Since I have an interest in
rehabilitation, I wanted to look at what kinds of treatment are used for people
post-stroke and what kinds of things therapists do to try and prevent recurrent
ones. As a quick review, a stroke is when blood supply to the brain is
disturbed, due to an event such as lack of blood flow to the brain caused by a
blockage or a hemorrhage. Loss in brain function from a stroke may result in
inability to move limbs on a particular side of the body, inability to talk or
understand speech correctly, or visual impairment. According to the American Heart Association,
when considered independent to other cardiovascular diseases, strokes are the 3rd
leading cause of death in the US, and it is proposed that incidence may
continue with the growing population of elderly Americans, increasing rates of
diabetes and obesity, and great prevalence of cardiac problems and inactivity
among communities. Think of it this way… 1 person nearly every 45 seconds
suffers a stroke, 1/3 of which are recurrent. It is crazy to think about! Post stroke,
only about 14% of survivors are able to fully recover; about 25-50% still
require some assistance throughout their lives, and others, in severe cases, receive
partial paralysis. By implementing exercise training and physical activity,
stroke survivors strive to regain ability to do daily functions, such as dressing,
bathing, or walking, learn how to manage muscle or joint pain, and improve
cardiovascular fitness.
Rehabilitation programs asses each
patient and design a program around their current condition, medical history,
any neurological complications or other medical conditions, and lifestyle.
Programs typically address 3 main goals. The first goal for the patient is to
start a physical conditioning regimen to recover the prestroke level of
activity. The second goal is to prevent recurrent stroke and cardiovascular complications;
by starting aerobic conditioning programs, stroke survivors can enhance glucose
regulation, decrease in body weight and fat stores, lower blood pressure, lower
serum triglycerides and LDL cholesterol, and increase HDL cholesterol and
improve cardiovascular functions such as blood flow or coronary artery
endothelial function. The third rehabilitation goal is for patients to improve
aerobic fitness despite limitations. As for recommended exercise programming,
the American Heart Association recommended that patients should utilize aerobic training modes (leg,
arm or combo) ergometry at 40-70% peak oxygen consumption, and train 4-7 days a
week with duration of 20-60 minutes a day of exercise. Treadmill training in particular can be very beneficial, as patients can decrease
their body weight by holding on to the handrails while regaining their ability
to walk, as well as increasing the grade of incline or speed as they gain
mobility. It is remarkable that in incorporating exercises such as upper-body
and resistance training or stretching, patients can improve sensorimotor impairments
and performance time, as well as range of motion, respectively. The AHA provides a nice table that shows
programming recommendations for stroke survivors that is quick and easy to read
and understand! (http://circ.ahajournals.org/content/109/16/2031/T1.expansion.html). Although this information focuses on the physical rehabilitation, it is very important to recognize that other members of the rehab team are just as essential in the process; occupational therapists aid in finer tasks such as eating, or writing, a speech-language therapist can help with speech impairments or difficulty swallowing, and psychologists/psychiatrists are important in assessing the emotions a patient goes through.
It is very interesting to see how
different people recover from something as serious as a stroke. My friend’s
father, for example, completely hid that he had a stroke from his daughters for
a while and they never knew the difference, whereas my mother’s best friend from
nursing school had one post car accident and now has a speech impediment. I am
very interested to see what is in store for cardiac disease/stroke prevention
and rehabilitation as I continue my own career in healthcare.
If you would like to read more,
here is the full AHA article!
I think this is an interesting article because we never really talked about long term treatment and rehabilitation that occurs after a patient is diagnosed with stroke. Obviously this isn't a condition with a quick fix and requires long term treatment. Perfecting this treatment and rehabilitation process is key to helping people regain the most post stroke. It is also really interesting to me how much of a variation in symptoms people can present post stroke because it deals with the brain; loss of blood flow to one area can have dier consequences while loss to another will present very little symptoms.
ReplyDeleteI looked up more disabilities that can result from a stoke and they include: problems controlling movement, sensory disturbance including pain, problems using or understanding language, problems with thinking/memory, and emotional disturbance (when survivors feel fear, anxiety, ect from their physical or mental losses). There are clearly a wide range of results from mild to severe. Apart of preventional efforts and the goals you listed above, it seems more beneficial to treat the symptoms/signs of the post-stroke patient rather than treating then all the same. This means having patients work with rehab nurses, physical therapists, occupational/recreational therapist, speech-language pathologist, etc. depending on their needs.
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