Overview of Stroke Rehabilitation
(Please see our article on Stroke to learn more about the types, causes, risks, prognosis, and prevention of strokes.)
A stroke is a sudden loss of brain functions due to a disruption of blood flow to the brain. The tissues in our brains rely upon the oxygen in the blood to function properly, so places in the brain where blood flow has been interrupted can no longer function. The brain is an extremely complicated and delicate organ, and when starved for oxygen, there is a possibility for permanent damage to occur due to this tissue suffocation. The more quickly a person recognizes the signs of stroke and can get medical attention, the less risk they will have for permanent brain damage.
The symptoms of a stroke depend largely on where in the brain the stroke occurs and what function that part of the brain performs. One common symptom of stroke is numbness or paralysis of the face and limbs, often on just one side of the body. If blood is blocked from the part of the brain that controls speech, the person may slur their words or become unable to talk. Loss of balance and motor control may also occur. If blood and oxygen are not restored to these tissues quickly, the damage to the brain tissue can become more extensive. A stroke is a serious, potentially fatal, medical emergency, and the faster that treatment can begin, the greater chance there is of recovery.
Stroke is currently the third leading cause of death in the United States, behind heart disease and cancer, and more than 700,000 people suffer a stroke each year. Thanks to increased vigilance of those at risk for stroke and improved medical treatments for patients who have suffered strokes, most people survive their ordeals. In 2007, it was estimated that there were approximately 4.7 million stroke survivors in the United States. For most, their lives are forever changed in physical, mental, or emotional ways, and some may lose the ability to work or live independently. Through stroke rehabilitation, stroke survivors can begin to restore their quality of life and work toward independence.
The Aftermath of a Stroke
The level of rehabilitation after a stroke depends on which area of the brain was damaged. There are five major categories of disabilities that may remain following a stroke: paralysis and problems with physical movement, sensory disturbances (pain), language difficulties, issues with memories and cognition, and emotional imbalances.
One of the most common disabilities arising from stroke is paralysis, often of just one side of the body (typically opposite the side of the brain where the stroke damage occurred). Depending on the level of paralysis, the stroke survivor may experience muscle weakness or loss of responsiveness on one side of the body, which can make day to day activities difficult to perform. If there is damage to the cerebellum, which is responsible for motor control, the stroke survivor may have trouble maintaining balance and body posture, making it difficult to walk. If the part of the brain that controls the muscles for swallowing is damaged, the patient may have trouble swallowing, a phenomenon called dysphagia.
Patients that have had a stroke may also suffer from a variety of sensory issues, as the brain is the primary interpreter of sensory information. Stroke survivors can lose the ability to sense temperature, pain, or even touch. Sometimes, the processing of visual information is disrupted such that the patient cannot recognize things. Likewise, damage to the brain can cause miscommunications to the body, interpreting normal sensations as pain. These false signals of pain can cause perpetual discomfort for the patient, and through trying to deal with the pain (often by not moving), additional complications can develop.
Due to a combination of both sensory and motor control problems, many stroke survivors often experience urinary incontinence for a short time after the stroke. In these cases, the patient is unable to control the muscles of the bladder or sense that the bladder needs to be empty. Although not usually permanent, this loss of control can be difficult for stroke survivors to deal with emotionally.
At least 25% of patients that have had a stroke emerge with difficulties using or understanding language, a condition also known as aphasia. If the language center known as Broca's center, is damaged, this can result in expressive aphasia. Patients with expressive aphasia have trouble communicating through speaking or writing, as they have difficulty constructing thoughts in a coherent way. If there is damage to the language center called Wernicke's area, the result is receptive aphasia, in which the understanding of language appears to be lost. Although someone with receptive aphasia may speak in grammatically correct sentences, the words they use do not make sense. If there has been extensive damage to the tissues in the brain devoted to language, the patient may incur global aphasia, a complete loss of the ability to use or understand language. A more subtle form of this aphasia, amnesic aphasia, may cause a stroke survivor to forget categories of related words.
Some stroke survivors also lose functions related to cognition and memory. Following a stroke, some patients notice a reduction in attention span and have difficulty learning new things. If the parts of the brain where information is processed are not functioning well any more, short term memory loss may be frequent and it may be difficult to comprehend the meaning of things that are occurring in the environment around them. Some particularly have difficulties with problem solving or completing tasks that require a completing a series of steps in sequence.
Emotional disturbances are also very common among those that have survived a stroke. Naturally, the trauma surrounding such a serious health crisis can cause sadness, fear, frustration, and even anger. Many survivors of stroke also suffer from depression and grief, either due to the occurrence of the stroke itself or any of the symptoms that remain following the losses of brain functions. Some of these emotional changes may also be caused physical changes to the brain tissues, as well, as the brain controls hormone levels and other physiological signaling that can control the mood. There may be sudden changes in personality in stroke survivors, including mood swings, irritability, and self-loathing. Stroke survivors may exhibit a lot of the signs of clinical depression, as well, including weight gain or loss, fatigue, sleep disorders, and suicidal thoughts.
Conventional Stroke Rehabilitation Therapies
Rehabilitation following a stroke usually involves a team of physicians and nurses, all with different specialties, to help work on each set of issues that a patient must overcome. Each patient requires specialized, individual care, since each stroke patient enters rehabilitation with a different set of obstacles and goals.
Early on, it is critical to take a comprehensive look at the patient's brain functions to determine what sort of damage remains after the stroke. This portion of the rehabilitation is typically led by a neurologist during the hospitalization of the patient. Once the patient has recovered from the incident of the stroke itself, neurologists can begin to perform tests for function in the various parts of the brain. Many of these neuropsychological tests are also used on people that have been in accidents or had brain damage due to other factors, and include tests for memory, concentration, cognition, visual tracking of objects, and flexibility of thinking. Problem solving, pattern recognition, and the ability to perform tasks in sequence are also examined.
Physicians also play a crucial role in the rehabilitation of stroke survivors, by helping to reduce the medical risk factors that may have led to the stroke. Long term care may be handled by a neurologist, but it is more often led by a physician who takes primary responsibility for helping stroke survivors manage their blood pressure, cholesterol, weight, and any other conditions that may contribute to their likelihood of having another stroke. Of those that survive their first stroke, more than ten percent have a second stroke within the year that follows. Patients may be placed on blood pressure and cholesterol medications and possibly continue to take aspirin and other blood thinners to reduce the chances of forming dangerous blood clots.
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