physical rehabilitation after a cerebrovascular accident.

1. REHABILITATION AFTERREHABILITATION AFTER
VASCULAR NEUROLOGICALVASCULAR NEUROLOGICAL
SURGERYSURGERY
CASE STUDY:
STROKE
HERMAN NDJAMEN

2. DEFINITION OF STROKE BY THE
WHO
 “Stroke is a cerebrovascular event with
rapidly developing clinical signs of focal or
global disturbances of cerebral function, with
signs lasting 14 hours or longer or leading to
death, with no apparent cause other than of
vascular origin.”

3. Stroke StatisticsStroke Statistics
 Third leading cause of death in U.S.
 Leading cause of severe disability in U.S.
 Estimated one-third to one-half have
disability
 Most common reason for rehabilitation

4. So What Are The Signs of Stroke?
 Sudden numbness or weakness in the face,
arm, or leg, especially on one side of the
body.
 Sudden confusion, trouble speaking, or
difficulty understanding speech.
 Sudden trouble seeing in one or both eyes.
 Sudden trouble walking, dizziness, loss of
balance, or lack of coordination.

5. TYPES OF STROKE
 ISCHEMIC  Intracerebral
Hemorrhage

7. POST-STROKE REHAB INCLUDES:
 PHYSIOTHERAPEUTIC REHABILITATION
 PHARMACOLOGICAL REHABILITATION
 PSYCHOLOGICAL REHABILITATION

8. Elements of Stroke Rehabilitation
1. Prevention of secondary complications.
2. Remediation or treatment to reduce the
effects of neurologic impairment.
3. Compensatory techniques to offset or
adapt to residual disabilities handicaps.
4. Maintenance of long-term function.
5. Reintegration into community and/or work.

9. The Goals of Stroke Rehabilitation
 Prevent, Recognize, and Manage
Comorbid Medical Conditions
 Maximize Functional Independence
 Optimize Psychosocial Adaptation of
Patients and Families
 Facilitate Resumption of Prior Life Roles
and Community Reintegration
 Enhance Quality of Life

10. Stroke Rehab Principles
 Identify impairments
 Careful attention to comorbidities and
complications
 Early goal directed treatment
 Systematic assessment of progress
 Experienced interdisciplinary team
 Education
 Comprehensive discharge planning

11. Criteria for Admission to Rehab
Programme
*Stable neurological status
*Significant persisting neurologic deficit
*Identified disability affecting at least 2 of the following:
Mobility
Self- care
Communication
Bowel/bladder control
Swallowing
*Sufficient cognition to learn
*Sufficient communicative ability to engage with therapists
*Physical ability to tolerate the active program
*Achievable therapeutic goals

12. Stroke rehab: Where?
• Inpatient
• Community Hospital
• Nursing Home
• Day Rehabilitation Centres
• Home based therapy (eg.
Community rehab
programme)

13. Rehabilitation during
the Acute Phase
GOALS:
Prevention of Medical
Complications
Prevention of Deconditioning
and Contractures
Training of New Skills

14. Rehabilitation during
the Acute Phase
TASKS:
 Range of Motion Stretching Exercises
 Frequent Position Changes
 Sitting in Upright Position to Improve
Orthostatic Tolerance
 Psychological Counseling
 Patient and Family Education

15. Rehabilitation during
the Acute Phase
TASKS:
 Training Personal Care Skills, Mobility,
and Ambulation Training
 Bladder and Bowel Management
 Evaluation of Swallowing Function
 Initiate Nutrition and Hydration
 Identification and Treatment of
Depression

16. Stroke Rehabilitation Interventions
 Functional Skills Training
– Personal Care Skills
– Mobility Activities
– Instrumental Activities of Daily Living

17. Stroke Rehabilitation Interventions
 Therapeutic Exercises
– Flexibility
– Strength
– Coordination
– Fitness

18. Stroke Rehabilitation Interventions
 Spasticity Management:
– Positioning and Orthotics
– Stretching and Other Exercises
– Medications
– Injections

19. Stroke Rehabilitation Interventions
 Aphasia Treatment:
– Individual Supervised Practice and Training
– Group Speech Therapy
– Encourage Verbalizations
– Conversational Coaching
– Melodic Intonation Therapy
– Oral Reading
– Computerized Training
– Medications

20. Stroke Rehabilitation Interventions
Treatment of Depression:
 Endogenous vs. Reactive
 Natural Recovery
 Interventions:
– Professional Counseling and Psychotherapy
– Peer Relationships and Family Involvement
– Medications

21. New Rehabilitation Interventions
 Partial Body Weight-Supported Treadmill
Training
 Pedaling
 Biofeedback
 Electrical Stimulation
 Constraint-Induced Muscle Training
 Robotic-Assisted Therapeutic Exercise

22. Functional Electrical
Stimulation

23. Constraint Induced Movement Therapy (CIMT )
 Evidence for arm
improvement ( EXCITE
trial )
 Good upper limb is
constrained ( 90% of
patient’s waking time )
 Affected upper limb trained
in functional tasks
 Must have some wrist and
finger function before
starting

26. Virtual Rehab
 Shown to have
improvement in
balance and gait
 Immersive vs. non
immersive
 Wii games

27. Robotic Technology
 New class of clinical
tools
 Highly reproducible
motor learning
experience
 Relieves strenous
repetitive effort of
therapists

28. Stroke Rehabilitation Outcomes
 80% Independent Mobility
 70% Independent Personal Care
 40% Outside Home
 30% Work

29. Factors Affecting Outcomes
 Neurological Deficits
 Motivation Level
 Learning Ability
 Level of Emotional and Social Support
 Coping and Adaptability
 Medical Comorbidities
 Rehabilitation and Training