A stroke causes havoc on the life of every sick person. Physiotherapy is the main treatment option for post-acute stroke patients. Physiotherapy is a very diverse therapeutic agent that is used in stroke patients in three main forms: kinesiotherapy (treatment with movement), physical therapy (treatment with physical stimuli) and massage.
Physiotherapy for post-stroke patientsshould be started as early as possible and include all patients. The most common and obvious method of treatment after a stroke is kinesiotherapy, which is a natural reaction to the consequences of a disease that causes partial or complete abolition of movement. Physiotherapy (light therapy, electric therapy, ultrasound, low and high frequency magnetic fields, aquatic environment, thermotherapy, etc.) and massage are not treated as independent methods of treating the main consequences of a stroke, but as an effect supporting kinesiotherapy or alleviating some secondary consequences of the disease, e.g. . pain, bedsores, swelling, etc. The use of physiotherapy is always justified in those cases when any automatic or reflex control of movement after a stroke is disturbed, i.e. almost always.
Physiotherapy after stroke: work of a team of specialists
The process of physiotherapy after a stroke is managed by a physiotherapist and this mainly concerns the basic elements of the therapy, i.e. the strategies used at a given stage, the level of intensity of the procedure, taking the most favorable forms of influencing the patient and determining the proportions in which other people should be involved into physiotherapy.
The physiotherapist directs the physiotherapy process after stroke.
Movement exercises and occupational therapy are carried out by specialists in these fields, but the absolute condition for effectiveness in this area is the active participation of other members of the rehabilitation team as well as caregivers and the patient's family. A patient after a stroke should be (preferably continuously) subjected to motor stimulation during all manifestations of daily activity, and the condition for this is the appropriate knowledge of all people who come into contact with him at that time. The above group way of dealing with the sick is part of the philosophystroke units and underlies their greater effectiveness in treating stroke.
Aims of post-stroke physiotherapy
Moving a stroke patient has different goals, depending on the degree and type of the motor disorder and the stage of recovery. The basic goals of physiotherapy are the same as the main goals of treatment, which are: to restore the patient to the fullest possible social role and restore the quality of life desired by the patient. The influence of the physiotherapist in the early period of the disease is focused on:
- ensuring constant airway patency and preventing pneumonia and pulmonary embolism
- restoring the patient's safe swallowing function (preventing aspiration pneumonia) in which the physiotherapist works closely with the neurologist, nurse and caregivers of the patient
- prevent deep vein inflammation (risk of pulmonary embolism) by ensuring smooth blood flow in the venous system (risk of clot formation) to the venous vessels, not the deep ones.
Since the recovery of motor functions can be achieved even many years after the stroke, and the patient's stay in the hospital is very short and usually does not extend beyond the first few months after the incident, physiotherapeutic treatment is initially focused on the recovery of basic motor skills which include:
- independence of changes in lying position
- independent sitting down and controlled return movement
- maintaining the position of the independent sitting down without holding and support and movements in this position
- transfer from bed to wheelchair on your own
- stand up independently and controlled reverse motion
- stand alone and move in this position
- independent, functional gait.
Parallel to the above activities, the patient should practice basic daily activities from the first days after the stroke, especially dressing, personal toilet, and preparing and eating meals. This procedure is deeply justified by the fact that the degree of disturbance of the above functions largely determines the degree of the patient's independence and is the foundation for shaping more complex motor skills - those that determine his return to work or other forms of self-fulfillment (e.g. manipulative).
Post-stroke physiotherapy: neuro-facilitation
The strategy of recreating motor functions in a premorbid form is the most obvious todaycourse of action with post-stroke patients. This direction was called "neuro-facilitation" and was most fully developed mainly by two physiotherapeutic concepts: Proprioceptive Neuromuscular Facilitation and the Bobath Concept. The approach of therapists using PNF and NDT-Bobath from the mid-twentieth century was a breakthrough in the treatment of movement of patients after stroke, because physiotherapy began to focus on the affected half of the body with faith, now supported by numerous scientific evidence that stimulation can reduce the degree of paresis. The precursors of modern physiotherapy believed, inter alia, that the patterns of pathological muscle tension are subject to modification in response to the use of appropriate exercises that contribute to the formation of more correct patterns of movement. It was believed that movement could be regained through the use of many facilitation and stimulation techniques in therapy, for which the therapist usually uses his body and everyday objects, and less frequently orthopedic aids.
The modern approach of both of the above concepts to the kinesiotherapy of patients after stroke is the result of the evolution of views of many specialists related to the subject over the years and is a practical reflection of the latest research results in the field of neurophysiology and adopts other concepts of improvement, such as the Movement Restoration Program, Necessary exercise therapy and others.
During the early inpatient physiotherapy period after a stroke, patients attempt to move their limp limbs unsuccessfully, and improperly conducted treatment with movement (e.g. too difficult exercise) exacerbates the condition in which patients stop using the affected body parts. Such a situation results from the patient's specific behavior consisting in experiencing failures. The patient, seeing the lack of exercise effects, subconsciously gradually resigns from using the diseased half of the body despite the existing motor potential, which has been defined as "learned disuse syndrome". In light of recent scientific evidence, the patient must be informed that rapid spontaneous function recovery may be limited by a certain time frame, but must also know that concrete improvement can be achieved for the rest of his life through intensive training and repetition of function.
Effectiveness of physiotherapy after stroke
There is ample scientific evidence that physiotherapy is effective after stroke. Muscle strength resistance training in the legs and arms can improve strength even many years after a stroke. Endurance training increases functional efficiency and significantly improves parameterscardiovascular disease many months after the stroke. From the first days after a stroke, it is very important to maintain the correct ranges of motion and prevent pathological muscle tension, which can be achieved by stretching techniques, joint and muscle mobilization, serial plastering of the limbs, taping (taping with an elastic band), using orthoses, working on the correct posture body.
Necessity Motor Extortion Therapy (abbreviation CIMT), or "a family of therapeutic interactions aimed at provoking in a person after a stroke a more intensive use of the weaker upper limb for many hours a day by limiting the movement of the he althy half of the body", it is effective even many years after a stroke. Walking training on a walking treadmill has been recognized as an example of an effective therapy focused on a specific task. Several scientific studies have shown a significant stimulation of the motor cortex during motor imagery.
Worth knowingNew technologies in kinesiotherapy after stroke are expected as "know-how" improving the effectiveness of treatment, mainly a greater reduction of motor deficits, and as subtle, sensitive and objective tools to verify the results of rehabilitation. In the field of movement therapy, the results of research on virtual reality, robotics and interactive feedback programs are very encouraging.
Polish Physiotherapy Association