Treatment of Stroke

A sudden blockage or bleeding of one of the vessels supplying the brain, and the series of neurological events that develop as a result of this, is called a stroke. We often encounter it as a sudden loss of strength in one-half of the body. It is also popularly known as “paralysis decor” cerebral palsy. ” In fact, a stroke is a general condition, and a stroke is the result of a stroke. Therefore, it is not a case that all patients who have had a stroke will be paralyzed.

Clinical Treatment of Stroke

Signs and symptoms of stroke usually begin suddenly. It is manifested by sudden double vision and speech impairment, confusion, difficulty understanding, inability to find a place, sudden weakness, and loss of balance on one side of the body, headache, and gushing vomiting. Hemiplegia (unilateral paralysis) develops in the vast majority of stroke survivors, and upper extremity (arm) function limitation develops in more than half of them. It is not a disease of the elderly. It can occur at any age. In recent years, there has been an increase in the number of cases in young people due to sedentary life, malnutrition, and stress. It ranks dec among the most common causes of death in the world. It basically consists of two ways:

Ischemic stroke: Occurs when clot fragments from the heart or carotid (carotid vein) break off and block any vessel that supplies the brain. In fact, cerebral ischemia means that the brain is deprived of oxygen due to the lack of blood flow. Due to atherosclerosis it can also develop due to the vessel itself. One of the main causes of ischemia in young people is atrial fibrillation (a rhythm disturbance in the heart). In addition, myocardial infarction (heart attack), blood clotting problems, high blood pressure, uncontrolled diabetes, smoking, and alcohol use, obesity,, and a sedentary lifestyle are important factors that play a role in stroke etiology.

Hemorrhagic stroke: It usually occurs as a result of bleeding in the brain caused by hypertension.

Treatment

As soon as the patient realizes that he has had a stroke, he should call 112 in no time and reach a stroke center. The arriving medical team will immediately take you to the nearest stroke center. Otherwise, the probability of permanent damage due to late diagnosis and intervention will increase. In the first 4-6 hours, the blocked area can be opened with special clot-dissolving drugs administered through the vein, mechanical methods (thrombectomy), clot-decompiler attempts can be performed with a special catheter for up to 8 hours. For cerebral hemorrhages, surgery may be required to reduce intracranial pressure.

Factors affecting recovery in stroke

It is very important in which area the ischemia or hemorrhage is located. Ischemia or bleeding in the movement areas of the brain called the motor cortex usually results in severe strokes. Early intervention in stroke is important in reducing neurological damage and prolonging life expectancy. The sooner the intervention is performed, the greater the chance of recovery. Other concomitant neurological diseases (epilepsy, Parkinson’s, dementia, etc.) presence may adversely affect the result. Patients who stay in intensive care for a long time recover later and are more difficult. It is easier for patients who have started rehabilitation early and correctly to recover. The patient’s desire and participation in the treatment is also one of the factors affecting the treatment. Age, gender, obesity, diabetes, and hypertension are also among the factors affecting the outcome.

Stroke rehabilitation

Rehabilitation in the treatment of stroke involves the most exhausting and longest part of the treatment. Treatment can take months, depending on the condition of the effect. Sometimes it can take years. In order for the treatment to be successful, the patient, the patient’s relative, the physical therapist, and the physiotherapist must be in cooperation and work in harmony with each other. In addition, a neurosurgeon, neurologist, psychologist, dietitian, and therapists are also part of the rehabilitation team. At the end of rehabilitation, most patients regain their former independent lives, while some may have many disability conditions. It should be remembered that patients who have had a stroke can walk, talk, or even do their daily life activities independently with a good rehabilitation team.

Many techniques are used in stroke rehabilitation. In general, the Bobath, Brunstrom, Johnstrom, and Todd-Davies methods are used. The brain has the ability to teach the function of damaged tissue to neighbor intact tissues. The main goal in stroke rehabilitation is the recovery of lost abilities (neuroplasticity).

Rehabilitation should begin when the patient is in more intensive care. Passive joint movements can prevent the development of contractures and spasticity (involuntary November contraction). Positioning is performed every two hours to prevent pressure sores. In order to prevent spasticity and contracture, hand splinting and AFO application can be performed. Head control, sitting balance, and in-bed rotation studies are performed on the patient at an early stage. Mobilizations are necessary to prevent adhesions and pain in the scapula. The shoulders, arms, hands, and legs are operated on individually with the patient’s active participation. In addition, respiratory rehabilitation can also be performed if necessary, as there may be a decrease in lung capacity due to immobilization during this period.

Particular attention should be paid to shoulder dislocation (subluxation) at an early stage. During this period, the paralyzed arm is lower and looser than the November side because the muscles holding the shoulder are not working hard enough. Due to incorrect positioning and unconscious pulling of the shoulder, the shoulder may be dislocated. Accordingly, a painful shoulder condition may develop. A special Kinesio-tape (taping technique) commonly used to prevent shoulder dislocation.

Again, family information should be provided at an early stage, movements that will increase pathological reflexes should be avoided, arm and leg positions should be taught in bed. The exercises performed must necessarily be commanded, and the patient’s active participation in the treatment should be ensured. After the patient has achieved sitting and head control, they now move on to more advanced exercises.

Exercises advanced stage: during this period, from simple to complex, respectively, sitting upright unassisted, shoulder-arm-training and weight transfer, knee exercises, exercises to strengthen back muscles bridge down in supine position, lifting one leg in the bridge position (for the purposes of weight transfer), sitting hip and knee movements, ankle pull yourself backed up a posterior shell (knee support) stand upright standing with isolated knee movements, parallel studies assisted at the bar, straight leg raises lying on his back, from the down position to the movement in its infancy, the weight transfer to the arms and legs in position on the floor crawling, crawling in the position of the right arm and left leg balance, coordination work, balance work on the floor of the laptop, the laptop stand about a foot from the position of getting up in front and exercises, standing balance – coordination exercises, exercises that don’t load on the hemiplegic side, go down the stairs,-work out, working isolated ankle in all directions, unassisted since forward-backward-walking, balance board balance- coordination, tandem walking on a straight line, shoulder-arm-hand isolated studies and fine motor activity exercises for the hand are performed.

Mirror therapy

In recent years, different new methods have been applied besides the classical rehabilitation practices. In mirror therapy, a person watches his image in the mirror while moving the unaffected limb. Thus, visual feedback on the movement of the affected side is provided to the brain. In a way, the brain is tricked by visually making the paralyzed hand feel like it is moving. With this method, the brain regions responsible for the movement of the paralyzed side are stimulated.

Compulsory use treatment: It is a treatment method in which the movements of the strong side are blocked, and the use of the weak side is encouraged. It has been shown that this technique is highly effective in developing affected arm-hand functions of patients after a stroke.

Hydrotherapy: Hydrotherapy (pool therapy) treats diseases and functional losses by using the lifting force of water. With this method, the load carried by the body is reduced, it is possible to make movements that cannot be done normally.

Lokomat is a robotic walking rehabilitation system used to restore and improve walking ability in cases of loss of walking ability caused by head injuries and spinal cord injuries, neurological or orthopedic causes.

Other treatments:

• TENS, ultrasound, hot-cold applications, and sensory training for pain
• Speech therapy
• Electrotherapy applications to prevent November atrophy
• Hand splint, posterior shell, passive rest splint orthoses to prevent spasticity
• Botox applications for spasticity if necessary.
• Kinesio-tape tape applications for low shoulder, pain treatment, preventing spasticity in the ankle and wrist
• Johnstone splint applications