Stroke Definition

Physiotherapists assist and treat patients with temporary or long-term physical injuries, movement disorders or disability, aiming to achieve the highest possible degree of recovery, activity, participation and quality of life . Physiotherapists are active  in the prevention of illness and injury and in the promotion of health. The initial process of evaluating the consequences of an internal injury in an individual is to ascertain the status of the respiratory system.There are lots of injuries that may affect other parts of the body system apart from the specific area the injury occurred. spinal cord injuries  are the injuries which may occur due to sporting activities or vehicular accidents. If there is a fracture of the lower lumbar, there may not be any direct effect of such injury on the breathing condition of the individual or the arms therefore the patient will readily be in good shape on the trunk and arm area in which normal aerobic activity may be carried out. However, if an injury affects the upper thoracic or the cervical area, it is likely to lead to respiratory impairment of the victim; it could further inhibit the patient’s arm function.

spinal cord injury results in  unstable spine a case often leads to paraplegia. . The surgeon will work to stabilize the spine with the help of instruments as well as bone grafting. This process allows the victim to begin early rehabilitation without having to wait long for the healing of the spinal fractures. . The earliest management a procedure is to initiate a physiotherapy practice by monitoring the respiratory condition and to ensure that there is always movement of the areas that are unaffected. Also passive movement should be performed on the paralyzed parts of the body in order to improve as well as retain the range of motion of the body that will be necessary for later independent function.

The physiotherapist will gradually make the patient assume more upright position by making the back of the bad upright. This recovery procedure must be as gradual as possible as quick and sudden getting up can force the blood pressure of the patient to drop suddenly.  As soon the patient learns to control the trunk in sitting as well as in wheel chair transfer, the patient should be taken to spinal cord injury specialist department

other goals of physiotherapist while treating spinal cord injuries

• Assessment of the respiratory ability of the patient
• Teaching the patient the process for taking deep breath in order to fully expand the lungs
• Making the patient cough to expectorate
• If there is a paralysis of the lower abdomen, the patient should be encouraged to keep that area stable by stabilizing with arms in order to allow a propulsive cough
• In cases of severe disability, the session would involve an external support for stability of the patient to aid the exit of air suddenly in coughing
• Provision for cough assist machine may be used for cough provocation
• For intensive care situation, there will be need for initial management in which a respiratory physiotherapy practice will also include a respiratory suction

By now, everyone knows that cigarette smoking can be a very dangerous pass-time. Smoking causes many strokes, cancers, and health issues in society, and puts a definite strain on the health system. Every smoker has been bombarded by facts and information on the effect that smoking is taking on their body, but they often still choose tobacco over their health on a daily basis. For many people, the risks of smoking just don’t seem to register. As smokers age, however, they can start to feel the effects on their bodies of a lifetime choice to smoke tobacco. If you’re a smoker, you may feel like the withdrawals are not worth stopping smoking, but you may not realize how quickly and efficiently your body can start to recover from a long-time tobacco habit.

Within One Week of Quitting Smoking

You lungs will begin to heal and repair themselves, making bronchioles relax and allowing for easier breathing. Food will begin to taste and smell more strongly, allowing you to use less salt and other harmful seasonings. Your body oxygen levels even out to where they should be, ridding your blood of harmful chemicals it has been relying on. You also decrease the likelihood of a heart attack nearly instantly.

Within Three Months of Quitting Smoking

Your body starts to change as your lungs continue to heal, and you may notice more energy as your airways and muscles become stronger and healthier. This means that you’ll be less likely to suffer from infection, as your body becomes better equipped to handle illness. You will also find your circulation improving, meaning less temperature regulation issues, and less will lead to fewer health complications down the road.

After Five Years Smoke-Free

Not only will your risk of smoke-related cancers be cut in half by the five year mark, your chance of getting other cancers which are not considered smoke-related will also fall to match the rate of a non-smoker. Risks of heart disease and strokes are also lowered drastically compared to someone who is still smoking.

Quitting smoking also lowers the risk of diabetes, and has proven benefits which add years on to your life. You will find that simple tasks which tire you out start to become easier after just a short period of time. Socially, you will also notice a benefit in that you no longer have to step outside to curb your cravings, and you will never miss a nit of conversation at a party. The benefits to quitting smoking don’t stop there, as this lifestyle change also is often accompanied by other positive lifestyle changes. You will also start to reap such rewards as lowered health insurance rates.

This guest post is from Allison with HealthInsuranceQuotes.org, where you can find more tips on lowering your health insurance rates.

Stroke patient may experience  very difficulties and barriers  to recovery of normal activities . These can take the form of impairments  directly caused by the stroke. There are number of different approaches to treatment for patients  with stroke. These include

 * Bobath( or normal movement approach)

    * motor learning (or motor relearning or movement science)approach

     *brunnstrom approach

    * Rood approach

     *proprioceptive neuromuscular facilitation

     * johnstone technique.

                                                Beside these techniques there are other general methods by which we can decrease the effects of stroke, these are as under:

1)  Spasticity

Spasticity referred to as an unusual “tightness” of muscles referred to as an unusual “tightness” of muscles in which there is   lack of inhibition from the CNS results in excessive contraction of the muscles, ultimately leading to hyperflexia( increase in reflexes).  It can be reduced by neurological physiotherapy. Physiotherapy will  use a combination of hands on treatment and exercise therapy  to reduce spasticity…

a)      Use of ice to decrease spasm and pain.

b)      Stretching of muscles through range to relieve stiffness in the joint and surrounding tissues.

c)      Exercise to increase muscle strength and functional performance. This may include regular standing and weight bearing.

d)     Activity to improve range of movement.

e)      Correcting and varying joint position during  activities.

f)       Hydrotherapy treatment to relieve muscle tension.

 2)      Gait disorders

It has been seen that treadmill training, particularly with partial(30-40%) body weight support may be effective in re-educating the patient in walking after stroke.

 3 )Biofeed back technique

This provides a patient both auditory or visual feed back relating to movement or postures of their body or limbs. Feed back related to body positions for example weight distribution between the legs during standing or while rising to stand is beneficial.

4)      Foot drop

Foot drop is inability to raise the foot at ankle joint.AFO”s (ankle foot orthoses) can be prescribed to patients with foot drop following stroke. It may help in maintaining  ankle dorsi flexion , reducing spasticity and improves the patterns and safety of gait. Foot drop can also be treated by the use of braces. Exercise therapy to strengthen, that transfer tendons from stronger leg muscle is occasionally performed.

 5)      Electrical stimulation

In this there is bursts of electrical current to a muscle or a peripheral nerve, to create or assist a voluntary muscle contraction. It thus may improve muscle force, strength and function.

6)      Communication skills

                    Aphasia an acquired impairment of cognitive system for comprehension and formulating language. symptoms such as communication deficit, affecting communication interaction, notably non-verbal communication  occur following right hemisphere stroke.  The role of speech and language therapist in aphasia include assessment, differentiation of aphasia from other communication difficulties ,advise and education, counselling and direct intervention

  Dysarthria  is a motor speech disorder affecting clarity of speech, voice quality and volume and over all intelligibility. It may be associated with aphasia. Patient with dysarthria refered to the speech and language therapist.

7)   Nutrition and swallowing

Careful assessment of nutritional status and swallowing impairment should be done. Fluid management and routine use of I/V fluids should be early management in stroke. Advise of dieticians should be sought.

 8)     Urinary/faecal Continence

Anti cholinergic drugs to treat urinary incontinence must be prescribed. Urinary catheter  should be used. Indwelling catheter should be used to treat painful urinary retention without delay. once precipitating cause  has removed patient care plan should include planned trial without catheter . Regular use of constipating agent and bowel care with enema.

9)     Pain

Most commonly patient having musculoskeletal pain and involving the hemiplegics shoulder. Central post stroke pain(CPSP) is characterized by partial or that deficit for thermal/or sharpness sensations.  Use of hi-lo Transcutaneous electrical stimulation may help patient.  Positive relaxation as an adjuvant therapy should be used

10) Shoulder hemiplegic pain

This problem contributes to poor upper limb recovery, depression, sleeplessness  following stroke. Careful handling of affected upper limb along with consistent supporting positioning strategies should be practiced. Electrical stimulation, physical therapy, ultrasound, strapping and support should be used in the management.

11)  Falls

Falls are the common features of stroke. Therefore treatment include muscle strengthening and balance retraining programme. Withdrawal of psychotropic medication shows benefit in reducing falls.

12)  Pressure ulcer

Pressure ulcers can be prevented by changing the position of the patient regularly, making use of water beds. Positioning of patient is helpful to prevent complications such as contractures, pain, abnormal tone.

13)  Depression and emotional liability

Stroke patient with depression should be offered a use  of treatment with anti depressant drug therapy.

                                                      Stroke may be defined as the abrupt onset of the neurological disorder that may occur due to some vascular cause. It occurs if an area of brain tissue is deprived of its blood supply, causing brain cells to lose their supply of oxygen. Without oxygen, brain cells can become irreversibly damaged within minutes. Stroke is mainly caused by disruption of blood flow to the brain as a result of blockage or leakage in a blood vessel. The effects of stroke vary depending on the severity of the blockage or leakage.

Stroke commonly causes an arm , leg weakness,  facial weakness and speech problems. This  may lead to decreased mobility, balance problems and difficulty in performing everyday tasks. Unlike other cells in the body, if brain cells are irreversibly damaged then they are unable to heal themselves. The brain, however is capable of learning new tasks to compensate for the areas that have been damaged and physiotherapy thus encourages the learning and help the body relearn normal movement patterns.

Types of strokes

Stroke is mainly of two types

a)      Ischemic stroke

b)      Haemorrhagic stroke

Ischemic stroke

Ischemic stroke is usually caused by a blockage within an artery. This blockage  results in decreased blood flow to an area of brain and therefore the brain cells in that area are damaged due to the lack of oxygen.

Haemorrhagic stroke

It is also called as “brain haemorrhage”. This occurs when  blood vessels in the brain ruptures causing bleeding into the area of brain. This causes a build up of pressure and damages the delicate tissues of the brain. Blood flow to the neighbouring brain cells also reduced and these cells get damaged due to lack of oxygen and causes stroke.

Common physical limitations during stroke

the common physical  limitations that occur during stroke are as follows;

a)      stair climbing

b)      bathing

c)      walking

d)     feeding

e)      urinary/faecal incontinence

The brain is however, very adaptable i.e. capable of relearning new tasks and, with physiotherapy recovery can take place. Patients often have recovery in first few months, followed by slower recovery over the following years. With the correct physiotherapy input and advice patient have lots of potential to improve from the condition. Physiotherapy will assist in regaining as much movement and function as possible. Treatment often  focuses on sitting, balance, standing, walking, using affected arm/hand, managing any change in the muscle tone , pain or stiffness. After stroke many people experience difficulties in performing tasks that were previously simple. Therefore physiotherapist will advise the patient the use of walking aids like crutches, sticks, splints and supports.

Manual handling training service should be done. This training involves teaching safe therapeutic handling and positioning techniques that will promote normal movement patterns and normal postural alignments of patients. Use of slings and wheel chair can also be taught.

 Cerebral vascular accident

It is defined as  damage to the brain caused by a disruption of the blood supply to a part of the brain. This disruption of blood supply can be caused by a blood clot, or by a ruptured artery. The symptoms of a cerebral vascular accident depend on the  part of the brain  affected.  CVA  are mostly related to heart function because they are often associated with conditions affecting the heart. CVA is also referred to as a Stroke. stroke  occurs all of sudden affecting the blood vessels of the brain. Stroke is the third leading cause of death in the United States and the second leading cause of death in the world.  It is called a Temporary Ischemic Attack (TIA) when the symptoms are temporary (less than 24 hours), and  stroke when the loss of brain function is permanent.

This “brain attack” occurs when there is not enough blood reaching the brain. A disturbance in blood flow may be due  to one of two main  causes:

1) there is blockage due to an arterial clot or fatty deposit and vessel rupture.

2) When there is a malfunction in blood flow, cellular death or infarction occurs

In case if  stroke is left untreated , more cells in the brain die due to oxygen and nutrient starvation. Therefore, cellular death in the brain can be localized or systemic. A stroke is a medical emergency . If there is any symptom of  stroke occurs the patient  should be taken immediately to a medical facility for diagnosis and treatment.

Types of Strokes

There are two major types, ischemic stroke and hemorrhagic strokes.

Ischemic strokes involve arterial or vessel blockage. The following are two types of ischemic strokes:

Cerebral Embolism – This type of stroke is one of the most common . The carotid arteries serve as the major blood vessel that travels blood to the brain. A stroke will occur if any smaller branch  is occluded, thereby blocking the passage of blood.   This may occur if cholesterol, a clot, or other material deposited in a vessel – usually within the carotid artery – breaks off into a  smaller vessel where it becomes lodged between the vessel walls. A traveling clot or piece of debris traveling from any where in the  body to the brain is called an embolus. When blood supply is cut off from the brain, there is a very serious risk of brain damage or death.

• Cerebral Thrombosis – The carotid artery in the neck and the cerebral artery in the brain can also succumb to a blood clot or atherosclerosis. When  it occurs , the occlusion is called a thrombus, a stationary blockage of the artery that cuts off blood passage. TIA, transient ischemic attacks, which may cause stroke-related symptoms last just a short time.

This is a guest post by Amrita Saxena. She has years of experience being a freelance and ghost writer. These days she writes about how to get rid of blackheads as well as blackhead remover.

Stroke complications

A stroke cause temporary or permanent disabilities, depending on how long the brain suffers a lack of blood flow and which part of the brain was affected.

The most common complications are:
• Brain edema  —  In this swelling of the brain  occurs after a stroke.
• Seizures —  There is abnormal electrical activity in the brain causing convulsions.
• Clinical depression — a treatable illness that often occurs with stroke and causes unwanted emotional and physical

 reactions to changes and losses.
• Bedsores —  After stroke pressure ulcers occurs due to decreased ability to move and pressure on areas of the body

because of immobility.

• Limb contractures —  There is shortness of  muscles in an arm or leg  because of  reduuced range of motion or lack of

exercise.

• Shoulder pain — common due to hemiplegia or exercise of an arm. This usually is caused when the affected arm hangs

 resulting on pulling of the arm on the shoulder.

• Deep venous thrombosis — This is because of  blood clots form in veins of the legs because of immobility  due to stroke.
• Urinary tract infection and bladder control —  such as urgency and incontinence are common.
• Pneumonia — causes breathing problems, a complication of many major illnesses.

   .   Paralysis or loss of muscle movement. Sometimes when there is  a lack of blood flow to the brain  person become paralyzed on one side of the body, or lose control of certain muscles, such as those on one side of the face

• Difficulty talking or swallowing. A stroke may cause a person to have less control over the way the muscles in the mouth and throat move, which makes  it difficult to talk, swallow or eat. A person may also have a hard time in  speaking because a stroke has caused aphasia, a condition in which a person has difficulty expressing thoughts through language.
• Memory loss or trouble with understanding. It’s common that people who’ve had a stroke  has  some memory loss. Others may  find  difficulty in  making judgments, reasoning and understanding concepts. These complications may improve with rehabilitation therapies.
• Pain. Some people who have a stroke may have pain, numbness or other strange sensations in parts of their bodies affected by stroke. For example, if a stroke causes lose feeling in left arm, you may develop an uncomfortable tingling sensation in that arm.  It may  also be sensitive to temperature changes, especially extreme cold. This is called central stroke pain or central pain syndrome (CPS). This complication generally develops several weeks after a stroke, and it may improve as more time passes. But because the pain is caused by a problem in the brain instead of a physical injury, there are few medications to treat CPS.
• Changes in behavior and self-care. People who have a stroke may become more withdrawn and less social or more impulsive. They may lose the ability to care for themselves and may need a caretaker to help them .

  Basilar artery stroke

Basilar artery is the most important artery in the posterior circulation. It is formed at the pontomedullary junction by the combination of both vertebral arteries. It lies on the ventral surface of the pons and, along  its course,  it gives off its median, paramedian, short, and long circumferential branches.The branch of the basilar artery with the larger circumference is the anterior inferior cerebellar artery. It normally arises at the junction of the proximal and middle thirds of the basilar artery and supplies the lateral pontine tegmentum, brachium pontis or middle cerebellar peduncle, flocculus, and a small part of the anterior cerebellum. The internal auditory artery usually arises from the anterior inferior cerebellar artery; however, it may also arise as a direct branch of the basilar artery.

The terminal branch of the basilar artery is the posterior cerebral artery (PCA);  which mainly  supplies the midbrain, the thalamus, and the medial aspect of the temporal and occipital lobes. Proximal to its bifurcation into the terminal branches (ie, PCA), the basilar artery gives off the superior cerebellar arteries that supply the lateral aspect of the pons and midbrain and the superior surface of the cerebellum. The clinical manifestations depend on the location of the occlusion, the extent of thrombus, and the collateral flow. If the proximal segment of the basilar artery is occluded and the occlusion resulted from a slowly progressive stenosis, collateralization occurs within the cerebellum into the circumferential branches of the basilar artery. In  most cases of distal (top of the basilar) or proximal (vertebrobasilar junction) occlusions which  are due to embolism either from a cardiac or an arterial source. On the other hand, midbasilar artery occlusion is typically the result of atherothrombosis. Arterial dissections are very rare and usually involve the vertebral artery and occasionally extend to the basilar artery .

•     Clinical presentation 
  • An abnormal level of consciousness and motor signs, such as hemiparesis or quadriparesis (usually asymmetric), are seen
  • Bulbar and pseudobulbar signs are the most common findings  .
  • Pupillary abnormalities, oculomotor signs, and pseudobulbar manifestations (ie, facial weakness, dysphonia, dysarthria, dysphagia) are common
                                            . The syndromes more commonly associated with basilar artery occlusion are:
  • • Locked-in syndrome: It is caused by infarction of the basis pontis secondary to occlusive disease of the proximal and middle segments of the basilar artery, which leads to quadriplegia. Because the tegmentum of the pons is spared, the patient has a spared level of consciousness, preserved vertical eye movements, and blinking.
    • • • Top-of-the-basilar syndrome:  it is the manifestation of upper brainstem and diencephalic ischemia  which is caused by occlusion of the l basilar artery, usually by an embolus. Patients present with changes in the level of consciousness.  visual symptoms such as hallucinations and/or blindness is common. Third nerve palsy and pupillary abnormalities are also frequent. Motor abnormalities include abnormal movements or posturing.
      • Oculomotor signs are common. They usually reflect involvement of the vertical gaze center in the midbrain or the abducens nucleus, the horizontal gaze center located in the paramedian reticular formation contiguous to the abducens nucleus, and/or the medial longitudinal fasciculus. Lesions to these structures result in the following:

        • Ipsilateral abducens palsy
        • Ipsilateral conjugate gaze palsy
        • Internuclear ophthalmoplegia
        • One-and-a-half syndrome caused by a lesion simultaneously affecting the paramedian reticular formation and the medial longitudinal fasciculus, resulting in ipsilateral conjugate gaze palsy and internuclear ophthalmoplegia
        • Ocular bobbing, which localizes the lesion to the pons: This is characterized by a brisk downward movement of the eyeball with a subsequent return to the primary position.
        • Skew deviation.
                                                                            Other reported signs of pontine ischemia include limb shaking, ataxia (usually associated with mild hemiparesis), facial weakness, dysarthria, dysphagia, and hearing loss.
                         Medical care
                                            Patients with unstable  neurological symptoms, decreased level of consciousness, active cardiac or respiratory  conditions, hemodynamic instability, or a need for interventional therapies (eg, thrombolysis) must be admitted to a neurological intensive care unit.Every effort should be made to maintain a normal intravascular volume by administering isotonic solutions.. Dobutamine should be used with caution and with close monitoring of the cardiac index because it can often cause vasodilatation and hypotension.  Management of the airway is  importantl.Endotracheal intubation is recommended in most patients to keep their airway clear while maintaining normal ventilation. Tissue plasminogen activator (tPA) is the only pharmaceutical agent used  for the treatment of acute ischemic stroke within the first 3 hours of onset. . In some cases Angioplasty with or without stent placement has been performed to treat patients with atherosclerotic stenosis or to mechanically dislodge thrombi. The combination of intravenous thrombolysis with consecutive on-demand endovascular mechanical thrombectomy may allow for early treatment initiation with high recanalization.Recanalization of the basilar artery is key to the successful treatment of basilar artery thrombosis and for improving its prognosis.

        Left hemispheric stroke

stroke occurs when blood supply is intrrupted to the brain. This is caused by a blood clot blocking a vessel in our brain, or a torn vessel bleeding into our brain. The left side (hemisphere) of our brain controls the right side of your body. It also controls our speech and language abilities. After a left hemispheric stroke, we may have trouble in  talking, swallowing, or walking. we become more slowly and our memory may be worse than before the stroke. A left-hemisphere stroke often causes paralysis of the right side of the body. This is known as right hemiplegia.

Causes of left side stroke

There are mainly two causes of stroke

 1)Ischemic stroke:   this mainly occurs when an artery to our brain gets blocked due to  plaque  in our artery. Plaque happens when fatty deposits and other things build up in an artery. It  can also get a blocked artery from a blood clot also. The clot can break loose from an artery somewhere else and travel to our brainstem. The clot may get stuck in a narrow blood vessel, stopping blood and oxygen from reaching our brain. This is called an ischemic stroke. Most strokes are ischemic strokes.

 2)Hemorrhagic stroke: A blood vessel may break and leak if a clot gets stuck in it, or the vessel wall is weak. Blood then flows out of the vessel and into brain tissue. This is called a hemorrhagic stroke

 Risk factors for left hemisphere stroke

•  patient may be  55 years old or more than that..
• Common in  woman  who  use birth control pills, or take  hormone replacement medicine after menopause.
•  father or mother already had a stroke, or  had a low weight when we were born.
• There is high blood pressure, or blood vessel or sickle cell disease that is not being treated.
•  There may be atrial fibrillation, diabetes or other heart or blood vessel conditions.

   Stroke medicine

Stroke medicine involves the management of all forms of stroke and transient ischaemic attack (TIA) and   whole patient pathway( which include diagnosis, investigation, acute treatment, rehabilitation and re-integration, secondary prevention and long-term complications).  stroke isl the most common cause of severe and  acquired disability in adult life, therefore  new and emerging interventions can reduce the personal and societal impact of the condition. stroke is a  medical emergency,it can cause permanent damage to the nervous system  and If it is not promptly diagnosed  and treated, it may lead to death

In the majority of patients blockage of an artery in the brain due to  clot (thrombosis) is the most common cause of a stroke. The part of the brain that is supplied by the clotted blood vessel is then deprived of blood and oxygen. As a result of the deprived blood and oxygen, the cells of that part of the brain die and the part of the body that it controls stops working. Typically, a cholesterol plaque in a small blood vessel within the brain that has gradually caused blood vessel narrowing ruptures and starts the process of forming a small blood clot.the stroke or TIA will be a manifestation of atherosclerotic disease, and coexisting conditions such as ischaemic heart disease, peripheral vascular disease, diabetes and hyperlipidaemia are common. However,  in younger patients, there may be  unusual causes of stroke such as arterial dissection, migraine, thrombophilic and vasculitic disorders.

Drug therapy is a relatively recent approach to the treatment of stroke, that will minimize the effects of the stroke Much of the damage caused by a thrombotic or embolic stroke occurs in the first six hours. The development of new clot-dissolving drugs and medications  make the brain more resistant to stroke commonly called as neuroprotective agents. medications for the stroke include

Antiplatelet medicines

•   Aspirin is most often used to prevent TIAs and strokes.
• Aspirin combined with dipyridamole is a safe and effective alternative to aspirin.
•  clopidogrel may be used for people who cannot take aspirin.

Anticoagulants

Anticogulants prevent   the formation of blood clots and keep existing blood clots from getting bigger. If there is atrial fibrillation,then we will  probably take an anticoagulant.

Statins

statins lower cholesterol level. It can greatly reduce the risk of  stroke  in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease  or high  cholesterol.

 blood pressure  medicines

If  high blood pressure is there  then we have  to take medicines  that  lower it. Blood pressure medicines include:

• .Angiotensin II receptor blockers (ARBs)
• . Angiotensin- converting enzyme(ACE) inhibitors
• . Beta blockers
• . Calcium channel blockers
• . Diuretics

Drugs that dissolve clots are known as thrombolytic agents.  if  these drugs should be given within the first few hours after stroke,  they minimize stroke damage.

• Thrombolytic Agents (tissue plasminogen activator [tPA]), widely used to dissolve clots that cause heart attacks, are also effective for dissolving artery-blocking clots in the brain during the critical early stages of stroke. Early administration of tPA after a stroke can reduce neurological damage.
• Neuroprotective Agents - Medications that make the brain less susceptible to the damaging effects of a stroke are called neuroprotective agents.