How Physiotherapy Helps Stroke Patients
How Physiotherapy Helps Stroke Patients
If you or someone you love has had a stroke, you’re not alone. Statistics show that more than 445,087 Australians are currently living with the effects of stroke.[i] While having a stroke can impact many aspects of your everyday life, getting the right treatment can make a big difference. Active Ability talk about how physiotherapy helps stroke patients regain their function, independence, and quality of life. But first, it’s helpful to understand a bit more about what a stroke is and how having one can affect you.
What is a stroke?
A stroke happens when blood flow to the brain becomes compromised. This can occur in one of two ways. Firstly, if a blood vessel is blocked and cuts off supply to a brain region, this is called an ischaemic stroke. A stroke can also occur if a blood vessel bleeds into the brain, which is known as a haemorrhagic stroke. Either way, because blood carries vital oxygen, if flow isn’t quickly restored it can cause brain cells to die off, leading to permanent damage of the affected brain area. With timely and good quality medical care, most people who suffer a stroke will recover to at least some degree. However, many people will continue to experience issues that affect their everyday activities after stroke. In Australia, stroke is the second leading cause of death, and the leading cause of disability. [ii] Lifestyle and health factors known to be associated with an increased risk of having a stroke include high blood pressure, diabetes, high cholesterol, smoking, physical inactivity and overweight.[iii] In fact, it’s estimated that more than 80 percent of strokes are preventable.[iv] Having said that, some people can have a stroke despite having none or few risk factors. Stroke can also affect young people. In 2020 in Australia, 24 per cent of first-time strokes were in people aged 54 years and under.
How might a stroke affect me?
The impact of having a stroke largely depends on where in the brain it occurs and how large an area it affects. Common functional and neurological issues after a stroke include:
- weakness or loss of movement in the arms or legs (usually down one side of the body)
- changes in sensation, such as tingling, numbness, or loss of feeling
- changes to your sense of perception (knowing where your body is in space)
- difficulty swallowing and/or speaking
- difficulties with reading and/or writing
- trouble with thinking and memory
- mood changes, such as feeling depressed
- vision issues, such as double vision
- balance problems
- shoulder pain
How physiotherapy helps after
Following a stroke, dramatic recovery usually occurs over the next few days as brain swelling reduces. Recovery continues over the next few months, as nerves in the brain adapt to take on some functions of those damaged by the stroke (in a process called ‘neuroplasticity’). Recovery can even continue for years after a stroke as you regain strength, endurance and confidence. Rehabilitation after a stroke is aimed at helping to maximise your functional capacity and independence. It will involve a team of health professionals, of whom physiotherapists play an important part. Physiotherapists work with you after a stroke to help improve how you sit, stand, walk, and use your arms. Physiotherapists work on things that are important for movement, including balance, muscle strength, range of motion, sensation, coordination and endurance. Here’s how a physio might help you through the different phases of stroke rehabilitation.
1. Early (or acute) phase
In the early days after a stroke, you are likely to be in hospital. Many people have trouble moving around and changing positions after a stroke. Therefore, a physio may be involved in providing positioning advice to help reduce limb swelling, the risk of skin damage or shoulder subluxation (a condition in which the affected shoulder drops down in its socket), and to maintain the length of soft tissues. A physio is also likely to be involved in getting you up and moving within 24-48 hours after your stroke, which is recommended to support recovery. This could include things like sitting out of bed, standing up, and walking. These activities help to minimise your risk of developing complications associated with immobility and improve your functional recovery. [v] Your rehabilitation needs should also be assessed within the first 24-48 hours after a stroke.
2. Sub-acute phase
If rehabilitation needs have been identified, a physio is highly likely to form part of your rehab team. People who’ve had a stroke and take part in early, comprehensive rehabilitation have much better outcomes.[vi] Rehab may be completed in a rehabilitation centre, or at home with support from a team of visiting therapists. For best results, rehabilitation should be intensive and structured to provide as much scheduled therapy time (occupational therapy and physiotherapy) as possible – ideally a minimum of three hours per day, with at least two hours of active task practice during this time.[vii] The first thing your physio will do is help you (and your family and/or caregivers) to set some recovery goals. This may include things like learning to walk again, dress yourself, and be able to get in and out of the car. These goals should be revised and updated regularly. Then your physio can help you, and your support people, to work towards achieving them. Some of the things you might work on include gait and mobility training, recovery of balance, recovery of arm function, spasticity management and cardiorespiratory training.
These are outlined in further detail below.
GAIT AND MOBILITY TRAINING
Regaining the ability to walk independently is one of the most common goals after a stroke. Physiotherapists are experts in gait and use various techniques to help people recover their mobility. Some examples include:
- walking-focused leg exercises, such as practising the components of walking (e.g. stepping forward and back with the affected leg)
- strengthening exercises for the affected leg
- over-ground walking practise
- circuit training classes with a focus on walking-related activities
- prescription of walking aids such as frames and walking sticks
- assisted gait training using robotic or electro-mechanical rehabilitation devices – these devices can provide longer periods of assisted and active walking practise
- rhythmic cueing, which involves matching your steps to the beat of a metronome (or music) to retrain the symmetrical, rhythmic nature of walking
- treadmill training
Balance problems are also common after stroke. Poor balance can affect your mobility and lead to falls. Your physio can assess the factors causing your balance issues (such as leg weakness, altered sensation or a problem in your vestibular system), and prescribe safe and appropriate exercises accordingly. Some exercises a physio might use to help retrain your balance include:
- strengthening of the trunk muscles
- practise of reaching further than arm’s length in sitting
- functional task practise in standing (such as reaching for and moving objects from one place to another)
- walking training that includes balance challenges (such as negotiating obstacles)
- leg strengthening exercises
- prescription of an ankle-foot orthosis (a splint used to help hold the foot up so you don’t trip over it).
RECOVERY OF ARM FUNCTION
Two-thirds of people who have a stroke have difficulty using their affected arm afterwards and unfortunately, many don’t regain full use.[viii] However, your physio can work with you to try to regain as much function as possible. Some techniques a physio might use to help with arm function include:
- functional task practice – that is, repetitive, high-intensity practise of functional arm activities
- bilateral arm training – using both arms to practise functional tasks, or to develop rhythmic movement patterns
- constraint induced movement therapy – this involves intensive task practise while the unaffected arm is restrained, making you focus on using the affected one
- electrical stimulation – if your muscles are too weak to work by themselves, a device that applies a safe electrical current can help stimulate muscle activity (this technique is also sometime used in gait training)
- robot-assisted arm training – similar to how they’re used in mobility training, robotic devices can provide extended periods of passive, active and resisted arm movement training
- virtual reality – in some centres, technologies like virtual reality and interactive gaming may be used to supplement your usual care and increase therapy time.
A stroke can affect the amount of tension in your muscles, which is called muscle tone. In many people, a stroke causes reduced muscle tone, making muscles more ‘floppy’. However, some people experience increased muscle tone, which makes muscles tense and tight. This is known as spasticity. Muscle spasticity can cause pain and deformities in the affected area, such as clawing of the hands. A physio may use various techniques to help with spasticity, including different types of stretching. In some cases, a doctor will use a Botulinum toxin injection to reduce spasticity. A physio might see you afterwards for treatment with stretching, electrical stimulation, or casting, or to update your rehab plan once muscles are relaxed after the injection.
Improving or maintaining cardiorespiratory fitness is an important part of stroke rehabilitation.[ix] Aerobic exercise interventions could include treadmill or overground walking training and circuit classes. Your physio can tailor an aerobic exercise program to suit your needs and functional capacity, taking into consideration any disability or impact of your stroke. In some rehabilitation teams, an exercise physiologist may be responsible for this aspect of your care.
3. Long-term (chronic) phase
Stroke survivors are sometimes told there is limited scope for rehabilitation after three to six months. However, research suggests that with the right advice and exercises, significant recovery is possible even years after a stroke.[x] Depending on your needs and goals, a physio can create a personalised program to work on any of the areas discussed above. And with research showing physical activity and fitness levels are usually low after a stroke, interventions to increase your fitness could help to improve your function and reduce disability and mortality.[xi] Reducing the likelihood of having another stroke is also a vital part of your management. Physiotherapists can play an important part in helping you make lifestyle changes that help prevent strokes from reoccurring, such as giving you strategies to increase your physical activity levels and maintain a healthy weight. Other health professionals, such as exercise physiologists and dietitians, often play a vital role here too.
At Active Ability, our team of dedicated allied health professionals are experienced in supporting people with a neurological condition such as stroke. Our NDIS registered, mobile physiotherapists can see you at your home, workplace, gym, or other convenient location to help you work towards your functional goals.
With no waiting lists or travel charges, we can see people in Sydney, Wollongong and the Sunshine Coast in a timely manner that ensures the best use of your NDIS funding.
[i] https://strokefoundation.org.au/About-Stroke/Learn/facts-and-figures Accessed 30.3.2021
[ii] https://choose.physio/your-condition/stroke-recovery Accessed 30.3.2021
[iii] https://choose.physio/your-condition/stroke-recovery Accessed 30.3.2021
[iv] https://strokefoundation.org.au/About-Stroke/Learn/facts-and-figures Accessed 30.3.2021
[v] https://app.magicapp.org/#/guideline/Kj2R8j/section/nyGJ2j Accessed 30.3.2021
[vi] https://choose.physio/your-condition/stroke-recovery Accessed 30.3.2021
[vii] https://app.magicapp.org/#/guideline/Kj2R8j/section/j94ANE Accessed 31.3.2021
[viii] https://choose.physio/your-condition/stroke-recovery Accessed 30.3.2021
[ix] https://pubmed.ncbi.nlm.nih.gov/32196635/ Accessed 30.3.2021
[x] https://choose.physio/your-condition/stroke-recovery Accessed 31.3.2021
[xi] https://pubmed.ncbi.nlm.nih.gov/32196635/ Accessed 31.3.2021