Post-Stroke Rehabilitation: Why Consistency Matters

What Is a Stroke?

Stroke is a neurological disturbance of normal function on one side of the body, caused by thrombotic, embolic, cavernous, or hemorrhagic changes in the central nervous system. The area of the brain in which damage occurs determines which side of the body is affected and which symptoms the patient experiences.

What Types of Stroke Are There?

• Hemorrhagic stroke - caused by blood leaking from a ruptured blood vessel. This blood damages brain tissue. This category includes subarachnoid hemorrhage, which accounts for 5% of cases, and intracerebral hemorrhage, which accounts for 10-15% of cases.
• Ischemic stroke - results from a sudden interruption of blood flow to the brain. The interruption may result from blockage of the lumen of an artery or simply its narrowing. This type of stroke is much more common, accounting for 85-90% of cases.

Rehabilitation - Reducing the Effects of Stroke

Rehabilitation is an integral part of the complex treatment process for patients after stroke. In the initial stage of treatment, it is very important to introduce specific medical measures intended to limit damage to the brain and surrounding structures as much as possible. Identifying the type of stroke and maintaining basic vital functions, such as breathing, are essential to prevent further progression of the stroke.

For rehabilitation to be effective and to make use of brain neuroplasticity, the following are necessary:

• starting therapy as soon as possible after the patient's condition has stabilized,
• continuous and intensive rehabilitation,
• the patient's regular daily work,
• a sufficiently large number of repetitions of rehabilitation exercises.

What Are the Stages of Rehabilitation?

• the period of functional prevention, or hospital rehabilitation,
• the period of full functional rehabilitation,
• the period of controlled adaptation, or community rehabilitation.

Early Inpatient Rehabilitation

During the first few days, it is particularly important to ensure the patient is positioned correctly, which helps prevent muscle and joint contractures.

Next, breathing exercises are introduced, including passive and active diaphragm mobilization. Chest percussion is also performed to avoid congestion. As the patient's condition stabilizes, passive exercises are added to improve the range of motion in the joint and gently stimulate the muscles to work. However, caution is needed, because improperly performed passive exercises in the initial period may increase spasticity.

The next stage is the gradual introduction of active-assisted exercises, intended to make the patient perform certain movements while external force provides only support. These exercises strengthen the muscles and help shape lost movement patterns. When possible, the patient begins self-assisted exercises, which form a transition between passive and active exercises. While exercising the affected limb, they support the movement with the healthy limb.

Late Inpatient and Post-Hospital Rehabilitation

This stage involves introducing isometric exercises, in which muscle tension changes and increases while muscle length remains constant. These exercises particularly increase the strength and endurance of weakened muscles. Active exercises with resistance, such as a weight, resistance band, or resistance provided by another person, are also used. If the patient's condition allows, physiotherapy in a specialist neurological rehabilitation unit is often recommended. However, the main purpose of staying in such a facility is occupational therapy and learning to function in the new circumstances of daily life.

Rehabilitation Methods

1. Proprioceptive neuromuscular facilitation (PNF) - aims to help the patient become independent through exercises that reflect everyday activities. The movements are diagonal and spiral and take place in more than one plane. The basis of the PNF method is complex movement patterns developed separately for each limb. Exercises may be performed independently or with the assistance of another person.
2. Bobath neurodevelopmental treatment - is based on assessing the maturity of the central nervous system to detect movement disorders early. The exercises follow natural human motor development. This method can help restore normal muscle tone and achieve varied active movements.
3. Constraint-induced movement therapy - aims to encourage a patient with hemiparesis to use the affected limb more. This is achieved by limiting or completely immobilizing the unaffected limb. This behavioral therapy aims to address the adverse phenomenon observed after limb denervation, known as learned non-use.
4. Mirror therapy - involves creating the illusion, using a properly positioned mirror, that both limbs are functioning normally. Most exercises are performed by the unaffected limb.
5. Mental training - used not only in rehabilitation, it makes it possible to activate areas of the brain that are active during actual exercises simply by imagining specific movements. A major advantage of this method is that it can be used from the first days after stroke.

Why Is It So Important to Start Rehabilitation Early?

• the musculoskeletal system needs to be properly prepared for gradual recovery of lost movement abilities,
• long-term immobilization of the patient can have a catastrophic effect on their health,
• psychomotor function needs improvement,
• it improves the patient's quality of life and comfort,
• it helps prevent loss of motivation and depressive states, which can hinder or significantly delay proper rehabilitation.

What Is Aphasia?

A common problem experienced by patients after stroke is aphasia, which is the partial or complete loss of the ability to use language. It is caused by damage to specific brain structures.

The condition makes it difficult to communicate with the patient and for the patient to communicate with their surroundings because of difficulties choosing words and forming logically correct sentences. However, aphasia can look different in every patient.

In addition to aphasia, a patient may experience paralysis or problems related to:

• awareness of their own movements,
• observing their surroundings,
• concentration, taking initiative, and memory.

Three types of aphasia can be distinguished:

1. Sensory, semantic aphasia - difficulty understanding spoken or written messages.
2. Motor aphasia - the patient understands speech and forms answers correctly in their thoughts but has difficulty articulating them.
3. Amnestic aphasia - inability to name objects, states, or phenomena that the patient is able to describe.

What Does Rehabilitation Look Like in This Case?

During exercises with a speech therapist, interactivity is important. It allows the patient to use sight, hearing, and touch, thereby stimulating different areas of the brain. The tasks require the patient to be willing to learn, understand, and remember, which may translate into noticeable therapeutic effects.

The Impact of Telerehabilitation on Returning to Function

Benefits of online rehabilitation and telemedicine solutions include:

• real-time conversations with a specialist and immediate feedback,
• easier contact with a specialist for people who do not live in large cities,
• additional home tasks that increase the effectiveness of therapy,
• no referrals or waiting lists,
• no burdensome transportation, as the patient exercises at home,
• the ability to choose the intensity of the exercise set,
• the ability to exercise at any time and for any duration,
• increased motivation to continue exercising.

Online rehabilitation technology gives the patient unlimited access to one form of therapy, without time or geographic limitations and sometimes even financial limitations. It can significantly improve and speed up recovery, but its existence alone will not work miracles - the patient needs to work consistently and diligently.

An important factor is educating the family, which must provide the patient with appropriate conditions for proper treatment in a rational way. Support from loved ones and help with exercises can often contribute to better results and, above all, help the patient avoid losing motivation in their struggle for health.