Stroke Treatment India

INTRODUCTION:-

Imagine yourself in a marketing place and you suddenly collapse on the ground and are unconscious. It can be just the vertigo or a STROKE!

To be classified as stroke, focal neurological deficits should persist for at least 24 hours.

Stroke is a disease that affects the blood vessels that supply blood to the brain. It occurs when a blood vessel that brings oxygen and nutrients to the brain either bursts or is clogged by a blood clot or some other mass. The former is called as the hemorrhagic stroke and the later an ischemic stroke.

When the rupture or blockage of the blood vessel takes place, there is no enough blood supply and hence, no enough nutrients and oxygen to that part of brain. This damages the nerve cells and may lead to their (cells) death.

As a result, that part of the brain is damaged which results in improper functioning of those body parts which are under the control of damaged brain area.

The term cerebrovascular accident (CVA) is also used to refer to the cerebrovascular conditions that accompany either ischemic or hemorrhagic lesions.

Stroke may be classified by the etiological categories, management categories and anatomical categories.

Etiological categories include:

  •  Thrombosis
  •  Hemorrhage
  •  Embolus
  •  Management categories include:
  •  Transient ischemic attack
  •  Minor stroke
  •  Major stroke
  •  Deteriorating stroke
  •  Young stroke

Anatomical categories:

  • Specific vascular territory.

IMPAIRMENTS OF STROKE:

  1. Somatosensory deficits.
  2. Pain
  3. Visual deficits
  4. Motor deficits:- this includes
    • Tone alterations
    • Abnormal synergy patterns
    • Abnormal reflexes
    • Paresis and altered muscle activation patterns
    • Motor programming deficits
  1. Seizures
  2. Bladder and Bowel dysfunction

Somatosensory deficits:

In a hemiplegic patient, the type and extent of the deficit is related to the location and extent of the vascular lesion. The sensory deficit can range from loss of either superficial or deep sensations. The most common distribution of loss is a face-upper extremity-lower extremity pattern. Proprioceptive losses are common. Loss of superficial touch and pain and temperature is also common.

The loss of sensation on the affected side can lead to a neglect of that side associated with difficulty with functional task and increased risk of self injury.

Pain:

Pain may be triggered by simply stroking the skin, pinprick, contact with heat or cold, and pressure. Loud noises, bright lights or other mild irritants may also trigger pain.

Pain may also result from indirect impairments such as muscle imbalances and improper movement patterns and poor alignment.

Visual deficits:

Vision impairment is one of the most commonly overlooked and under-treated conditions of the elderly and those who have had traumatic brain injury or stroke. Following a cerebrovascular accident (CVA) or stroke, a patient may suffer from additional visual deficits. Field defects contribute to the patient’s overall lack of awareness of the hemiplegic side. With a lesion in the brain disrupting the visual pathways, a person’s ability to take in the entire visual field may be interrupted.

Hemianopsia, or loss of visual field on one side, occurs with lesions involving the optic radiation in the internal capsule or to the primary visual cortex. Patients may also experience impairments in visual neglect, depth perception and other problems in spatial relationships.

Patients with hemispheric lesions may look away from the hemiplegic side, while patients with brainstem lesion may look towards the hemiplegic side.

Motor deficits:

Stroke is a major disabling chronic condition often associated with muscle weakness, altered muscle tone, and abnormal movement patterns. These impairments affect mobility and the performance of daily activities.

Tone alterations:

Flaccidity (hypotonicity) is present immediately after stroke and is due to cerebral shock and is short lived.

Spasticity is a motor disorder attributable to an upper motoneuron lesion traditionally characterized by velocity dependent hyperactivity of the stretch reflexes. Clinical measures of tone such as the Modified Ashworth Scale (MAS) grade severity on the basis of the resistance encountered while passively stretching the spastic muscle.

Abnormal synergy patterns:

Abnormal synergistic patterns are typically present and are characterized as highly stereotyped and obligatory. Thus, the patient is unable to move an isolated segment of a limb without producing movements in the remainder of the limb. Two distinct abnormal synergy patterns have been described for each extremity: a flexion synergy and an extension synergy.

Abnormal reflexes:

Reflexes are altered and vary according to the stage of recovery. Primitive or tonic reflex patterns may appear in a readily identifiable form similar to that seen in other types of neurological insult. Associated reactions may also be present.

Paresis and altered muscle activation patterns:

Here, patients are unable to generate tension or force necessary for initiating and controlling movement.

Motor programming deficits:

Any stroke patient exhibits motor function deficits. Paresis is a common finding. Movements can be graded using the following ordinal scale:

  •  no movements
  •  palpable contraction or flicker
  •  movement with gravity eliminated
  •  movement against gravity
  •  movement against some resistance but weaker than the other side
  •  normal strength

Seizures:

Seizures can be precipitated by strokes by a number of mechanisms. The most common seizures resulting from strokes are those that occur weeks or months after the initial event.

Seizures that occur immediately during or shortly after a stroke most often result from hemorrhagic strokes in which a stream of blood squirts out of an artery under pressure into brain tissue. The blood produces a ripping and tearing effect in the tissue as it forces a space for itself. Additionally, it pushes aside adjacent brain tissue causing a compression effect. The compressed tissue also becomes deprived of oxygen (a state known as anoxia). The tearing, compression, and anoxia all act as provocative factors that can precipitate epileptic electrical discharges from neurons, resulting in a seizure. Less commonly, immediate seizures can occur in an ischemic stroke.

Bladder and bowel dysfunction:

Urinary incontinence can result from bladder hyperreflexia or hyporeflexia, disturbances of sphincter control, and/or sensory loss. Disturbances of bowel function can include incontinence and diarrhea or constipation and impaction.

Are you at a risk of STROKE?

  • Age (over age 65)
  • Brain tumor
  • Coagulopathy (blood clotting disorder)
  • Diabetes
  • High cholesterol level
  • High blood pressure (hypertension)
  • Heart disease
  • Infection (e.g., meningitis, endocarditis)
  • Smoking

What are the warning signs of STROKE?

  •  Sudden severe headache with no known cause
  •  Sudden difficulty seeing in one or both eyes (particularly in one eye)
  •  Sudden problems with walking, dizziness, loss of balance or coordination
  •  Sudden weakness or numbness of the face, arm, or leg on one side of the body
  •  Difficulty in swallowing

Diagnostic tests in stroke:

A number of routine laboratory and diagnostic tests are performed. These include:

  1. Urinalysis: this detects infection, diabetes, renal failure or dehydration.
  2. Blood analysis: provides a complete blood count (CBC), platelet count, protrombin time, partial thromboplastin time, and erythrocyte sedimentation rate.
  3. Blood sugar level.
  4. Blood chemistry profile: indicates serum electrolytes and serum cardiac enzyme levels; elevation of the creatinine phosphokinase isoenzyme CPK MB is indicative of coincidental cardiac infarction.
  5. Blood cholesterol and lipid profile.
  6. Radiograph of the chest (heart size, lungs)
  7. ECG: used to detect arrhythmias as a source of emboli or coincidental heart disease; stroke may also cause ECG.

SEQUENTIAL STAGES OF RECOVERY IN HEMIPLEGIA:

Stage 1: Recovery occurs from a stereotyped sequence of events which begins with a period of FLACCIDITY, immediately following acute episode.

Stage 2: Here, spasticity begins to develop. As recovery begins, the basic limb synergy or its components may appear as associated reactions or minimal voluntary movement responses may be present.

Stage 3: Spasticity here further increases or becomes severe. The patient gains voluntary control of the movement synergies.

Stage 4: Here, the spasticity begins to decline. The patient masters Some movement combinations that do not follow the paths of either synergy.

Stage 5: More difficult movement combinations are learned by the patient, if the progress continues.

Stage 6: Spasticity here disappears. Individual joint movement becomes possible and coordination becomes normal.

PHYSIOLINE’S AIMS of STROKE REHABILITATION:

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Prevent physical problems that may occur later because of   immobility, too-tight muscles or the over use of the good side
  • Maintain and improve a person’s physical condition
  • Improve physical abilities
  • Prevent of bed sores in initial stages
  • Restore the person with a stroke to their greatest potential and maximum independence.

At Physioline, Stroke Rehabilitation is done with “COMBINATION THERAPY

This Combination therapy incorporates all the worlds best techniques, treatments and approaches used worldwide for paralysis patients. This includes Mentamove therapy from Germany and various other therapies. The details will be given at Physioline after initial assessment of the patient.

Apart from physiotherapy includes speech therapy and occupational therapy to manage swallowing and /or communication difficulties and help the person to regain competence in the activities of daily living thus treating the patient as a whole. Physioline provides all the rehabilitation treatments at its best

DETAILED TREATMENT:- Kindly contact Physioline for  detailed assessment and treatment program which is individualized according to every patient.

Visit Physioline for further treatment and rehabilitation.