Stroke! Can you recover?

Stroke! Can you recover?

We can take action to avoid strokes - but if it happens to us, a dedicated
and highly skilled medical team will help us regain function

Stroke! Can you recover?

We can take action to avoid strokes - but if it happens to us, a dedicated
and highly skilled medical team will help us regain function

Martin was an active 62 year old, nearing the end of his working career and
looking forward to retirement and time to pursue his leisure activities. One
morning as he tried to get out of bed he was horrified to find that he fell
to the floor and was unable to get up again. He was totally paralyzed on the
left side, his mouth was drooping and his speech was slurred.

Susan, at the age of 53 had a career, her children were leading independent
lives and she was about to become a grandmother for the first time. While at
work one day, she suddenly found that she could not speak. As the reality sank
in and she tried to attract the attention of her colleagues she found that her
right side didn`t seem to want to obey her commands and she could not make sense
of anything that people around her were saying.

In one instant the lives of these two people had changed. They had each had
a "stroke" or "brain attack". The unexpectedness of such
an event and the sudden loss of independence are extremely difficult to cope
with. Prompt medical intervention and good rehabilitation can have a major effect
on the future quality of these people`s lives.

A rehabilitation team comprising doctors, nursing staff, physiotherapists,
occupational therapists, speech therapists, psychologists and social workers
will all become involved in the person`s return to function.

The role of the physiotherapist is crucial

A physiotherapist in the field of neurorehabilitation is in the unique and
privileged position of really getting to know her patients, their own specific
problems and needs and how these fit into the context of their lives. Once the
medical crisis has been dealt with and the stroke patient is stable in hospital,
the physiotherapist is often the first member of the paramedic team to come
into contact with the patient. Patients and their families are often bewildered,
afraid and terribly uncertain of how they will cope in the future. The physiotherapist
can become a lifeline at this stage as she spends time with the patient and
can provide enormous reassurance to both patient and family.

While brain cells that have died do not re?generate, it is now known that the
brain has a degree of "plasticity", enabling neighbouring cells to
grow new connections and take over the function of those destroyed. It is this
ability that physiotherapists try and stimulate with therapy; the degree of
success is dependent on many factors, chief of which is probably the ability
of the patient to learn and put into practice what he has achieved during his
therapy sessions.

Physiotherapists are primarily concerned with encouraging the return of normal
movement, but in neurorehabilitation it is seldom possible to treat this problem
in isolation as so many other facets of the patient`s difficulties will impact
on how he is able to respond to the therapy. Therefore, a close association
with other members of the team is very beneficial. Therapy begins in hospital,
initially focusing on preventing complications such as respiratory infections
or pressure sores, as well as facilitating correct movement patterns and teaching
good positioning to reduce the negative impact that spasticity and reflex patterns
of movement can have. Emphasis is placed on postural alignment and symmetry,
and at the same time teaching patients how to regain some of their lost independence.

Patients are helped to set small attainable goals at a time, thereby giving
them a feeling of success which then provides further motivation. Therapy continues
after discharge from hospital, perhaps in a rehabilitation unit for a few weeks,
but ultimately with the goal of returning the person to their own home, at which
stage therapy can continue as an out patient or as home based therapy, depending
on the individual`s circumstances.

Personal stories: how rehabilitation can help

Bob, a 64 year old man who suffered a stroke which left him paralyzed on the
right and unable to speak, was fearful, bewildered and despairing in the initial
stages of his rehabilitation. His wife Jane was scared and uncertain of the
future, but at the same time trying to remain positive and supportive for Bob`s
sake. He had had a string of medical problems related to his diabetes and heart
problems and so they were not unfamiliar with illness and hospitals, but nothing
had prepared them for this sudden and devastating change to their lives. However,
with the steady support of the rehabilitation team and determination and a positive
outlook on the parts of Bob and Jane, a year later Bob has again become the
cheerful and fun?loving person he always was. Their lives are different now:
Bob has only regained some speech and although he has begun walking, still needs
assistance to do so but he continues to improve and to work at his rehabilitation.

Mary was 80 when she had a stroke. She had been living in her own home until
that stage but after her husband`s death the previous year was finding it an
increasing strain coping on her own. With the guidance of the rehabilitation
team she came to realize that moving into a retirement home had many advantages
and two years later has regained enough independence to enable her to enjoy
the company of other residents and the relief of no longer having to worry about
running a home.

Ben, on the other hand, was only 30 when he suffered a brain haemorrhage. As
a professional man with his life ahead of him, it was unthinkable that he might
not work again. He set about his rehabilitation with the same drive and determination
with which he had always approached life and within a year was driving his car
and back at work. However, he found his priorities had changed and after careful
consideration made a career change that would allow him more time to relax and
enjoy life and his family.

Not all stories have a perfect ending and recovery from stroke is no exception.
Compromises generally have to be made, adjustments to lifestyle are inevitable
with most people, but improvement is possible and the return to a meaningful
life for her patient is the goal of every therapist.

Background info

The signs of a stroke are not always obvious, so one must learn to recognize
a possible stroke patient quickly and try to ensure that the person affected
is taken to hospital as soon as possible, as early medical treatment can greatly
reduce the damage to brain tissue if given within the first 3 hours. These signs
can include any of the following:?

* Sudden weakness of one side of the face or any limb

* Sudden numbness of one side of the face or any limb

* Sudden difficulty speaking

* Sudden visual disturbances such as blurring or double vision

* Sudden onset of dizziness or loss of balance

* Sudden difficulty in walking or with co?ordination

* Sudden difficulty in swallowing

A stroke or brain attack (also known as a cerebro vascular accident or CVA)
occurs when an interruption to the blood supply of an area of brain occurs.
This can either be due to a clot becoming lodged in a blood vessel or the rupture
of a weakness in the vessel wall, resulting in a haemorrhage. Without the oxygen
and nutrients supplied by the blood, brain cells will die very quickly and a
chain reaction at a cellular level is set in motion, which can result in continuing
damage over the next few hours. It is during this window period that prompt
medical treatment can make a difference to the degree of damage and therefore
to the patient`s level of function later.

The location of the damaged area within the brain and the size of the area
involved will determine the degree and type of deficit that the patient has
to try to overcome. There could be problems with movement, sensation, perception
of space or position sense, balance, speech, swallowing, vision, concentration,
memory, or the ability to process instructions. Generally there are combinations
of several of these disabilities

Note: All names of patients have been changed

If you would like to be put in touch with a physiotherapist who deals with
people who have had a stroke, you can contact the South African Society of Physiotherapy:

South Gauteng/National Office Tel: 011?485 3794 (Karen )

Western Cape Office Tel: 021?531 2717 (Shirley)

Original article compiled by Jenny Harcourt-Wood.

Issued on behalf of the South African Society for Physiotherapy.


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