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Treatment, therapy and rehabilitation after stroke

What happens in emergency treatment after stroke?

Stroke treatment

In the event of a possible stroke (see Symptoms/warning signs and causes of stroke) every minute counts. The patient must receive immediate medical treatment in a nearby hospital. It is a clear advantage if the hospital has a Stroke Unit especially equipped for the treatment of stroke patients.

A targeted therapy requires a differential diagnosis to determine the existence of reduced blood flow or cerebral hemorrhage. This examination uses imaging techniques such as computer tomography (CT) and/or magnetic resonance imaging (MRI) of the brain.

After diagnosis the following treatments are possible:

  • If a cerebral blood vessel is blocked by a blood clot (reduced blood flow), medicinal thrombolytic therapy is often used to dissolve the blood clot. Another option is thrombectomy where the blood clot is sucked out of the blood vessel with a catheter. Acetylsalicylic acid may also be administered to stop the growth of the blood clot and thus prevent the risk of another stroke.

  • In the event of a cerebral hemorrhage, hemostasis is of the utmost importance. It is often also necessary to reduce the excessively high blood pressure by administering medication. If a larger amount of blood has leaked into the surrounding cerebral tissue, surgical removal may be necessary.

Stroke treatment depends on the diagnosis and varies between patients. 

Adjacent regions of the brain (penumbra) may also be affected. Blood flow should be improved as quickly as possible to minimize damage in the adjacent areas - because “time is brain”.  Suspected stroke should be diagnosed as quickly as possible to immediately start with adequate treatment.


Therapy and rehabilitation after stroke

Physical handicaps are common consequences of cerebral damages caused by reduced blood supply. Various rehabilitation methods can help completely or partially restore impaired body functions. Structural and functional changes can transfer tasks from damaged to undamaged brain areas (neuroplasticity).

Early rehabilitation – Long-term rehabilitation

The sooner appropriate rehabilitation starts, the better the results. Early rehabilitation should therefore already begin in the hospital. A multidisciplinary and coordinated team of therapists can start with activating measures in patient care, exercises to increase mobility, speech abilities and swallowing. The type of impairment determines subsequent rehabilitation measures to be performed regularly and over a longer period of time. Individual therapy plans usually include different therapy methods of various specialties (physiotherapy, ergotherapy, speech therapy, biofeedback, electrotherapy, etc.). Modern therapy usually focuses on a complex and comprehensive approach. It is important to set realistic, reachable and clear therapy goals and adjust those goals regularly. Activities of Daily Life (ADL) are often practiced in therapy to enable the patient to return to independent life step by step. The patient is asked to actively and intensively repeat tasks. The exercises are integrated into the patient’s daily life. 
  

Stroke rehabilitation
 

Goal of rehabilitation


The goal of stroke rehabilitation is to help patients regain an independent and self-determined life. This includes the basic activities of daily life and also the participation in social and professional life.

Sometimes rehabilitation can only reduce the need for care and alleviate discomfort due to the severity of the stroke. Patients often depend on help in their daily life. It is important to realize and find ways to overcome barriers and use appropriate aids and appliances or further therapy. 

Motor learning

Motor learning aims at changing or relearning movement competency and activities consisting of individual, coordinated movements. The patient’s active participation and motivation are crucial factors.

A motor learning process is considered successful when, for instance, improved movements are still noticeable even several days after physiotherapy. During therapy patients regularly practice several tasks sequentially with increasing intensity and changing sequences. Patients are required to continually find new solutions to the execution of the movement. After executing a movement the brain checks if the desired goal has been achieved and saves the experience to have it automatically ready for the next equivalent task. Therapy success can be facilitated by a positive feedback after reaching the goal of the exercise.

What therapy options do I have after stroke?

The following therapies can improve functional mobility deficits and activities:

Physiotherapy

The physiotherapist develops an individual therapy plan based on the functional deficits and problems. Exercises to relearn natural motion sequences or alternative compensation strategies with or without aids, muscle strengthening and exercises to increase endurance, improve balance and coordination, body awareness, etc. are performed regularly.

In addition, physiotherapy also aims at regaining normal movement patterns by, e.g., reducing spasticity (increased muscle tone). The primary goal is to maintain and/or improve the patient’s mobility to enable them to regain the best possible physical independence. The patient’s family is often involved in physiotherapy.

Physiotherapy after stroke
Ergotherapy after stroke

Ergotherapy

Ergotherapists train the patient in the use of everyday aids to compensate limitations caused by handicaps. Exercises include motor-functional activities and practical tasks (e.g. personal hygiene, getting dressed, shopping) intended to increase the patient’s activity level.

Affected persons shall regain the best possible independence in their daily lives. Ergotherapists also counsel family members and instruct and help them in supporting the patient.

Speech therapy

Speech therapists treat speaking and swallowing disorders. Speech therapy helps improve the patient’s ability to communicate, speak, pronounce clearly and ingest independently.

Another therapy focus is on facial nerve paresis. Therapy is targeted at the individual deficits.

The family also learns how to handle these disorders.

Speech therapy after stroke
Biofeedback after stroke

Biofeedback

Motor impairments can be treated with biofeedback. An electromedical device provides the patient with a visual and acoustic feedback of the performed movement. The user becomes aware of their movements. This enables cognitive relearning of movements and/or voluntary relaxation of spastic muscles. Symptom-oriented biofeedback training, if necessary combined with muscle-activity-controlled electrotherapy, effectively supplements the therapy of nerve damage and can be used by the patient in the rehabilitation phase or after rehabilitation in controlled home therapy.

Electrotherapy

Electrotherapy is an ideal supplement to conventional motor therapy in stroke rehabilitation. Electrotherapy can already be used in the hospital after acute treatment has been completed. Outpatient/inpatient treatment according to a defined therapy plan should be performed regularly over an extended period of time. Patients can use some electrotherapy devices at home according to the physician’s/therapist’s instructions (STIWELL med4).

Electrotherapy can be used in all phases of neurorehabilitation. The effectiveness of electrotherapy has been proven in several studies.

Electrotherapy after stroke

How does electrotherapy help after stroke?

Stroke causes partial failure of the transmission from the brain via the spinal cord and the nerve tracts to the muscle because the responsible brain/nerve cells have been damaged or are dead. The affected muscles cannot or not so frequently be stimulated and muscle mass decreases (muscle atrophy). Electrotherapy is intended to prevent this from happening. Electrotherapy strengthens the flaccid muscles in early therapy and helps to relearn motion sequences with the aid of electrotherapy and biofeedback. For the therapy to be successful it is necessary to practice targeted, reproducible functions with frequent repetitions.

Functional electrostimulation (FES)

Functional electrostimulation is intended to restore complex movements. This is achieved with well timed, subsequent stimulation of muscles and muscle groups which need to be activated for a functional movement.

The affected muscle is contracted by electrical stimulation of the motor points. Electrodes attached to the skin create an electrical field stimulating the nerve and muscle tissue, thus leading to a contraction of the muscle. Through interaction with the nervous system the brain receives a positive feedback of the executed movement. Regular repetitions enable the formation of new synapses between brain cells. Healthy brain areas can partly take over lost tasks from dead cells (EMG-triggered).

With targeted initialization and control of muscle movement functional stimulation in combination with physiotherapy or ergotherapy can significantly improve the therapy outcomes. Centrally paralyzed muscles can be curatively treated with electrostimulation. Residual functions can be improved in cases of incomplete tetraplegia. In addition, functional stimulation can contribute to relaxing spastic muscles by reducing muscle tone. The STIWELL med4 offers different functional programmes whose parameters can be individually adjusted.

Examples for functional electrostimulation are these motion sequences:
Hand to mouth, grasp/release, open/close hand, arm extension, standing up, treatment of foot drop.

EMG-triggered electrostimulation

In addition to physiotherapy and ergotherapy, EMG-triggered electrostimulation can be recommended as a useful rehabilitation method. Muscle activity is measured and a certain level of activity (e.g. by actively contracting the muscle) triggers stimulation. EMG-triggered electrostimulation after stroke increases voluntary motor activity and reduces spasticity (muscle tone), thus improving the ability to cope with everyday tasks. After individual programming by the therapist, EMG-triggered electrostimulation enables the patient to perform controlled, targeted motion sequences.

Rehabilitation after stroke

Rehabilitation is an important step towards recovery after stroke. Therapy should begin as early as possible with an individual rehabilitation programme consisting of several therapy methods. Regular application of the different methods and support by family and caregivers contribute to a successful therapy.


Important:

This article contains only general information and must not be used for self-diagnosis or self-treatment. This information does not replace medical advice.