process, starting when the patient is still in hospital and continuing as an outpatient. In the recovery process, the brain cells affected are stimulated by physiotherapy optimising their reorganisational capacity, both in the gymnasium and with basic tasks in a home environment.

Between the first and third month after a stroke, neurological recovery of the structural lesions of the brain occurs, whereas the most important functional recovery occurs between the third and the sixth month, which is why physiotherapy should be started as soon as possible.

The Hospital Particular do Algarve is a reference in this area, with trained and specialised teams that provide the most proven scientific techniques in the rehabilitation of patients who have suffered a stroke.

In addition to intensive rehabilitation programmes – interdisciplinary programmes consisting of eight hours’ daily therapy can be organised – equipment is also used to increase the results of manual techniques such as electrostimulation, robotic devices for walking, orthoses, kinesiotapes, among others. In recent years, the use of hyperbaric medicine has also proved to be a very important aid in rehabilitation techniques, with very positive results, especially in chronic injuries.

Facial deviation, decreased strength on one side of the body and difficulty in communicating are the first signs of a stroke. Knowing how to identify them can be the key to rehabilitation or even a lifesaver. Be aware of these important signs.

A quick response is the key in minimising brain damage.

By João Felício
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João Felício is a physiotherapist and specialist in neurological and vestibular rehabilitation at Hospital Particular do Algarve in Alvor.