Role of physiotherapists in treatment of acute and chronic strokes

Physiotherapists rehabilitate the patient with different techniques, which they study in their academics. Physiotherapists teach home exercise programs after considerable true recovery. Physiotherapists or physical therapists check which muscles still have some power and check whether the patient is utilizing that muscle in functional movement or not. If not, then they teach him how to use it. If the patient is already using that muscle, then they try to improve patient's quality of movement and include voluntary control exercise in their treatment regimen. If necessary, they ask the patient to have proper splint for lower limb if involved. Also check the patient's daily activities and needs according to it. They choose different tasks for them. Aerobic exercise is included to increase the patient's endurance. They improve cognition and perception if affected. Physiotherapists ask for the patient's interest and go for recreational activity according to it. Posture awareness training is emphasized.

Different strokes and their treatments

If stroke is caused by blood clot (ischemia), then thrombolytics (tPA - Tissue Plasminogen Activator) within 3 hours of stroke onset gives the best chance of recovery.

If the stroke is caused by bleeding (hemorrhage), then thrombolytics will worsen the condition, so perfect diagnosis is required before proceeding to medical treatment.

In other circumstances, doctors prescribe blood thinners such as heparin and Coumadin to treat strokes due to blood clots. Aspirin may also be used.

Physical therapy in recovery and compensation of stroke patients

In stroke literature, most important question is recovery or compensation. Recovery after stroke always depends on the area of brain involvement, size of lesion, duration of getting treatment and many others things according to which the patient will recover.

Some patients' get compete recovery within a month and live as normal. Full recovery without any residual dysfunction might be also due to that they might have only suffered from hemiparesis in which you can aspect almost full recovery but this might not be the case with hemiplegia.

In other cases where damage is more, patient is not able to get full recovery but yes most probably functionally they get some recovery. Gaining full recovery will be very difficult with these types of patients, so for such patients, a doctor goes for compensation and will not get a true recovery.

In these types of cases, physiotherapists help patients to recover through rehabilitation process with all other drugs and medications. They train affected muscles through strengthening, stretching, PNF, and other treatments to gain maximum level of independence. During this period of training, the patient's brain through capacity of plasticity learns to do the activity near normally without use of infarcted part of brain. In other words, normal part will take over the function of infarcted part to control the body movement, so result will be ability to do near normal movement without any dependence.

Lesion location and all other things described above play a huge role in gaining recovery.

But in chronic stages also, now it is believed that neural plasticity (i.e., the surrounding neurons branch to the affected area and try to provide collateral circuit to optimize function) does occur and so based on that true recovery of such chronic patients is possible. With appropriate physical therapy and practice, there are chances of gaining true recovery in chronic stroke patients too but it would still differ from patient to patient.

Still a question remains that how much true recovery can be expected from chronic stroke patients but there is a hope that in about 10-15 years, the rehabilitation of such stroke patients might be completely different and physiotherapists will not have to rely on their luck.

Advanced therapies, which can change the current rehabilitation protocols

For Upper Extremities:

Functional Task Training/

Virtual reality training

Strength Training (for spastic group of muscles)

Bimanual Training

Robotic Training

For Lower Extremities:

Body Weight Support Gait Training

Locomat is a treadmill, which is, automated which helps in rebuilding muscles in stroke patients.