This document provides information about stroke, including its definition, types, causes, risk factors, symptoms, diagnosis, treatment and rehabilitation. It defines stroke as a sudden neurological deficit lasting over 24 hours caused by a blood vessel blockage or rupture in the brain. It notes the two main types are ischemic (85% of cases, caused by blockage) and hemorrhagic (15%, caused by bleeding). Risk factors include age, family history, smoking and high blood pressure. Diagnosis involves tests like CT/MRI scans and treatment depends on the type but may include clot-busting drugs, surgery or coil embolization. Physiotherapy aims to improve mobility, prevent complications like shoulder subluxation, and help
2. WHAT IS STROKE ?
Hippocrates, the “father of medicine,” first recognized stroke more than 2,400 years
ago. Universally accepted definition for stroke by the World Health Organization is “
The sudden onset of neurological deficits due to an abnormality in cerebral
circulation with the signs and symptoms lasting for more than 24 hours or longer”. It
occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a
blockage in the blood supply to the brain. The rupture or blockage prevents blood
and oxygen from reaching the brain’s tissues.
The cumulative incidence of stroke ranged from 105-152/100,000 persons per year,
and the crude prevalence of stroke ranged from 44.29 to 559/100,000 persons in
different parts of India during the past decade.
15. ISCHEMIC STROKE (85%)
An ischemic stroke happens when a blood vessel supplying blood to your
brain gets blocked by a blood clot. Occurs when a blood vessel supplying
blood to the brain is obstructed. It accounts for 85% of all strokes. Ischemic
stroke is seen among those aged 15 to 42 years.
The symptoms depend on which parts of your brain is affected. They can include things like:
• Sudden numbness or weakness of your face, arm, or leg, often on one side of the body
• Confusion
• Problems speaking or understanding others
• Dizziness, loss of balance or coordination, or trouble walking
• Vision loss or double vision
17. Hemorrhagic stroke contributes to 15% - 20% of strokes. It accounts for up
to 50% of all strokes that occur under the age of 45 years, it is due to
bleeding into the brain by the rupture of a blood vessel. These happen
when bleeding in your brain damages nearby cells.
HEMORRAGIC STROKE (15%)
The symptoms of Hemorrhagic stroke usually increase gradually over minutes or a few hours, which
includes:
Intense headache
Confusion
Nausea or throwing up
Sensitivity to light
Problems with vision
Passing out
19. TRANSIENT ISCHEMIC ATTACK
It is also called a mini-stroke, as the symptoms are
like those of a stroke but don't last long. It occurs
when the blood flow to the brain is blocked or
reduced often by a blood clot. TIA symptoms are
similar to that of a stroke but symptoms of TIA
occurs suddenly and wont last long, mostly go
away in 10-20 minutes.
Symptoms:
Numbness, tingling, weakness or paralysis in
the face arms or legs especially on one side of
the body.
Sudden vision change, problems with walking
and balance.
Sudden trouble speaking and confusion in
understanding simple statements.
Sudden severe headache that is different from
previous headaches.
21. IMMEDIATE MANAGEMENT
The blood flow to the brain should be restored immediately. This may be done with:
• Emergency IV medication therapy: An IV injection of recombinant tissue plasminogen activator (TPA)
— also called alteplase (Activase) or tenecteplase (TNKase) — is the gold standard treatment for
ischemic stroke.
• Emergency endovascular procedures/endovascular therapy.
• Removing the clot with a stent retriever.
22. • Carotid endarterectomy, this
surgery removes the plaque
blocking the carotid artery and
may reduce the risk of
ischemic stroke.
23.
24. • Surgical clipping: a tiny clamping at the base of the
aneurysm to stop blood flow to it. This clamp can keep
the aneurysm from bursting, or it can keep an
aneurysm that has recently hemorrhaged from
bleeding again.
25. • Coiling (endovascular embolization). Using a
catheter inserted into an artery in the groin
and guided to the brain, the surgeon will
place tiny detachable coils into the aneurysm
to fill it. This blocks blood flow into the
aneurysm and causes blood to clot.
28. Improve respiration and circulation
Breathing exercises
Chest expansion exercises
Postural drainage
Huffing and coughing techniques
Passive & active ankle and toe movements
29. Prevent pressure sores
Proper positioning
Relieve pressure points by padding and cushion
Frequent turning and changing positions
Prevent from moisture
Use cotton clothing
Tight fitting cloth is prevented
Use of water bed, air bed and foam mattress
30. Prevent from deconditioning
Early mobilization in the bed (active turning, supine to sitting, sitting to standing)
Early propped up positioning, sitting and then later to standing
Facilitate movement of functioning limbs
Pelvic bridging exercises
Moving around the bed
31. » Improve sensory function
» Flexibility and joint integrity
» Manage spasticity
» Improve motor control
» Postural control and functional mobility
» Improving functions of the extremities
» Managing shoulder pain and subluxation
» Improve balance
» Improve locomotion
» Improve aerobic functioning
» Improve motor learning
» Patient and family education
POST ACUTE MANAGEMENT
32. Shoulder subluxation happens when the upper arm bone, called the humerus, becomes partially
dislocated from the shoulder socket. This condition starts when the muscles around the shoulder become
weak or paralyzed after stroke.
SHOULDER SUBLUXATION