Initial management following a stroke.
Acute physiotherapy management of a stroke patient is quite different to management once you are discharged from hospital. During your hospital stay a physiotherapist will assess you. They will provide chest management if necessary and advise you on appropriate positions in the bed and out in the chair. Depending on the physical symptoms some patients will mobilise or go on a treadmill. An occupational therapist may also be involved to assess personnel activities of daily living.
An integrated care pathway will be used by the multidisciplinary team.
Common Impairments after a first stroke include:
Aphasia.
Apraxia of speech.
Arm/hand/leg weakness.
Dysarthria.
Dysphagia .
Gait, balance and coordination problems.
Sensory loss.
Perceptual dysfunctions.
Visual problems\facial weakness.
Activities that will be limited:
Bathing.
Communication.
Dressing.
Eating and drinking.
Walking and mobility.
Transferring.
Psychological; decision making.
Urinary and/or faecal incontinence.
Complications for stroke patients:
Anxiety.
Confusion.
Depression.
Falls.
Spasticity.
Venous thromboembolism.
Pain.
Pressure Sores.
Recurrent Stroke.
Fatigue.
Infections.
Rehabilitation approach.
- Assessment of the patient; needs are identified and quantified.
- Goal Setting; Goals are divided up into short, medium and long.
- Intervention, this is needed to assist in the achievement of goals.
- Re-assessment: progress assessed against the agreed goals.
The process of rehabilitation can be interrupted at any point by a previous disability, co-morbidities and stroke complications.
Physiotherapy management of the Stroke Patient once discharged from hospital.
Physiotherapy focuses on restoring movement and strength using exercise and other therapies. Difficulty moving arms and legs following a stroke is a common problem. The physiotherapist will offer advice on positioning your arm in the chair and when in bed. Exercises will be given which are often repetitive tasks such as reaching for an object. A splint may be necessary for the foot to facilitate gait. Splints are also used on the hand to prevent muscles shortening and allow the hand to be cleaned easily. Spasticity is a common feature following a stroke, making it tough to move the muscles. A unique orthotic is the Saebo splint which can allow you to grasp objects. This increases the activities of daily living and upper limb function. Other equipment such as mirrors may be used for example with table top activities.
Sit to stand and walking training may be part of the management when you are ready. Physical activity can increase to static bike work as well as sessions outside and at your local gym/sports centre.
