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Physiotherapy


Stroke

Symptoms

Many symptoms can be observed during and after stroke. The symptoms depend on the Area of brain affected, Type of stroke, and it’s Severity.

The stroke effects may develop suddenly, slowly without warning and get worse.

Non physical effects

• Mood, Behavior and Emotional changes.
• Cognitive abnormalities – Abnormal behavior, Confusion, Loss of memory etc.
• Sudden headache, while sleeping, lying, turning positions.
• Perception problems - Trouble while speaking, Trouble in understanding others while speaking.
• Vision problems – Decreased vision, Double vision, Total loss of vision.
• Behavioral changes – Changes in alertness (Sleepiness, Unconsciousness and coma)

Physical effects 

• Decreased mobility.
• Weakness/Paralysis of muscles (especially one side of the body).
• Numbness/Tingling sensation.
• Sensation changes in Touch, Pressure, Temperature and other stimuli.
• Difficulty in swallowing
• Easy fatigue
• Pain in the muscles and joints.
• Balance and co-ordination disorders.
• Difficulty while walking.
• Fatigue
• Dizziness
• Bladder and Bowel disturbance.

Physical therapy 

Note: Rehabilitation / Physical therapy should start soon after the attack of stroke for good results. Rehabilitation should a team effort and family members support is important factor.

Stroke rehabilitation is to be done both inside and outside hospital.

Aims:

1.Improve strength of muscles.
2.To re-educate normal daily activities.
3.Improve balance and walking.
4.Prevent falling.
5.Improve movements in bed/sitting/standing.
6.Reduce muscle Pain, Muscle spasm and Joint stiffness.
7.Improve quality of life.
8.Help in performing all the activities independently.
9.Prevent complications, Minimize impairments and maximize function.
10.Prevent stroke re-occurrence.
11. Patient and patient’s family members should be educated regarding the exercise program and treatment plans.

Evaluation: (Physiotherapist should evaluate)

1.The patient’s range of motion
2.Strength of the affected and unaffected side
3.Bed mobility of the patient
4.Whether patient is able to move from bed to wheel chair
5.Balance and walking

Passive Range of Motion Exercises

• Passive movements are done by the physiotherapist because the patient is unable to move his limbs on his own.
• Passive movement means therapist supports and moves the limb through its full range of motion. (gently holding the body part and Turning, Bending and Raising etc)
• Passive movements are repeated several times in a day. They help in Maintaining blood flow, Maintain tendons and muscles flexible, Prevents joints from tightening, Prevents blood clots.
• Passive movement doesn’t help in building and strengthening muscles.

• Passive movements are done to all joints from head to toe in the bed itself. (E.g. Shoulder, Elbow, Knee, Hips, Feet, Toes etc).

• The family member should also be trained to do the passive movements. After discharge, home exercises program with clear written instructions is to be taken.
TENS, Electrical stimulation may help.

Balance and Transfer exercises

• If the patient is bed-ridden, therapist should teach the patient to move on the bed to avoid infection, bed sores etc.
• Then after recovery, teach and assist the patient to move from lying to sitting position and help in practicing sitting balance.
• Next, start practicing moving from bed to wheel chair, wheel chair to bed, slowly standing on the sliding board.
• Then practice standing with assistance and balancing in parallel bars.

Gait training exercises

• Slowly make the patient to start practicing standing in between parallel bars with the assistance of the therapist.
• Then teach him standing independently.
• Then tell him to shift weight from one leg to other, shift both from side to side, front to back.
• Next, make the patient walk in the parallel bars with/without assistance for few steps and then make him to walk independently without any support.
• Teach the patient using of sticks, canes, tripod sticks, quadrupeds, walking frames etc.
• Gait belt/Adjust belt may be used by the therapist on the waist of the patient to provide support to the patient while walking to prevent falls.
• Make the patient independent to do all his daily activities with least/no support. (E.g. Toileting, Bathing, Dressing, Eating)

Active Range of Motion Exercises

• Active movements are done by the patient itself without assistance of the therapist.
• These exercises also help in Maintaining blood flow, Maintain tendons and muscles flexible, Prevents joints from tightening, Prevents blood clots.
• Active movements help in building and strengthening muscles. Active movements are to be done on both sides.
• Active movements means the patient voluntarily moves the limbs through full range against gravity without assistance.

Stretching Exercises

•  If the patient is not able to move, therapist only should perform slight stretching during passive movement. Care must be taken as the stroke patient may have spasticity.
• This helps in preventing tightening of muscles and prevents stiff joints.

Strengthening Exercises

• If the patient’s muscle strength is good and is performing full range of movements of  all the body parts, then advice him to do strengthening exercises using very light weight until his comfort level.
• Strengthening exercises include circuit training, weight training, Isometric exercises etc which increase muscle strength and energy levels.

Aerobic Exercises 

• Walking training
• Swimming
• Initially stationary cycling then cycling (Works on large muscle groups and increases cardiovascular and daily activity tasks).
• Stair climbing
• Jogging

Facial Exercises

• These are to be done as speech and feeding get affected during stroke.
• All the facial muscles are to be exercised. (Frowning, Eye blinking, Smiling, Grimacing, Masticating, Puckering lips etc)
• Singing, Reading loudly with concentration in front of mirror may help.
• Chewing on both sides help in strengthen facial and jaw muscles.
• Yawning with opening whole mouth helps in improving swallowing and speech.

Orthotics/serial casting

 • Foot orthotic may be used if the patient has foot drop. Foot orthotic improves walking ability.
 • Serial casting may help in preventing and reversing contractures.
 • Splinting reduces spasticity.Inflatable air splints

Occupational therapy teaches different tricks which help to perform daily activities. They also supply different specially designed gadgets which helps the patient to perform daily activities easily.

 • Maintain good handwriting and fine movements of arm and hands.
 • Modify house according to the needs.
 • Eating adaptations
 • Dressing and grooming.
 • Use of wheel chairs.
 • Speech therapy – Speaking, Understanding, Reading, Writing, Improving memory, Solving problems, Dealing with numbers etc.

All joints and muscles are to be exercised.

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