BRAIN STROKE AND PHYSICAL REHABILITATION

BY- JITENDRA KUMAR GROUP- 407

GUIDED BY – PROF. Bobrik Yu.V.

BRAIN STROKE-• A stroke occurs when the blood supply to your brain is interrupted or

reduced. This deprives your brain of oxygen and nutrients, which can cause your brain cells to die. A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagicstroke).

Disabilities – Caused by brain stroke:-• Hemiparesis (48%) “• Inability to Walk (22%) “• Need for Help in daily activities. (24-53%) " • Clinical Depression (32%) “• Cognitive Impairment (33%)

Recovery:-Dependent Upon – " Type “1) Cerebral Ischemia.2) " Cerebral Hemorrhage. " Extent “3) Level of Recovery in Rehab 2) Remaining Disability 3) Pre-existing Comorbidities.

Brain stroke and role of physiotherapy:-• To understand the role of physiotherapy following stroke. • To be aware of causes of hemiplegic shoulder pain and methods of

prevention. • To recognize the importance of positioning and know how to position

an patient with acute stroke.• To understand the term Early mobilization.

What is Physiotherapy? • Physiotherapy is concerned with helping to restore well-being to

people following injury, pain or disability through mainly physical means. ! Following stroke, the overall aim is to help people regain functional independence in everyday tasks such as standing, walking and eating etc.

Initial stages:-• Assessment !• Advice on positioning ! • Advice on prevention of shoulder pain ! • Respiratory management. !• Sitting out/ mobilizing

Core areas in stroke physiotherapy :-• Sitting balance ! • Transfer training !• Gait reducation !• Upper limb functional rehab !• Strength, co-ordination, balance, tone etc. !• Assessment of falls risk ! • Stair practice!

Hemiplegic shoulder pain:-• Incidence somewhere between 5% and 80% !• Severe, persistent shoulder pain in 5% ! • Secondary, muscular-skeletal disorder.

P eeehabilitation

ELEMENTS OF THE STROKE REHABILITATION:-• Prevention• Treatment• Compensation• Maintenance• Reintegration

Goals of physical rehabilitation:• Restore patient to maximum mobilization• Help patient regain functional independence and confidence• Provide measures to prevent falls and

ensure safety• Educate patient and family about secondary prevention• Facilitate psychosocial adjustment

Rehabilitation team members• psychologists• OTs • recreational therapists• PTs • speech pathologists• medical social services personnel

Patient assessment:• repeated clinical examinations• full & consistent documentation

throughout

Assessment target-• neurologic impairments• medical problems • disabilities• living conditions and community reintegration

Continuity of care and family involvement:• Multiple care settings during

recovery• Patient and family must:• be fully informed &

participate in decisions• participate actively in

rehabilitation

Mobilization;• Within 12-24 hours, if possible• Daily active/passive ROM exercises• Progressively increased activity• Changes of position in bed• pullsheet method• limb positioning & support

• Encouragement to resume self-care & socialization

Measures to prevent recurrent strokes:• Carotid endarterectomy in patients who have 70%-99% carotid artery

obstruction.• Anticoagulants in patients with atrial fibrillation and other nonvalvular

cause of embolic stroke.• Antiplatelet agents in patients who have had transient ischemic attack

(TIA).

Preventing deep venous thrombosis:• Heparin• low molecular weight (LMWH), or• low-dose unfractionated (LDUH)

• Other effective measures• intermittent pneumatic compression• elastic stockings

Management of dysphagia:• Goals• prevent dehydration and malnutrition• prevent aspiration and pneumonia• restore ability to chew and swallow safely

Indicators of poor rehabilitation:• Severe functional/motor/cognitive deficits• Persistent urinary/fecal incontinence• Severe visual/spatial deficits• Sitting imbalance• Severe aphasia• Altered level of consciousness• Major depression• Severe comorbidities• Disability before stroke• Older age

Threshold criteria for admission in rehabilitation:• Medically/moderately stable• One or more persistent disabilities• Able to learn• Physical endurance sufficient to:• sit at least 1 hour per day• participate in rehabilitation

Management plan for rehabilitation:The management plan should identify

• significant impairments and disabilities• measures to prevent recurrence• treatments for comorbidities• rehabilitation interventions• plans for periodic monitoring

Measure of successful rehabilitation;• Normalized health patterns• Freedom from physical pain/emotional distress/impairments• Retention of cognitive/communicative abilities • Mobility and independence in ADL• IMPROVED QUALITY OF LIFE

Summery; requirement of successful physical rehabilitation:• In-depth assessment at all phases• Appropriate patient selection• Early introduction to rehabilitation• Teamwork approach in multidisciplinary setting• Shared goals and management plan• Detailed, shared record keeping

Thank You!!!!!!!!!!!!!!!!!!!!!!!