Stroke rehabilitation and aids for recovery

Stroke is the second most common cause of death worldwide after heart disease, and the third most common cause after heart disease and cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. in the UK and USA. A stroke results when the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. supply to the brain is cut off or greatly decreased, and the process is similar to a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., except that it occurs in the brain. Brain cells start to die immediately after a stroke Any sudden neurological problem caused by a bleed or a clot in a blood vessel. - in fact, 32,000 cells die every second - and prompt action is needed to limit the damage.[1] Additionally, many brain cells continue to die for a period even after the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. supply has been restored because of the previous lack of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid..

Strokes occur most frequently in older people, but they can affect people of all ages, including children.

This article will look at:

Types of stroke

The two most common types of stroke are ischaemic strokes, which occur in 80-85 per cent of cases, and haemorrhagic strokes.

An ischaemic stroke is caused when a bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessel becomes so narrow or clogged with plaqueAny flat, raised patch; for example, a raised patch on the skin, fatty deposit in the inner wall of an artery, or layer over the surface of a tooth. that insufficient bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. can get through to keep the brain cells alive. It can also be caused by small bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clots, or emboli, that travel through the bloodstream, then block an arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood..

Haemorrhagic strokes occur when the wall of a bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessel becomes weak and bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. leaks out into the brain. This type of stroke tends to be more serious than an ischaemic stroke.

Many people recover completely after a stroke. For others, it can take many months, while some may never regain full function. However, physical therapy and other retraining methods are greatly improving rehabilitationThe treatment of a person with an illness or disability to improve their function and health. and recovery prospects.[2]

The aims of stroke rehabilitation

It is usual for people who have had a disabling stroke to go through a process known as stroke rehabilitationThe treatment of a person with an illness or disability to improve their function and health. to help them return to normal life as far as possible. They will be supported as they relearn and regain the skills of everyday living.

Stroke rehabilitationThe treatment of a person with an illness or disability to improve their function and health. can last from a few days to several months. In most cases, the goal is to help the person who has had a stroke to return home to live independently, although this is not always possible.

Rehabilitation can take place through:

  • A rehabilitationThe treatment of a person with an illness or disability to improve their function and health. unit in a hospital
  • A specialised rehabilitationThe treatment of a person with an illness or disability to improve their function and health. hospital
  • Home therapy
  • Home with outpatient therapy
  • A long-term care facility that provides therapy and skilled nursing care.

What's involved in the recovery process

If you have had a stroke, you will usually be treated by a multidisciplinaryRelating to a group of healthcare professionals with different areas of specialisation. team, whose members will work together using their different skills to aid your rehabilitationThe treatment of a person with an illness or disability to improve their function and health.. The recovery process will include:

  • Occupational therapy. This involves exercises and training to help you relearn everyday activities such as eating and drinking, dressing, bathing, cooking, reading and writing, and using the bathroom
  • Therapeutic recreation. This works on several areas, including problem solving, improving movement and re-entry into the outside community, for example, by helping you relearn how to cross the road or use money
  • Speech and language therapy. This is appropriate if you have problems with written words or with forming or understanding speech, as well as cognitive loss, which includes loss or degeneration of memory and confusion. Speech therapists also assess your ability to swallow safely after a stroke, to make sure that you are not at risk of choking and are able to eat properly
  • Psychology and vocational rehabilitationThe treatment of a person with an illness or disability to improve their function and health.. Psychologists can assess your cognitive function, including the ability of the brain to remember, and can teach you coping strategies. Vocational rehabilitationThe treatment of a person with an illness or disability to improve their function and health. can work directly with you and your employer to facilitate your return to work.[3]

Aids to use in the home

People who have had a stroke may be worried about being at home on their own, and this is also often a source of anxiety for their caregivers. However, making simple modifications can help to reduce these fears and enhance recovery. These include:

  • Grab bars and ramps to provide additional safety and make movement easier around the home
  • A raised lavatory seat for easier sitting
  • A seat in the shower, so you can sit rather than stand, and a hand-held shower head
  • Plastic adhesive strips on the bottom of the bath to prevent slipping
  • Long-handled brushes and washing mitts with pockets for soap
  • Electric toothbrushes and razors.[4]

Movement aids

People who have had a stroke can be helped to improve their strength and move about more freely using braces, canes, walkers and/or wheelchairs.

Foot drop, for instance, is a common problem during stroke recovery and occurs when the person's foot or ankle drops down when they lift a leg to take a step. This may cause the person to trip and fall if their foot and ankle are not supported by a brace at all times. The most common type of brace for this long-term problem is an ankle-foot orthosis (AFO). The AFO starts below the knee and encompasses and controls the ankle and foot.

Training in safety procedures and the proper use of orthotics, including getting a proper fit and advice on maintenance, is essential.[4]

Outdoor mobility aids

If you have limited leg strength and a lack of endurance following a stroke, it can make running errands, shopping or travelling difficult, and even impossible.

Anyone who has had a stroke may want to consider the following aids:

  • Mobility scooters. These motorised scooters allow users to get around while remaining seated. Many supermarkets and shopping complexes provide the free use of scooters to people with mobility difficulties
  • Walkers. These provide a stable support on wheels, and can be pushed by users as they walk.

Music as a recovery aid

Listening to music in the early stages after a stroke can help in several ways, including:

  • The recovery of memory and attention skills
  • Promoting a more positive frame of mind in general, and decreasing the likelihood of depression or confusion
  • Bringing about an improvement in the person's ability to control and perform mental operations and resolve conflicts.

Music may be particularly valuable for people who are not yet ready for other forms of rehabilitationThe treatment of a person with an illness or disability to improve their function and health..[5]

References: 
  1. 'Stroke's deadly toll: 2 million brain cells each minute'. Link. Accessed January 2010.
  2. Joel Stein. 'Stroke and the Family: A New Guide'. The Harvard University Press Family Health Guides, 2004
  3. Warlow CP, van Gijn J, Dennis MS, Wardlaw, JM. 'Stroke: Practical Management'. Blackwell Publishing, 2008.
  4. 'Recovery after Stroke'. National Stroke Association, USA. Link. Accessed January 2010.
  5. Teppo Sarkamo, Tervaniemi M, Laitinen S et al. Music listening enhances cognitive recovery and mood after middle cerebral arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood. stroke. Brain: A Journal of Neurology. 2008; 131(3):866-876; doi:10.1093/brain/awn013.