Stroke

Stroke

What Is Stroke?

Stroke is sometimes called a “brain attack.” With a heart attack, blood supply to the heart is reduced or stopped. With a stroke, blood supply to part of the brain is reduced or stopped. This means that part of the brain does not receive enough oxygen. Millions of brain cells die every minute during a stroke, increasing the risk of permanent brain damage, disability, or death.

One common cause of blockage that leads to stroke is a blood clot or a build-up of fatty deposits (arteriosclerosis) in blood vessels that supply the brain. The reduction in blood flow results in an ischemic stroke. Most strokes are ischemic.

Another common cause of stroke is a leaking vessel in the brain. This is called a hemorrhagic stroke.

Ischemic Stroke-Small
Ischemic Stroke: See More Detail

Hemorrhagic Stroke-Small
Hemorrhagic stroke: See More Detail
Signs and Symptoms

If you are having a stroke, you might:

Feel a sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
Be confused about where you are or what you’re doing
Have trouble speaking or understanding what others are saying
Have trouble seeing in one or both of your eyes
Have trouble walking, be dizzy, or lose your balance
Have a sudden, severe headache that seems to come out of nowhere
A transient ischemic attack (TIA) is a kind of “warning stroke” or “mini-stroke” that produces stroke-like symptoms but no permanent damage.

Recognizing and treating TIAs can reduce your risk of a major stroke.

Stroke can cause a range of long-term problems, such as:

Inability to move on one side of the body(“hemiparesis”)
Severely limited movement
Balance problems
Weakness in the leg or arm on one side
Off-and-on numbness
Unusual physical sensations
Sensitivity to cold temperatures
Memory loss
Slowed or slurred speech
Difficulty remembering words

How Can a Physical Therapist Help?

How well you recover from stroke – and how long it takes to recover—depend on the size and location of the stroke, how quickly you receive care, and, in some cases, other health conditions you might already have.

Rehabilitation begins very soon after your stroke, and your physical therapist is an important member of your health care team. The therapist’s main goal is to help you return to your roles in the home, in the community, and at work.

After examining you and evaluating your condition, your physical therapist will develop an individualized plan to help you achieve the best quality of life you can. The plan will focus on your ability to move, any pain you might have, and ways to prevent problems that can occur after a stroke.

One of the first things your physical therapist will do is show you how to move safely from the bed to a chair. Later, the therapist will:

Help you relearn how to walk
Fit you with a wheelchair, if needed
Provide training to your family and caregivers
Train you in how to use devices that can help you keep mobile when a stroke has affected your ability to move, walk, or keep your balance: orthoses, prostheses, canes, walkers, wheelchairs—perhaps even robotics.
Depending on the results of the physical therapist’s evaluation, and depending on how long it’s been since you had your stroke, treatment will vary.

Relearning How to Use Your Upper Body, How to Walk, and How to Do Your Daily Activities
Your physical therapist will design a training program based on tasks that you need to do every day, selecting from well-established as well as cutting-edge treatments. Physical therapist researchers are at the forefront of innovating many of these techniques:

Constraint-induced movement therapy – used to strengthen your weaker arm (the arm on the side of your stroke); your physical therapist will apply a mitten or a sling on your strong arm to keep you from fully using it. This “forces” you to use your weaker arm or hand to do daily tasks, which helps build your strength and control.
Functional electrical stimulation (FES) – used to help move your muscles and make them more usable. For instance, your therapist might use FES to treat “hemiplegic shoulder”; where the shoulder is painful, stiff, and even “out of joint” and doesn’t work as it should.
Motor imagery and mental practice – used to strengthen the arms, hands, feet and legs; working with your therapist, you “rehearse” a movement without actually doing it, which stimulates the part of your brain that controls the movement.
Positioning – used from the very beginning after a stroke, positioning also is important throughout rehabilitation, particularly if you’re using a wheelchair or if you have shoulder problems. Positioning helps to reduce the muscle pain, spasms, slowness, and stiffness that can result from stroke. Your therapist will teach you how to safely move (“transfer”) from a sitting to a standing position and how to support yourself when sitting or lying down, using foam wedges, slings, and other aids.
Virtual reality and interactive video games – a computer-generated environment that provides experiences similar to real life. Using a keyboard and mouse, a special wired glove, or sensors on your body, you can practice daily tasks as your therapist helps you “re-wire” your brain and nerve connections.
Partial body weight support (BWS) – combined with treadmill training to help people walk better; the physical therapist gradually decreases the amount of support as your posture, strength, balance, and coordination begin to improve.
Biofeedback – used to make you aware of how your muscles work and how you might be able to better control them; your therapist attaches electrodes to your skin to provide measurements of muscle activity that are displayed on a monitor. The therapist will work with you to help you understand and change those readings.
Your needs will change over time. Even after rehabilitation is completed, your physical therapist will assess your progress, update your exercise program, help you prevent further problems, and promote the healthiest possible lifestyle.

Can this Injury or Condition be Prevented?

Some risk factors for stroke can’t be changed—such as family history, age, gender, race (stroke death rates are higher for African Americans even at younger ages) and previous heart attack or stroke. But there are many other stroke risks that you can change:

High blood pressure
Cigarette smoking
High cholesterol
Diabetes
Carotid artery disease
Obesity
Physical inactivity
All of these risks can be reduced through lifestyle changes, such as regular exercise. As experts in designing exercise programs tailored for people with health problems, physical therapists can help you reduce your risks for stroke.

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