Post Stroke Rehabilitation: Pathways And Possibilities

A middle aged woman is evaluating her postural setup by using one of Euleria Health rehabilitation device in Euleria Care.

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After stroke: which rehabilitation pathway can support the frail person’s limitations and disabilities?

What is stroke: spread…

A stroke is when a neurological deficit occurs in a sudden form and affects a person for a time longer than 24 hours.

Caused by cerebral ischemia (ischemic stroke) or, in smaller percentages, from internal bleeding (hemorrhagic stroke), stroke is estimated by the Ministry of Health as the second leading cause of death in Italy (9-10% of all deaths) and the first cause of disability (90,000 are the annual hospitalizations attributable to stroke in Italy).

According to the World Health Organization, stroke affects 15 million individuals worldwide each year.

… and symptomatology

Once verified the symptomatology (which may include headaches, blurred vision, tingling, asymmetries of facial expression, reduced motor control and/or strength, difficulty speaking and/or coordinating, emotional and memory problems), the stroke center of expertise will be able to quickly diagnose the type of stroke in progress and determine the most appropriate therapies and possible surgical procedure.

In this video (by Planet Health 2.0) the prevalence, symptomatology, and risk factors of stroke are explained by Giovanni Morone | Physiatrist | UOC Neurorehabilitation Fondazione Santa Lucia IRCCS | Member of the Board of Directors of the Italian Society of Neurological Rehabilitation (SIRN):

After stroke: limitations and disabilities

Following the hospitalization and treatment of acute phase stroke, it is crucial to carefully coordinate the post-hospitalization phase. Indeed, it is necessary, at this stage, to address both the management of the patient and that of the caregiver(s), so as to ensure that the stroke sufferer has as much autonomy as possible in terms of adopting a proper lifestyle and putting into practice the post-rehabilitation process.

By incidence, stroke is unfortunately also the third leading global cause of disability. In fact, only 25% of survivors recover completely; depending on the area of the brain that was affected, the remaining 75% will report one or more limitations or disabilities, afferent to areas including:

  • movement(spasticity, muscle weaknesses)
  • swallowing (dysphagia)
  • language and memory
  • the psyche (mood depression, emotional disorders)

Usually, along with clinical therapy, the center of expertise also schedules a series of rehabilitative interventions, to be performed at home or in rehabilitation and nursing facilities, as appropriate.

These interventions range from physiotherapy to speech therapy, occupational therapy to specific adapted physical activity programs, and are aimed at recovering as much of the brain function damaged by stroke as possible.

Post-stroke rehabilitation: pathways and possibilities

Clinically, stroke results in the death of some nerve cells and damage to others; both of these scenarios cause (depending on the severity and area of the brain affected) the limitations and disabilities we have mentioned.

The first improvements are usually seen as early as the acute phase, that is, in the first weeks post-stroke; but it is during the post-acute phase, as part of an individualized rehabilitation course, that the affected person will be able to exercise and recover all the skills that may have been impaired by the stroke.

Post-stroke neuromotor rehabilitation pathways are varied, and aimed at restoring both cognitive and more strictly motor functions. Following the patient’s evaluation by the physiatrist (who circumscribes the patient’s residual motor skills and disabilities), it will be the physiotherapist’s task to initialize neurorehabilitation treatment, to teach the patient to:

  • Regain, to the extent possible, motor and cognitive functions impaired by hyposthenia, dysphagia, dysarthria etc.
  • Managing/introducing compensation and new practices to make up for lack of coordination and balance
Riablo biofeedback gaming experience

Exergames to train neuroplasticity

La terapia dell’esercizio fisico può contare su numerose tecnologie in grado di promuovere una riabilitazione motoria completa.

Prominent among these is biofeedback, the basis of those medical devices that can accurately measure movement through inertial sensors and provide visual-auditory feedback in real time. There are numerous evidence-based approaches that can improve neuroplasticity in patients who have suffered brain injury.

Especially useful in rehabilitation post-stroke was found to be the exergame technology (video game), which involves performing exercises in front of a screen on which objects and paths appear that, depending on the scenarios, the patient tries to catch or complete by performing simple movements and thus exercising the balance and strength functions of the lower and/or upper limbs.

This allows for accurate and challenging work on motor control, with specific training for gait and load acceptance.

Stroke: goals of rehabilitation

Thus, post-stroke rehabilitation aims to restore the frail person to as much independence as attainable, promoting the restoration of physical and emotional functions. Sometimes, full recovery is unfortunately not achievable, but the rehabilitation pathway can teach the patient to live with limitations and possible outcomes of disability. Despite the stroke, one can therefore be proposed to regain much independence and a good quality of life.

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