Physiotherapy Management Strategy for Stroke - Essay Example

Topic: Physiotherapy Management Strategy for Stroke Physiotherapy Management Strategy for Stroke Introduction A stroke is defined as the sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. A stroke is an acute loss of neurological function due to an abnormal perfusion of brain tissue, most of which are ischemic 87% in nature and usually result from an arterial obstruction by a thrombus or embolus. Hemorrhagic strokes 13% are caused by rupture or leak of a blood vessel either within the primary brain tissue or subarachnoid space (Moheet). Stroke is regularly grouped together with coronary heart disease as cardiovascular diseases but there are considerable differences in the epidemiology of stroke and coronary heart disease. The most distinguished differences is time trends and the fact that pronounced male excess found for coronary heart diseases is not seen as a stroke. Strokes occur at any age but much more common in the elderly, with the death rate doubling ever ten years between ages 55 and 85 (American Heart Association). As a result of this and the age distribution of the population, approximately ¾ of stroke deaths occur in individuals over 65. Strokes are responsible for about 10% of all deaths in industrialized countries and for a vast burden of disability in the community. When a stroke has occurred treatment is largely focused on care and rehabilitation. On the other hand, there is evidence that suggest a stroke is potentially preventable. Firstly, there are great international variations in mortality from stroke and migrants between areas where the rates of stroke differ generally experience a change in risk, this imply that environmental factors may be of great importance than genetic resistance in determining risks. Secondly, many countries have experienced a steep turn down in mortality from stroke in recent decades though alterations in diagnostic manner or certification practice might account for a small portion of this decline, the most probably explanation seems to be changes in risk factor level over time. Thirdly, epidemiological studies on causes of stroke have indicated that some are avoidable. Anybody can suffer from stroke. Many risk factors are out of our control, several can be kept under control through proper nutrition and medical care. Risk factors for stroke are over age 55 years, male, family history of stroke, high blood pressure, high cholesterol, smoking cigarettes, diabetes, obesity, overweight, cardiovascular diseases, transient ischemic attack, and high levels of homocysteine, use of birth control, and use of cocaine and heavy use of alcohol. Ischemic strokes are caused by a thrombus or embolus that blocks blood flow to the brain. Blood clots usually occur in areas of the arteries that have been damaged by atherosclerosis from a build up of plaques Types of Strokes The Ischemic Stroke, are the most common, it occurs when a blood vessel becomes blocked usually by a blood clot. Clots can develop when blood vessels become clogged with fat and cholesterol a condition known as atherosclerosis. Blood does not reach the brain and brain cells suffer from the lack of nutrients and oxygen. They may be caused by a deformity in the valves of the heart as a result of endocarditis. The hemorrhagic stroke, it occurs when a blood vessel in the brain bursts or breaks causing bleeding in the brain. They are most often traced to high blood pressure but may also be caused by an aneurysm; this is when a weakened portion of a blood vessel balloons out, ruptures and causes bleeding in the brain. Role of Physiotherapy Of Stroke Physiotherapy is also referred to as physical therapy; it involves evaluating, diagnosing and treating a range of diseases, disorders and disabilities using physical means. Practiced by physiotherapists or physical therapist, it is considered within the realm of conventional medicine. Physiotherapy aims to restore a person to their optimal functional potential within the limits of his/her abilities and needs. Physical problems associated with a stroke are paralysis, pain, sensory loss, excessive muscles stiffness, balance impairments and functional loss. Modern physiotherapy approaches to those problems consist of treatment techniques which relax muscles when tight and stimulate muscles when weak. The physiotherapist through his/her handling of specific bodily parts influences the muscles and guides the patient through a particular movement for example learning to sit and turning in bed or standing up. Moment in time the patient may learn to carry out a movement with better control and less assistance. A thorough understanding of normal movements is a necessity when analyzing why abnormal movements present in a patient with stroke, which may cause difficulty with a particular function. Disability resulting from stroke is variable in each individual. Research indicates that following a stroke most individual regain the ability to walk. On the other hand many are slow and may never walk outside. This means a comprehensive assessment is essential for planning an effective rehabilitation programme. They includes detailed examination of body movements, muscle tone, sensation, balance, function and activities of daily living. Goals are laid down by the therapist and patient, which include functional tasks relevant to lifestyle. Rehabilitation begins on the day of the stroke. This initially consists of positioning and passive stretches to maintain muscle and joint range, together with a close cooperation with medical staff. The physiotherapist has several significant roles in caring for stroke patients, depending on their individual needs and stages of the illness. Soon after a severe stroke, the physiotherapist may be involved in at least seven functions which are as follows providing a detailed assessment of the motor and sensory problems of patients to help approximate their prognosis, assessing and treating chest problems which include pneumonia and retention of speech, advising nurses and other carers on the best way to position patients to prevent unwanted changes in muscle tone that may lead eventually to contractures and further limitation of function, teaching the nurses and informal carers the best way to handle the patient in order to avoid pain or injury to the patient. This will frequently involve teaching proper methods of transferring, lifting, standing and walking the patient, providing therapy so as to improve the patient’s mobility and arm function and finally advising on walking aids and splints that may sometimes improve a patient’s function (Warlow et al, 78). The physiotherapist will ensure that the patient is comfortably positioned in bed or a chair and not lying or sitting in a manner that could cause harm or hinder motor recovery. Several decades ago stroke patients were normally assigned to bed in the early stages of recovery after stroke. Currently we know this is to be detrimental and a contributory factor in the cause of complications such as limb oedema and deep veins thrombosis. As the patient makes progress, the physiotherapist’s attention will be attending to standing and walking. Stroke Therapy Assessment Scale and Tools Assessment is the determining the extent, importance and value of a medical or psychological condition, social or environmental situation or treatment. A stroke occurs when the arteries to the brain become blocked or ruptured, cutting off the blood supply to the brain and causing brain tissue to die. They are various stroke assessment tools and are as follows, comprehensive geriatric assessment; it is a multidimensional, multidisciplinary diagnostic instrument that is designed to collect data on the medical, psychosocial and functional capabilities and limitations of elderly patients. The geriatric assessment differs from a standard medical evaluation in three common ways it focuses on elderly individuals with complex problems, it emphasizes functional status and quality of life and lastly it frequently takes an advantage of an interdisciplinary team of providers. The primary care physician and community health worker normally initiates an assessment when he or she detects a potential problem. Although all geriatric practitioners do not use a standard assessment format most agree on basic content. The comprehensive assessment follows the physical diagnosis. It incorporates all aspects of a conventional medical history including demographic data, chief complaint, present illness, past and current medical problems, family and social history and review of systems. Initial assessment, assessment of the patient with a stroke starts with recognition of the event as a stroke is the Prehospital phase of care and continues throughout care. Emergency medical technicians and ambulance staff need training in recognition of signs and symptoms of stroke. Tools such as the face arm speech test and the shortened national institutes of health stroke scale have been tested and found to be effective in increasing the diagnostic accuracy of ambulance staff. Examination Assessment, It aims to confirm the following factors confirmation of the presence of focal neurological signs anticipated from history, discover possible etiological explanations for the event for example fibrillation, carotid bruits, cardiac murmurs just to name a few, some of which may not be anticipated, identify contraindications to investigation example a pacemaker and anticipation of nursing and rehabilitation needs. Stroke Rehabilitation, all patients with stroke should begin rehabilitation therapy as early as possible when medical stability is reached. Patients should undergo as much therapy appropriate to their desires because they are willing and able to tolerate. The team should promote the practice of skills gained in therapy into the patient’s daily schedule in a consistent manner. Therapy should include repetitive and intense use of novel tasks that challenge the patient to acquire necessary motor skills to use the involved limb during functional tasks and activities. Stoke unit teams should carry out at least one formal interdisciplinary meeting per week at which patient problems are identified, rehabilitation goals set, progress monitored and support after discharge planned (Law & Macdermid, 177). Neuropsychological assessment, the neuropsychologist working with a stroke patient should have access to neuropsychological tests appropriate foe assessing patients at different stages of their recovery. The test library should include reliable measures with which to assess the major cognitive domains. The neurologist can utilize other methods of assessment so as to reach a formulation regarding the impact of a stroke on a patient’s cognitive, emotional and functional status. Observation is a key approach, especially if it is an inpatient. The neurologist should be responsible for assessment and intervention across the patient’s trail from the stroke until many years after the stroke (Lincoln, Kneebone, Macniven & Morris, 59). Consultations, with neurologists and physiatrists are important aspects of treatment in patients who have suffered a stroke. Consultations with psychologists are important. Objectives of Stroke Assessment The objectives of assessments are to document the diagnosis of stroke, its etiology, area of the brain involved and clinical manifestation, identification of treatment needs during the acute phase, identification of patients who are most likely to benefit from rehabilitation, to select the appropriate type of rehabilitation setting, provide basis for creating a rehabilitation treatment plan, to monitor progress during rehabilitation, facilitate discharge planning and after return to a community residence. To achieve these objectives, assessments should be performed by skilled people in rehabilitation using a combination of clinical examinations and well validated standardized measures (Grshman, Duncan & Stason, 33). Stroke rehabilitation is a combined and coordinated use of medical, social, educational and vocational measures to retain a person who has suffered a stroke to his or her physical appearance, psychological, social, vocational potential, consistent with physiological and environment restrictions. The initial clinical examination of an acute stroke patient includes a thorough detailed neurological examination. The neurologic findings are used by the rehabilitation team for prognostication, development of the specific details of the rehabilitation plan and selection of the appropriate setting of rehabilitation. Reassessment of the patient’s situation during rehabilitation provides a means of monitoring progress and subsequently evaluating outcome. The initial rehabilitation assessment should start immediately following onset within two to seven days and then at repeated intervals. Outcome of Physiotherapy The judicious use of outcome measures to monitor the health status of patients is considered an aspect of good clinical practice in physiotherapy. About half of stroke survivors are left with significant disability. The brain however is very adaptable and with physiotherapy recovery can take place over a period of years. If the correct level of physiotherapy input, long term improvements made it will led to improvements. Physiotherapy assists in the patient regaining as much movement and function as possible. This treatment frequently focuses on sitting balance, standing balance, walking, using the affected arm or hand and managing any changes in muscle tone, pain or stiffness. Neurological stroke physiotherapy can help to improve balance and walking, increase ability to roll or move in bed or stand or sit, reduce muscle spasms, pain and stiffness, increase strength, retain normal patterns of movement, increase affected arm and leg function, increase energy levels, increase independence quality of life and reduce the risk of falls. In order to evaluate the effectiveness of physical therapy it is important to test patients at the beginning and end of therapy. For many elderly patients, physiotherapy is mostly effective when given on a daily basis. This may be easier and more effective while temporarily staying in a resident treatment facility where 24 hour staff is on hand to tend to any medical issues or complications that may arise. In each physiotherapy session patients work on developing new skills, such as eating or getting dressed with one hand or learning to communicate if language abilities have been impaired. Conclusion Physiotherapy is very important when one has had a stroke because it helps the patient to recover. Through physiotherapy he or she will be able to walk, sleep, speak, stand and manage any changes in muscle tone, pain or stiffness. Physiotherapy should not be rushed. The patient and his or her physiotherapists should cooperate in order to enable to patient to go through the process and recover as expected. Bibliography: Irene Katzan, retrieved from http://www.clevelandclinicmeded.com Journal of Neurology. 1996. Neurosurgery, and Psychiatry. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC486569/pdf/jnnpsyc00010-0007.pdf Warlow, Gijn, Dennis, Wardlaw, Bamford, Hankey, Sandercock, Rinkel, Langhorne, Sudlow, & Rothwell. 2011. Stroke practical management. Oxford: Blackwell Publishing Mant & Walker. 2008. ABC of stroke. Oxford: Blackwell Publishing. Law & MacDermid. 2008. Evidence-based rehabilitation. 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