STROKE DEFINITION Stroke is defined as “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin”

CLASSIFICATION STROKE ISCHEMIC HAEMORRHAGIC THROMBOTIC EMBOLIC SUB ARACHNOID INTRA CEREBRAL

TIA (Transient Ischemic Attack) ISCHEMIC STROKE Ischemic stroke accounts for about 87 percent of all cases. Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain HEMORRHAGIC STROKE Hemorrhagic stroke accounts for about 13 percent of stroke cases.  It results from a weakened vessel that ruptures and bleeds into the surrounding brain. TIA (Transient Ischemic Attack)  Transient ischemic attack (TIA) is often labeled “Mini-stroke or Warning stroke”. Most TIAs last less than five minutes; the average is about a minute. When a TIA is over, it usually causes no permanent injury to the brain.

CLASSIFICATION STROKE (BASED ON BLOOD SUPPLY) ANTERIOR CEREBRAL ARTERY (ACA) STROKE MIDDLE CEREBRAL ARTERY (MCA) STROKE STROKE INTERNAL CAROTID ARTERY (ICA) STROKE POSTERIOR CEREBRAL ARTERY (PCA) STROKE BASILAR ARTERY STROKE

RISK FACTORS Age Hypertension Diabetes Cardiac disorders Cigarette smoking Previous episode of TIA Elevated Blood cholestrol Physical inactivity Obesity Excessive alcohol consumption

CLINICAL FEATURES

Clinical Features Motor deficits – Usually one side of the body is paralysed (Hemiplegia) Speech disturbances – Broca’s aphasia (Nonfluent) and Wernike’s Aphasia (Fluent) Cognitive dysfunctions Bladder and bowel involvement Seizures

KEY POINTS HISTORY Hemorrhagic Stroke Onset – Sudden onset of severe head ache followed by loss of consciousness (Rapid Coma) 2) Embolic Stroke Onset – Sudden, Frequently associated with Cardiac diseases 3) Thrombotic Stroke Onset – Variable or uneven onset

NEUROLOGICAL IMAGING CT Scan & MRI It is used to rule out the brain lesions such as tumors or abscess and to identify hemorrhagic stroke Greater resolution of brain and its structural details is obtained in MRI than with a CT scan

PHYSIOTHERAPY MANAGEMENT

Physical therapy - Acute Stage Positioning – Supine, sidelying, sitting Prevention of Pressure sores – Skin inspection on bony prominences, Frequent change in positioning (Once in 2 hours) & use of pressure relieving devices (Eg- Water bed) Maintainence of Range of motion – ROM exercises Training functional activities -like rolling, bridging (Useful for bed pan) Respiratory management – Breathing exercises Facial exercises Bridging

POST ACUTE REHABILITATION

MANAGEMENT OF SPASTICITY Slow icing Slow icing – Origin to Insertion 2) Stretching Slow sustained stretching Maintained for 30 sec 3) Slow stroking Alternative strokes with flat hands in the paraspinal areas at 3 – 5 times per minute 4) Weight bearing Promotes stabilization and reduction in Spasticity

MAT EXERCISES Rolling to Prone Prone on Elbows Quadrupod Kneel sitting Kneel standing Half Kneeling Standing Prone on Elbows Quadrupod

BALANCE TRAINING GAIT REHABILITATION Sitting balance Sit to Stand transition In case of postural hypotension – Tilt table should be used for vertical progression Standing balance GAIT REHABILITATION Emphasize on Knee flexion and heel Strike Discourage Circumduction gait (Seen in Stroke patients) Provide foot marks – Visual cues ASSISTANCE Ankle Foot Orthosis (AFO) Quadrupod in the normal side FUNCTIONAL ELECTRICAL STIMULATION Electrical stimulation for performing a functional activity In case of foot drop – prevents foot dragging in swing phase