Rehabilitation and treatment strategy for stroke

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.

 

 

 

 

 

 

 

 

 

Article publié pour la première fois le 19/09/2016

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