Rehabilitation
After the acute treatment (=phase A) it is important that rehabilitation is started as soon as possible, ideally 24 hours after stroke but only if the patient is stabilized. Stroke units, neurological departments and acute treatment centres normally offer early rehabilitation (=phase B).
Ideally patients can transfer directly from the hospital into a specific rehabilitation institution (=phase C) where one treatment course will usually take about 4 weeks. If therapeutically necessary this rehabilitation period can be extended with an appliation.
Rehabilitation can also be carried out in day clinics (= phase D) and can be regarded as an effective alternative to an inpatient stay or as a continuing stabilisation of the achieved rehabilitation success.
The goal of rehabilitation programs is to provide patients with a largely unimpaired and independent life after stroke.
Information about rehabilitation
The consequences of a stroke depend on the brain region which was affected. Depending on the location and size of the brain damage different physical, cognitive and psychiatric impairments may happen. Dead brain cells cannot be replaced but it is possible that neighboring brain regions can compensate or take over lost functions. This ability for regeneration is called “plasticity of the nervous system” or neuroplasticity. In order to utilize this capacity the brain needs stimulation – as early as possible.
During the rehabilitation period the treatments are individually matched to the needs and condition of the patient.
The plan for successful rehabilitation is always drawn up as a team. In this team, physicians, nurses and specialists from the fields of physiotherapy, occupational therapy, speech therapy and psychology work closely together with the patients and their relatives.
From larger studies it can be deduced that the largest possible improvement, especially for motor recovery, can be achieved within 3-6 months after stroke. The earlier the rehabilitation process begins the better the outcome (results). TIME IS BRAIN is also important in stroke rehabilitation.
Potential Consequences of a stroke
Impairment
Motor Impairment & Hemiparesis
EXPLANATION
Motor impairments are the most frequent consequence after stroke as 80% of all patients suffer from paralysed or not fully functional arms and/or legs. Especially the impairment of arms (upper extremities) represents a large problem in everyday life. Getting dressed or eating independently can become real challenges and the overall quality of life decreases.
Support
Physiotherapists help patients to overcome motor impairments of arms and legs as well as with balance disorders. They will propose exercises for muscle strengthening to enable specific activities again.
Find helpful exercises for home-based rehabilitation here.
Occupational therapists can help to develop strategies how to regain activities of daily living like eating, bathing, getting dressed, writing and cooking.
It is recommended to combine physio- and occupational therapy in combination with Cerebrolysin® if motor impairments of the upper extremities or hemiparesis affect the patient. Clinical studies have shown that this combination therapy improves the quality of life of patients by improving motor recovery and activities of daily living!
IMPAIRMENT
Swallowing Disorders
EXPLANATION
In the acute phase after stroke about 50% of all patients are affected by a swallowing disorder; for about 25% these disturbances last longer.
SUPPORT
Speech therapists and dietologists can support the affected person exercising chewing and swallowing.
If necessary, dietologists can develop an individual meal plan which can e.g. recommend liquid or semi-solid food in case the swallowing disorder is more severe.
IMPAIRMENT
Speech- and comprehension disorders = Aphasia
EXPLANATION
Aphasia happens when the brainhemisphere where the language centre is located is damaged (in most persons this is the left side). It takes a lot of patience for caregivers and affected persons to deal with these limited communication possibilities.
SUPPORT
Speech therapists treat these disorders. They support the affected persons to relearn how to speak, read and write and give individual advice how to deal with this limitation.
IMPAIRMENT
Visual disturbances
EXPLANATION
About 20-40% of all patients suffer from some form of visual disturbances after a stroke. Among the most common visual disturbances belong double vision (diplopia), visual field losses which limit patients to recognize their environment only partially (hemi-anopsia, quadrand-anopsia) and a visual perception disorder (visual neglect) in which the affected person’s opposite side of the brain lesion disregards or perceives his environment only partially or not at all. This can cause great dangers e.g. in traffic for himself and other.
SUPPORT
Orthoptists are experts in the field of detection and treatment of functional diseases of the eyes, eye movements or vision. In the case of visual field defects, orthoptists offer appropriate therapies that lead to an increase in visual search performance in the affected half of the room and to an improvement in reading performance.
IMPAIRMENT
Neuropsychological Disorders
EXPLANATION
Neuropsychological Disorders can cause attention deficits or reduced cognitive functions. Attention is important in all-day- and professional activities. Attention gives human beings the ability to process the multitude sensory impressions, to filter them and to deduct specific activity plans. In many stroke patients this ability is impaired and leads to limitations handling daily activities.
SUPPORT
Neuropsychologists can support stroke patients who are exposed to changes in cognition, memory and behaviour.
Cooperating with neuropsychologists can minimize cognitive deficits as memory-, concentration- and communication disorders.
IMPAIRMENT
Depression and other psychological consequences
EXPLANATION
Stroke is an injury to the brain that can have a direct impact on the patient’s emotional state. In addition, depression may develop in response to the dramatic life disruption. Other personality and behavioral changes after a stroke may include mood swings or decreased resilience. Agitation, impulsivity, and aggressiveness also occur in some cases.
SUPPORT
Depression is often treated with medication (antidepressants) and/or psychological interventions – such as psychological counseling or psychotherapeutic therapies.
IMPAIRMENT
Spasticity
EXPLANATION
After a stroke, mild to severe muscle tension and stiffness (spasticity) may occur.
SUPPORT
Oral medications, physical or occupational therapy, and injections (Botox treatment) can help with spasticity.
Personal stories
Experience reports from therapists in rehabilitation
