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Stroke - Rehabilitation

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Rehabilitation begins as soon as possible after stroke, and recovery involves several different health disciplines. Along with the stroke survivor and his or her family and friends, the recovery team can include the physician, nurses, physiotherapist, occupational therapist, speech therapist, dietitian, social worker, and psychologist.

Not knowing the effects of a stroke is one of the most frightening aspects when beginning rehabilitation. The stroke survivor is faced with the prospect of not only lasting physical disability, but also lasting mental disability. The extent of damage that the stroke survivor must overcome depends largely on the type of stroke experienced and where the stroke damaged the brain. The rehabilitation team is there to support the patient and the family in recovering lost ability and learning to accept what cannot be changed.

The rehabilitation team’s first task begins as soon as the patient’s health has stabilized. The main goals are to prevent a second stroke and avoid any complications that may delay recovery. Keeping the patient as mobile as possible helps to prevent blood clots from forming and any stiffening of the joints.

Common effects on muscles and movement of the patient include weakness, paralysis, spasticity, loss of sensation, and loss of bladder and bowel control. Most patients suffer from some sort of muscle weakness after stroke, either because the muscle has been directly affected or because the muscle is atrophying from lack of use. Paralysis is another common effect and tends to involve one side of the body. If the arm and the leg on the same side of the body are affected, it is referred to as hemiplegia. Rehabilitation concentrates on maximum recovery of use of the paralyzed limbs, but if recovery is limited or not possible, the rehabilitation team teaches the patient techniques to compensate.

Spasticity occurs when the brain loses control over the contraction of a muscle and the muscle contracts involuntarily. It is a common physical response to any injury to the brain. The muscle does not, and cannot, obey the brain’s signals to relax, and remains stiff, taut, and painful. Spasticity sometimes is reduced but more often than not it remains. Physiotherapists help move the affected limbs through range of motion exercises to stretch the muscle, and casts, splints, or local anesthesia may be used as temporary measures. Any medication to treat spasticity must be used with caution, so as not to interfere with any medication being taken to control the stroke. Only in rare, severe cases is surgery performed.

Damage to one side of the brain can cause the patient to lose sensation in the opposite side of the body. For instance, some patients scalded themselves with water because they could not feel its temperature. The rehabilitation team can help set up the stroke survivor’s home with basic safety features to avoid such mishaps.

Difficulty with bladder and bowel control happens to some stroke patients. The most common problem is frequency. The patients must empty their bladder more often and cannot avoid wetting accidents if a toilet cannot be found quickly. Bowel incontinence is not as common and both conditions can be helped by the use of medication and adult diapers.

Speech problems are common in stroke survivors. This can be one of the hardest aspects of stroke recovery because many people associate mental incompetence with speech disorders. Speech disorders are a result of the brain being unable to function properly rather than a reflection of mental competence.

There are two basic categories of speech disability: aphasia and dysarthria. Aphasia, a disorder of language, can be divided into two main categories: expressive, or Brace’s aphasia (the most common form of aphasia) is the term used when a patient cannot express thoughts verbally or in writing. Frustration is common in patients with aphasia because they understand what people say to them and they know how they want to respond but are unable to find and say the proper words. Receptive, or Wernicke’s aphasia, occurs when the patient cannot understand spoken or written language.

Dysarthria is a speech disorder that causes the patient to slur words or make the pronunciation hard to understand. Pitch of the voice and ability to control the volume of voice may also be affected. As soon as possible, a speech therapist will involve the patient in a series of exercises to try to recover any lost function of the brain. Over time, aphasia and dysarthria can sometimes be partially reversed.

Helping the patient to adapt is a key function of the rehabilitation team. They can teach the patient and the family new methods for coping and techniques that will make routine tasks easier. Practicing routines with the patient also plays a part, particularly when the patient is having difficulty thinking. It is common for the stroke survivor to suffer from a decreased attention span, lack of concentration, limited memory, or decreased ability to make a decision or solve a problem. The rehabilitation team can provide simple, step-by-step instructions and practice a routine with a patient who is having difficulty remembering how to start a task or difficulty processing the steps required to finish it. Accepting that it may take longer to think, make decisions, or complete tasks can help reduce the frustration that the patient feels.

Stroke often makes a formerly independent individual dependent on others for even the most basic tasks. This can leave the individual with feelings of anger, inadequacy, unworthiness, and discouragement. As a result, clinical depression is a very common aftereffect of stroke, not only for the stroke survivor but for the care-giver as well. Depression is a natural reaction to any loss, and the rehabilitation team can help the stroke survivor and the family come to terms with the loss by offering methods for coping, contact with support groups, and, in some cases, medication.

A patient who is depressed after a stroke also commonly suffers from emotional lability, the dramatic swing of emotions from tears to laughter and back. This swing is uncontrollable and may appear to happen for no reason at all. Fortunately these responses tend to occur less often over time.

When the brain is injured as a result of stroke, personality and behavior may change. A stroke survivor who previously was always cheerful and helpful, may now be surly and despondent. Emotional and behavioral responses to stroke are often interlinked. The stroke survivor may have damage in a part of the frontal lobe that is causing him or her to act in such a manner, and may also be reacting emotionally to a sudden and devastating situation. A physician’s diagnosis and the rehabilitation team’s support will help the patient and their family find ways to cope with all of the changes.

There is no set timeline for the recovery of stroke survivors; however, neurological recovery tends to peak within the first few months after a stroke and then lessen. The physical recovery tends to be slower than the neurological recovery but usually continues for a longer period of time. Ultimately, the earlier recovery begins the better the prognosis, though individual determination and a strong support system have proven to be big factors in the recovery of stroke survivors.

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about 10 years ago

Just wanted to comment that the aphasia you talk about as the most common is called Broca's aphasia (not Brace's as listed in your article).