Treatment of stroke with physiotherapy

Good posture helps stroke patients in achieving good quality of life.
Good posture helps stroke patients in achieving good quality of life.

What is the role of physiotherapists in treatment of acute/chronic strokes?

Physiotherapists make a plan to rehabilitate the patient utilizing different type of techniques, which they learn through their physiotherapy classes and academics. Physiotherapists teach patients about home exercise programs after the patients achieve considerable recovery. Physiotherapists or physical therapists evaluate which muscles and ligaments still have power left and assess whether the patient is using those muscles and ligaments in functional movement and ADLs or not. If not, then physical therapists teach the patients on how to use them effectively. If the patient is already utilizing those muscles or ligaments, then they help the patients in improving their quality of movement and add voluntary control exercise in their present treatment protocol. If it is necessary, then a physiotherapist can prescribe a lower limb or upper limb splint. Also, PT doctors can asses the patient's daily needs and activities according to splint wear. Physiotherapists choose different types of work for them. Aerobic exercise is an important physical treatment modality to increase endurance and stamina. PT physicians also help in improving perception and cognition deficits if any. Physiotherapists also ask the patient for their interest and can include recreational activity in the treatment regimen. Posture awareness training also plays an important in PT.

Brain ischemia versus brain hemorrhage
Brain ischemia versus brain hemorrhage

Different types of strokes and their treatment

If a patient is suffering from a stroke due to blood clot formation, i.e., ischemia, then (tPA - Tissue Plasminogen Activator) thrombolytics in three hours of onset of stroke provide best chance of recovery for stroke patients.

If a patient is suffering from stroke due to bleeding, i.e., hemorrhage, then (tPA - Tissue Plasminogen Activator) thrombolytics will only worsen the situation so accurate diagnosis through physical examination is necessary before proceeding towards further therapy.

For hemorrhagic strokes, physicians can prescribe blood thinners such as Coumadin, heparin, and Aspirin to reduce bleeding and prevent further damage.

Neuroplasticity explained
Neuroplasticity explained
Advanced therapies like robotic training assisted by a bot helps stroke patients recover much faster.
Advanced therapies like robotic training assisted by a bot helps stroke patients recover much faster.
Automated Locomat Machine for stroke rehab
Automated Locomat Machine for stroke rehab

Physical therapy for recovery/compensation of patients suffering from strokes

According to international stroke literature, the most vital question is recovery or compensation. On an interesting note, recovery after stroke is usually dependent on the size of lesion, location of brain involvement, and the time duration of getting therapy and several other things according to which we can get to know that the the patient will recover.

Some patients are able to achieve compete recovery within 1 month of stroke and live normal life. Full recovery without residual dysfunction is possible in patients suffering from hemiparesis but might not be a case with patients suffering from hemiplegia.

In some cases where there is more damage to the involved parts, the patient is not able to achieve complete recovery but functionally they can achieve some recovery. Gaining full recovery is difficult for these patients, so for these patients, a physician takes the route of compensation which does not represent a true complete recovery.

In this case, physical therapists try to help the patients to get well with rehabilitation including physical therapy, exercise, drugs, and medications. PT doctors try to train affected ligaments and muscles through stretching, strengthening, proprioceptive neuromuscular facilitation, and other therapies to achieve an optimal level of independence.

This rehabilitative training teaches the patient's brain with capacity of plasticity to perform certain activities without utilization of infarcted part of brain. In simple words, normally functioning parts of the brain take over the function of dysfunctional and infarcted part of brains to control movement of body resulting in increased ability to perform near normal activity independently.

Location of lesion and other things mentioned above play a vital role in gaining at least if not complete but near normal recovery.

But in chronic cases of stroke, it is now thought that neural plasticity plays a vital role. In this case, the surrounding unaffected neurons connect to the affected area and help in providing a collateral circuit to initiate function. In this way, true recovery in such chronic stroke patients has become a possibility. With appropriate and continuous physical treatment, there are chances of achieving true recovery in patients suffering from chronic stroke too but this differs in an individual to individual.

Least but not last, a question still remains in everyone's mind that "how much true complete recovery can be expected from patients suffering from chronic stroke, but still there are hopes that in about another 5 to 10 years, the rehabilitation process of chronic stroke patients might be more advanced and physical therapists and patients will not have to rely on their destiny.

Advanced therapies that can be included in current rehabilitation protocols

For Lower Extremities:

Use of an automated treadmill known as Locomat to help rebuild muscles in patients suffering from stroke.

Body-Weight Support Gait Training

For Upper Extremities:

Functional Task Training

Strength Training for spastic group of muscles

Virtual reality training

Bimanual Training

Robotic Training

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Comments 16 comments

r-m 7 years ago

soni this article is great, thank you


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soni2006 7 years ago from New Delhi, India Author

It's my pleasure r-m. Thanks for your support.


sandeep dhar 5 years ago

soni this article is good and useful to me


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soni2006 5 years ago from New Delhi, India Author

I am glad Sandeep that you found this article useful enough to leave a comment.


Physiotherapy Rhodes 5 years ago

It is really a good article and have given lots of information about physiotherapy, You can find the more on Physiotherapy Rhodes.


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soni2006 5 years ago from New Delhi, India Author

Thanks a lot Physiotherapy Rhodes. I am really glad that you found this article interesting enough to leave a comment but I am sad that a few people have stolen my content and I have tried to file DMCA complaint but to no avail.


George 4 years ago

Found out exactly what i was looking for in this article..thanks a lot..


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tarajeyaram 4 years ago from Wonderland

Great article.


simon chris 4 years ago

This article is absolutely gud for the management of hemiplegia. I applied and its like magic.


vipul 4 years ago

GR8 , this article is actually good. I wanted to know in case of mild stroke in the back of the brain can cause how much damage? and if this can lead to permanent disability?


selvi 4 years ago

thanks for your kind of treatment.


kunle B. 4 years ago

I find this article really revealing. My dad suffered from stroke about a week ago... basically he still trying to have total control of his wrist and fingers. do you think we can get proper medical attention at Apollo Hospitals India... currently we are based in Nigeria


RAJENDRA 4 years ago

THANKS, FOR EXPLAINING MINUTE DETAILS I THINK THIS ARTICLE WILL SURELY HELP MY BROTHER IN LAW WHO IS SUFFERING FROM BRAIN HAEMMORAGEFROM MAY 25 2012. FIRST HIS LEFT LEG AND LEFT HAND HAD GOT PARALYSED YOU CAN ALSO ALSO SAY GOT HEAVY, WHEN TRANSFERRED TO HOSPITAL AFTER 4 HOURS HE GOT FITS AND WAS UNCONCIOUS, HE IS IN HOSPITAL TILL DATE 8.6.2012 IN ICU MILK AND SOUP FED THROUGH NOSE ,SLEEPING POSITIONS ARE CHANGED.


Niranjan 4 years ago

my mother is having a brain hemerage in year 2003, she is walking on plain surface but not like normal person (you can sat abnormal walk), this time she is admit in hospital as her both kindnies fails, when doctors started dylasis after 3rd dylasis she lost control on whole body, she is not able to even open her eyes, now she is completely on bad, no movement from past 4 days but when doctors pinch her body she feel that and we can see small movement on her hand or body, as per doctors my mother half brain was already week due to her past injury, now half brain is not responding or slow responding to whole body. I just want to know is there any brain, body, muscels therepy through which her brain starts responding as earlier it was, is it possible her damaged brain can also respond now, please sugest


ranbaglepadmaraj@gmail.com 4 years ago

hi soni ,i wud like to have ur opinion on the left hemiplegic conditions of my mother .she suffered a stroke on feb 2012,since lying in bed with rt feedings and tracheostomy and urine catether.decompression crainotomy on right side which left her weak on right side as well.what's best neurophysiotherapy procedures wud benifet her.plz answer


Pelumi 2 years ago

My dad suffered from stroke (ischemic) on the 7th of march 2014,was taken to the hospital and as since been discharged,but he dose not look okay to me,he cant use his left hand and leg,he mixes words atimes and cant move his back,please what do you advise we do,is to start his physio on the 17th of april 2014,but i feel that is too far,what can we do in the house (exercise) to help him recover on time?

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