Rehabilitation after stroke: what it is and how it works

More and more people are suffering from strokes such as stroke, a disorder caused by the blockage of blood vessels in the brain, due to the narrowing of the arteries or the blockage by a clot.

To avoid this, it is essential to lead a healthy lifestyle and avoid risk factors such as smoking or obesity. And above all, it is very important to stop this type of stroke in time and to start, as soon as possible, rehabilitation at all levels, so that the person regains his functional autonomy and reintegrates into daily life. .

In this article we tell you how rehabilitation is done after a stroke and what activities are carried out in this process.

    What is a stroke?

    A stroke, also called an ischemic stroke, it occurs when there is a sudden reduction in blood flow to the brain, Usually caused by an obstruction or bleeding. This type of stroke occurs when a blood vessel ruptures or narrows (thrombosis), or when it is blocked by a clot (embolism), for example; and the consequence is that some areas of the brain do not get the oxygen and glucose they need.

    Brain infarctions usually come on suddenly and grow quickly, Worsening over time if not treated promptly. Stroke is more common in people over 55 and is the most common cause of death in women and the second leading cause in men. Bad habits, such as smoking, physical inactivity or obesity, also have a negative effect, increasing the risk of having a stroke.

    People with a family history of stroke, diabetes, and sleep apnea syndromes are also at increased risk of having such a stroke. Each year, it affects around 130,000 people, And a third of them suffer from sequelae ranging from motor difficulties, cognitive impairment and loss of functional autonomy.

    However, two elements are essential to fight against a phenomenon like this, namely: on the one hand, prevention, which consists in raising awareness of the benefits of simple habits such as exercise or life. and on the other hand, early detection and rehabilitation. Then we will talk about this second part, which is essential for the patient’s recovery from stroke.

    Rehabilitation after stroke

    When a person suffers from a stroke, a number of characteristic symptoms occur: Numbness or weakness on one side of the body, sudden confusion, difficulty walking and lack of coordination, and headache. When this happens, you need to quickly activate emergency services and take the person to the nearest hospital. He will then be referred to the Stroke Unit, which specializes in these disorders.

    After the necessary medical tests have been performed and after receiving the relevant diagnosis, the patient will be admitted until clinically stable. The first few hours are very important, as there may be signs that report more or less extensive injuries which will then be used to plan for proper rehabilitation. Again the brain tries to spontaneously recover damaged functions (Restructuring of healthy tissue) is often only possible to a certain extent and is not always achieved.

    After being discharged from medical care, the patient who has suffered a stroke will begin the rehabilitation plan, which includes a multidisciplinary therapeutic approach that will vary according to the needs of each person. It needs to be started early and needs to be coordinated among the different healthcare professionals who will be a part of the patient’s life throughout the recovery process.

    1. Physical rehabilitation

    The physical rehabilitation of the patient will be considered based on the parts of the body and physical abilities that were affected after the stroke. The main objective is to regain, in whole or in part, a functional autonomy and basic skills such as: walking, having a stable body, maintaining balance, etc.

    The physical rehabilitation plan also includes physical activities which may include: mobility training (use of canes, ankles and mobility aids in general), fine and gross motor exercises to improve coordination and muscle strength), restriction-induced therapy (restricting the unaffected area while practicing movement with the injured limb) and range of motion therapy (for patients with spasticity problems).

    Today and thanks to technology, new practices have been integrated to address physical rehabilitation after stroke, such as: functional electrical stimulation, robotic technology, virtual reality or wireless technology. All of these technology-assisted physical activities are used to improve weakened muscles and re-educate certain movement patterns that have been affected by stroke.

      2. Cognitive rehabilitation

      Cognitive problems and impairments in language, memory, attention and concentration, among others, can occur after a stroke. The goal of cognitive rehabilitation is to slow down and reduce the negative impact of these disorders, by stimulating the different cognitive functions that have been damaged by a stroke, take advantage of the neuronal plasticity of the brain which allows neurons to regenerate functionally and anatomically to form new connections.

      In most strokes in which there is cognitive impairment, the patient has difficulty in orienting himself both temporally and spatially. In this sense, guidance-oriented therapies will facilitate that in the early stages of rehabilitation the person has a better personal location and better space-time.

      Cognitive stimulation tasks in patients with cerebral infarction, they can be done on paper or assisted by technology (usually a computer or tablet), depending on the preserved abilities of each person.

      The neuropsychologist in charge of rehabilitation must be attentive not only to progress at the cognitive level, but also to other contextual variables linked to the family, social and / or work environment of the person suffering from the stroke. Finally, the ultimate goal of this rehabilitation process is for the person to acquire as much functional autonomy as possible and to be able to perform the tasks of daily living correctly.

      3. Speech therapy rehabilitation

      Language disorders after stroke are a major obstacle for the patient, especially if they involve clinical manifestations such as aphasia, which involves an inability to utter or understand language; or dysarthria, which involves difficulty in articulating sounds and words.

      The speech therapist is the professional in charge of that the patient regains his language functions and communication skills. Usually, reading, writing, speaking and comprehension exercises are usually performed, with methods ranging from verbalizing sentences at a certain pace, naming pictures or discriminating phonemes.

      In all cases, the goal of speech therapy is for the patient to regain the language skills he had before the stroke; or at least regain a functional autonomy that allows him to communicate with others and interact with his environment in the best possible way.

      4. Occupational therapy

      Occupational therapy is part of the brain infarction rehabilitation process and its goal is to achieve that the patient regains the ability to perform basic and advanced activities of daily living, So that he can be properly reintegrated into society after having suffered a stroke.

      During the occupational therapy process, healthcare professionals assess possible adaptations to the environment and the incorporation of supportive elements for the patient. Sometimes people who have had a stroke need to modify certain elements of the house so as not to have difficulties in their reincorporation: for example, by installing a stairlift on their gate, by modifying the furniture or by it. replacing the tub. for a shower tray.

      Stem cells: the last rehabilitation

      In recent years, a new therapy based on the implantation of neural stem cells has been studied to recover lost functions in patients with cerebral infarctions. In the studies carried out, mice having suffered a stroke were used in which stem cells of mesenchymal origin were implanted., Encapsulated in a harmless, biocompatible material, such as silkworm fibroin, a type of highly fibrous protein.

      In the experiments carried out, it was observed that the animals in which this stem cell therapy has been used have considerably improved their motor and sensory abilities. who had been affected after suffering a stroke. In addition, encapsulation has been shown to increase the survival rate of implanted stem cells, thereby positively influencing the repair of damaged brain tissue and preventing its spread after stroke.

      In short, researchers are working on the future development of drugs that can stimulate these types of stem cells in the brain, so that they can multiply, move to affected areas of the brain, and begin the process of cell repair.

      Bibliographical references:

      • Brott, T. and Bogousslavsky, J. (2000). Treatment of acute ischemic stroke. New England Journal of Medicine, 343 (10), 710-722.
      • Patel, M., Coshall, C., Rudd, AG and Wolfe, CD (2003). Natural history of cognitive impairment after stroke and factors associated with its recovery. Clinical rehabilitation, 17 (2), 158-166.
      • Rodríguez García, PL (2014). Ischemic stroke: advances and projections. Cuban Journal of Neurology and Neurosurgery, 4 (1), 71-88.

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