How Important is Physiotherapy for Stroke Recovery?

Strokes are the leading cause of severe long-term disability in the Western World. A stroke is a debilitating condition that occurs when there is a lack of blood supply to the brain. They occur most in those aged over 55, those who have high blood pressure, and those who were recently in car accidents. If not caught and treated early, strokes can cause long-term memory loss, muscle weakness, and speech problems.

Physical therapy has always played a vital role in stroke rehabilitation. Therapy aims to address some of the issues faced by stroke patients, including regaining motor skills, coordination, balance, and strength. Here, we are going to take an in-depth look at the importance of Physical therapy after Stroke and some of the different approaches that can be taken.

Understanding Strokes

Strokes are common in individuals with high blood pressure or those who have been involved in car accidents. Recognizing the signs and symptoms of a stroke early can be crucial for effective treatment and recovery. Here are the most common symptoms to watch for:

• Face drooping: One side of the face may droop or become numb. When the person smiles, it may appear uneven.
• Arm weakness: One arm may feel weak or numb. When the person raises both arms, one arm may drift downward.
• Speech difficulties: Speech may be slurred, or the person may have trouble speaking or understanding speech.
• Sudden numbness or weakness in the legs, arms, or face: This often occurs on one side of the body.
• Severe headaches: A sudden, severe headache with no known cause can be a sign of a stroke.
• Nausea or dizziness: These symptoms can appear suddenly and may be accompanied by other stroke symptoms.
• Loss of balance or coordination: The person may experience trouble walking, dizziness, or a lack of coordination.

Importance of Stroke Rehabilitation

After suffering a stroke, the patient will often suffer a loss of balance, coordination, and cognitive skills. It’s important to start retraining these skills as soon as possible to try to get back as much as possible of what was lost.

Usually after a stroke, strength is lost in one side of the body. Much of this loss of strength can often be regained if therapy is started early. It’s important to rebalance the body, if the body is not equal this can often cause things like SIJ pain around the pelvis which will then translate to pain in the upper back and neck alongside obviously, the loss of function in one side of the body.

Role of Physical Therapists:

Physical therapy was first introduced to stroke recovery in the early 20th century during WW1. Stroke was a common occurrence in soldiers. It’s used widely throughout the world and it’s usually believed that earlier intervention is superior. Some of the most common treatments involved in traditional therapy include training and balance exercises, strength training, functional exercises, and fine motor skill development.

Physical therapy has been shown to improve stroke patients’ recovery significantly. In the upper limbs, traditional therapy alone has been shown to improve proprioception and coordination by around 15 %. Lower limb recovery studies often range from around 15-50 percent better outcomes than those without physiotherapy,

Techniques in Physical Therapy

Many techniques can be used to rehabilitate stroke patients:

• General strength, Balance, and coordination training: Because a stroke is caused by a temporary lack of blood to the brain, some of what was lost can often be regained with traditional exercises. This includes balancing strength on each side of the body, proprioception training, and weight-shifting exercises.
• Gait training and Mobility work: One of the key aspects of rehabilitation is helping to restore walking ability. This is often done with assisted devices such as a Swiss ball, Walkers, and parallel bars or this can be done in the swimming pool.
• Constraint-Induced Movement Therapy (CIMT): This involves restraining the unaffected limb to intensively train the unaffected limb, which then restores balance in the body.
• Mirror therapy: This therapy involves using mirrors to create the illusion of movement in the affected limb, stimulating the brain.
• BOBATH Concept: The therapist uses their hands to guide movement and retrain sensory input.
• Hydrotherapy: Hydrotherapy seems to be very effective at improving stroke outcomes with average increases in function around 30-50 percent compared to no treatment
• Functional electrical stimulation: This involves the application of low-level electrical current to stimulate the nerves that control specific muscles causing them to contract. This helps to restore movement in patients who may be weak or paralyzed after a stroke.
• Primitive reflex integration therapy: Primitive reflexes are our infant reflexes such as our Tonic Labyrinth Reflex or grasping reflex. These are present in babies and usually integrate as we grow. These reflexes can often resurface in stroke patients. Unintegrated reflexes are linked to neuro divergence and If not re-integrated these could affect coordination and emotional regulation.
• Exoskeleton therapy: This is a new therapy that involves training the body using assisted limbs. Research has shown that it is very effective in treating the upper limb, particularly after stroke. A recent randomized control trial showed that exoskeleton therapy improved outcomes in stroke therapy in the upper limb by around 30 – 130 percent. Compared to traditional physical therapy, this is a huge improvement.

Other Emerging therapies for stroke patients:

• Virtual Reality: recently, we’ve started to see the introduction of virtual reality in Stroke recovery. During these sessions, the patient is placed in an immersive environment where they can practice movements and tasks in a controlled setting.
• Biofeedback: these provide real-time information about physiological functions enabling patients to gain more control over their body movements these help quantify improvements to motivate the client and show imbalances allowing patients to adjust their efforts for optimal performance during physiotherapy sessions.

Conclusion

Physical therapy has always been part of stroke rehabilitation. However, previous studies have only shown that physiotherapy only improves patient outcomes by 15 percent. A 15 percent increase in mobility and proprioception of the affected limb is still a great improvement considering the further implications of asymmetry of the body further down the line.

These results also don’t take into account more progressive rehabilitation methods such as using the swimming pool, FES, CIMT, primitive reflex integration, and Exoskeleton therapy which appear to significantly increase patient outcomes. With the addition of these new techniques, we believe physical therapy is even more beneficial than traditionally believed.