Recovering from a Stroke with Physical Therapy
In the United States, a stroke occurs every 40 seconds and can have long-lasting effects on a person’s movement, coordination, vision, speech, cognition, and emotional processing. A stroke occurs when blood flow in the brain is blocked or bleeds. It is therefore imperative that stroke survivors receive intensive rehabilitative care in the 3 months post-stroke to maximize their recovery and improve their quality of life. Physical therapists play a critical role in stroke recovery, helping stroke survivors maximize their functional abilities, relearn basic skills, and improve quality of life.
How Strokes Affect the Body
A stroke occurs every 40 seconds in the United States and affects more than 795,000 people each year. It is the leading cause of long-term disability in the United States. A stroke is a medical emergency in which blood flow in the brain is blocked or bleeds. This can be caused by an ischemic stroke or a hemorrhagic stroke.
An ischemic stroke occurs when a blood vessel in the brain is blocked, typically due to arteriosclerosis, which is a build-up of fatty deposits. A hemorrhagic stroke occurs when a blood vessel leaks or ruptures.
A stroke can affect a person’s movement, coordination, vision, speech, swallowing, thinking abilities, and emotional processing depending on the location of the stroke in the brain and the extent of the lesion or tissue involvement. The severity of stroke symptoms is dependent on where the stroke occurred in the brain, how extensive the damage was, and the duration of the stroke.
Common stroke symptoms include:
Problems with speech and language or slurred speech
Difficulty swallowing due to the nerves that control swelling being affected
Short-term verbal and visual memory issues
Visio-perception problems, e.g. inability to pay attention to one half of the body
Mental confusion such as forgetting where they are or what they were doing
Hemiplegia, or weakness on one side of the body
Balance problems such as vertigo, particularly if the brainstem was affected
Changes in personality, emotions, and mood with mood swings and feelings of anger, anxiety, or depression without apparent cause
Initially, the stroke survivor is treated in a hospital. Depending on the severity of the stroke, they may spend time in an inpatient rehabilitation facility or in-home physical therapy before progressing to outpatient physical therapy.
Stroke Recovery with Physical Therapy
Physical therapists play a critical role in stroke recovery, working together with a team of medical professionals to provide stroke patients the best possible care. The aim of the physical therapist is to help stroke survivors maximize their functional abilities, relearn basic skills, and improve their quality of life.
Experts have noted that the most significant improvements post-stroke occur in the first few weeks up to 2-3 months after the stroke. It is therefore imperative that stroke survivors receive intensive rehabilitative care in the 3 months post-stroke to maximize their recovery and improve their quality of life.
A 2021 study demonstrated that the first 2-3 months after a stroke are a critical time for intensive stroke rehabilitation. The study involved 72 stroke patients divided into 4 groups. All groups received standard stroke rehabilitation therapy; however, three of the four groups received an extra 20 hours of intensive motor skills therapy at different stages (one group within 30 days of stroke, the second group during 2-3 months after stroke, and the third group 6-7 months after stroke). Researchers noted that those in the 2–3-month intensive therapy group showed the greatest improvements one year after their strokes. Those in the 30-day group showed smaller but still significant improvements, while those in the 6–7-month group showed no significant improvement over those that received no intensive therapy.
After a stroke, the body tries to repair the damage in your brain by rebuilding and rewiring the neuron connections that were destroyed by the stroke. These neurons connect different areas of the brain and can start sending messages from your brain to the body once more. This rebuilding process is called neuroplasticity.
By engaging in a customized rehabilitation program, stroke patients can capitalize on the neuroplasticity process of the brain and enhance recovery.
Physical therapy for stroke patients can involve:
Motor skill exercises: these exercises focus on improving coordination and the ability to control movements, such as gross motor skills like moving the arms and legs as well as fine motor skills requiring dexterity of the hands to grasp and grip objects
Passive movement exercises: The therapist moves the stroke survivor’s limbs through a movement for the survivor on the affected side of the body. This helps to get affected limbs moving and stimulates the parts of the brain involved in muscle movement.
Mental practice training: this involves speaking an action out loud before performing it to help rebuild the response between the brain and the body.
Mobility and gait training: the physical therapist works with the patient as they progress in healing to perform movements and improve functional strength, e.g. getting in and out of bed, standing up from a chair or toilet, walking, or navigating stairs. The therapist may also help patients practice with assistive devices to maintain balance initially like a cane or walker.
Constraint-induced movement therapy (CIMT): this mode of therapy involves restricting or constraining one arm to encourage the use of the other arm to work to complete certain tasks. Because a stroke generally causes weakness on one side of the body, this can lead survivors to overcompensate with the other fully functioning side. By restraining the unaffected arm, this forces the patient to use the affected arm to improve muscle activation, strength, and coordination.
Range of motion exercises: these exercises work on improving the flexibility of muscles and mobility of joints, particularly if increased muscle tone or contractures have developed post-stroke that restrict movement in the arm, wrist, hand, leg, or ankle.
Functional electrical stimulation: a physical therapist may use electrical stimulation therapeutically to deliver an electrical current to muscles via electrodes placed on the skin to help stimulate nerves in weakened muscles to improve function.
The therapist utilizes both hands-on treatment and equipment-supported therapy to help stroke survivors regain function. One piece of equipment commonly used in stroke recovery is the NuStep, which is a recumbent cross-trainer that allows survivors to sit while moving both arms and legs forward and back, alternating sides, in a gentle gliding motion to activate the muscles commonly used during walking. A stationary bike is also used to support bilateral movement as both legs are used in unison to contract muscles that are used when walking.
At Mangiarelli Rehabilitation, we understand that a stroke can be a life-altering event in your family and in your life. As physical therapists, we are here to accompany you through your stroke recovery and help you regain movement, function, and the best possible quality of life.
