What is a stroke?

What is a stroke?

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A stroke, also known as a cerebrovascular accident (CVA), is a sudden loss of neurological function caused by an interruption of the blood flow to a part of the brain. This interruption can be caused by either a blockage in the blood vessels supplying the brain (ischemic stroke) or the rupture of a blood vessel in the brain (hemorrhagic stroke). 

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• Ischemic Stroke: This is the most common type of stroke, accounting for about 80% of all cases. It occurs when a blood clot or plaque buildup narrows or blocks an artery that supplies blood to the brain. The lack of blood flow deprives the brain cells of oxygen and nutrients, leading to their damage or death.

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• Hemorrhagic Stroke: This type of stroke happens when a blood vessel in the brain ruptures and causes bleeding into the surrounding brain tissue. The bleeding can compress and damage the brain cells, disrupting their normal function.

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Clinically, a variety of deficits are possible, including changes in the level of consciousness and impairments of sensory, motor, cognitive, perceptual and language functions. Motor deficits are characterized by paralysis (hemiplegia) or weakness (hemiparesis), typically on one side of the body opposite to the side of the lesion.

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Strokes are considered medical emergencies because they can lead to serious complications and even death. Immediate medical attention is crucial to minimize brain damage and improve the chances of recovery. Treatment options for stroke include medications, surgical interventions, rehabilitation therapies, and lifestyle modifications to reduce the risk of future strokes.

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If you or someone around you experiences symptoms of a stroke, it is important to call emergency services right away to ensure prompt medical care. Remember the acronym FAST to help recognize the signs of a stroke: Face drooping, Arm weakness, Speech difficulty, Time to call emergency services.

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Common symptoms of a stroke

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The first indication of the onset of stroke may be transient with focal symptoms, but is the first warning sign that a stroke is about to occur. Strokes can cause various symptoms, depending on the area of the brain affected. Common symptoms include sudden weakness or numbness on one side of the body, particularly the face, arm or leg, difficulty speaking or understanding speech, severe headache with no known cause, unexplained dizziness, loss of balance or coordination, sudden falls, dimness or loss of vision, particularly in one eye. 

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What causes a stroke?

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A stroke occurs when the blood supply to a part of the brain is disrupted, leading to damage or death of brain cells. The most common cause of stroke is the blockage or narrowing of an artery supplying blood to the brain. This type of stroke is called an ischemic stroke and accounts for about 85% of all strokes.

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Ischemic strokes can occur due to two main reasons:

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1. Thrombotic stroke: This type of stroke occurs when a blood clot forms within one of the arteries that supply blood to the brain. The clot usually forms at the site of an atherosclerotic plaque, which is a buildup of fatty deposits and other substances in the artery walls. The clot blocks the blood flow, causing a stroke.

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2. Embolic stroke: In this case, a blood clot or another material, such as a piece of plaque or a blood clot from another part of the body, travels through the bloodstream and lodges in a smaller artery in the brain. This blocks the blood flow to that area and causes a stroke.

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Various risk factors increase the likelihood of having a stroke, including:

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1. High blood pressure: This is the most prevalent and modifiable risk factor for stroke. Decreasing the blood pressure decreases the risk of stroke by 40%.
2. Smoking: Cigarette smoking increases the risk of stroke by approximately 50%, the risk is directly related to the number of smoke per day.
3. Diabetes: This condition has been long established as a risk factor for stroke. Diabetes is known to cause large artery atherosclerosis (thickening or hardening of arteries due to build up of plaque in the arteries), and increased cholesterol levels.
4. High cholesterol: High total cholesterol levels create increased risk of ischemic stroke.  Individuals with low high density lipoprotein (HDL) also known as “good” cholesterol are at greater risk.
5. Obesity: Individuals with significant obesity, particularly abdominal adiposity (excessive abdominal fats) increases the risk for stroke.
6. Sedentary lifestyle: Physical inactivity increases the fat build up in the arteries that can potentially lead to stroke and other conditions.
7.  Heart disease: Various cardiac diseases have been shown to increase the risk of stroke, including coronary heart disease and cardiac failure. The stroke risk increases with the degree of stenosis (narrowed artery).
8. Family history of stroke: Genetic variants appear to be most related to a specific stroke subtype. This has implications on both prevention and treatment related to stroke.
9. Age: It constitutes the greatest risk. The incidence of stroke doubles with every decade after age 55 years. 
10. Gender: Men are more likely to be affected. Women have a 20% less chance of stroke, but age increases the risk just as with men. 
11. Certain medical conditions: Other certain medical conditions such as atrial fibrillation (rapid irregular heart rhythm) is also a risk factor.
12. Prior history of stroke or transient ischemic attack (TIA): Individuals with prior history of stroke are at higher risk of having another stroke.

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It is important to note that while these factors increase the risk, a stroke can occur in anyone, including those without any known risk factors. It's essential to maintain a healthy lifestyle, manage underlying health conditions, and seek medical attention promptly if any stroke symptoms occur to minimize the risk and potential impact of a stroke.

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How can physical therapy help? 

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Physical therapy plays a crucial role in the recovery and rehabilitation process after a stroke. It focuses on restoring movement, strength, coordination, balance, and overall functional abilities that may have been affected by the stroke. Physical therapy interventions vary depending on the stage of motor recovery of the patient. Here are some ways in which physical therapy can help:

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1. Mobility training: Activities that promote voluntary movement control, postural control and functional use of extremities are the primary focus of initial mobility training. During initial training, the physical therapist focuses on dissociation of different body segments and selective movement patterns. As control develops, postures can be changed to more difficult ones that challenge developing control. In the later phases of rehabilitation, repetitive task-specific training is the main focus to improve functional mobility. 

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2. Strengthening exercises: Muscle weakness is a major impairment after stroke and contributes to significant activity limitations (e.g. walking, sit-to-stand transfers, stair climbing and upper extremity activities). Progressive strengthening exercises have been shown to improve muscle strength in individuals with stroke. Physical therapists design specific exercises to target weakened muscles. It involves the use of  different exercise modalities such as free weights, elastic band or tubing and machines. By gradually increasing resistance and intensity, these exercises help regain strength and improve overall physical function.

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3. Range of motion exercises: Soft tissue/joint mobilization and range of motion exercises are initiated early to maintain joint integrity and mobility as well as to prevent contractures. Passive range of motion and active range of motion, when possible, with end-range stretch are prescribed by the physical therapists and should be performed daily in all motions. If a contracture is developing a more frequent range of motion exercises are necessary.

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4. Postural control, balance and coordination training: Stroke results in significant changes in postural control, balance and coordination, which makes daily activities challenging. The goals of training are to progressively increase the level of difficulty (e.g. range and speed of self-initiated movements) while encouraging consistency, symmetry, and maximum use of the more affected side. Once the postural control and static stability is achieved in upright postures, the physical therapists will progress the exercise to target the dynamic stability and coordination.

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5. Gait Training: Gait abnormalities arise as a result of impairments in flexibility strength, movement control, coordination and balance. Physical therapists prescribe gait training for stroke patients to promote functional mobility and independence through regaining a more efficient gait pattern.

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6. Aerobic Conditioning: Patients with stroke demonstrate decreased levels of physical conditioning following periods of immobility and reduced activity. The energy costs to complete many functional tasks are higher than normal. Individuals recovering from stroke can benefit from aerobic conditioning exercises to improve cardiovascular function.

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7. Functional training: As the patient’s muscle strength, endurance, performance, balance and coordination improve, functional training is prescribed. It involves practicing activities that simulate the physical demands of a patient’s daily activities. Simulated activities and drills enable a patient to practice under supervised conditions to receive feedback on correct mechanics. 

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8. Pain management: Physical therapists can employ techniques and modalities such as manual therapy, heat or cold therapy, ultrasound and electrical stimulation to manage pain that may result from spasticity, or joint stiffness.

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9. Adaptation and assistive devices: If necessary, physical therapists can recommend and train individuals to use assistive devices such as braces, orthotics, or mobility aids to compensate for any physical limitations, promote mobility and improve independence.

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10. Education and guidance: Physical therapists educate stroke survivors and their caregivers about stroke, its causes and effects as well as the role and importance of the rehabilitation program in managing the condition. They also teach proper body mechanics, energy conservation techniques, activity pacing and strategies to prevent falls or injuries. 

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11. Home Exercise Program:  Physical therapists provide home exercise programs for each patient and teach how to safely and effectively incorporate it into their daily routine to reinforce the interventions and promote optimal recovery. 

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It's important to note that physical therapy is just one component of a comprehensive stroke rehabilitation program. Other therapies, such as occupational therapy and speech therapy, along with medical management, and social support, may also be involved in the overall stroke recovery process. The specific treatment plan is tailored to each individual's needs and goals, with the aim of maximizing functional independence and quality of life.

Trust PeteHealth for recovery from a stroke

Looking for a physical therapist to help you recover from a stroke? PeteHealth is the trusted physical therapy solution that you can access on your schedule, bringing you the care you need wherever you need it – including your home or office. Our licensed physical therapists are at the top of their profession, and we accept most insurance carriers.

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Finally – the all-in-one, professional, convenient approach to physical therapy that you deserve with PeteHealth.

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