Stroke is a vascular problem that has many long-lasting physical side effects. Neurological physiotherapists help patients with stroke get back to living the life they want.
Although many patients who suffer from a stroke have similar symptoms, each one has different goals, living environments and levels of disability. Hence physical therapists design customised programs for each patient and include specific rehab techniques in each.
In this article, we’ll go over the eight most common ways that physiotherapy helps stroke patients. We’ll explain how each technique works and why it’s used in post-stroke rehab.
What Is a Stroke?
The medical term for stroke is Cerebrovascular accident (CVA). It’s a condition where there’s an interruption in the blood supply to a part of the brain.
It happens due to a problem with the blood artery. This problem could be a blood clot that stops the blood from flowing forward or a rupture of the artery.
Stroke is a medical emergency and it’s the second leading cause of disability and death globally.
The most common symptoms and side effects of stroke include:
- Paralysis
- Increased or decreased muscle tone
- Imbalance in muscle strength on both sides of the body
- Loss of facial muscles mobility
- Partial vision loss
- Loss of speech
- Seizures
- Problems with balance and walking
The treatment of stroke patients requires a multidisciplinary team. It includes neurosurgeons, neurologists, physical therapists, occupational therapists, nurses, and home aids.
8 Ways Physiotherapy Helps Stroke Patients
Stroke physiotherapy is a domain of neuro physiotherapy where we help you recover from the aftermath of a stroke.
It includes improving muscle strength, regaining motor control, and relearning to walk and do activities of daily living.
Here are the different techniques that physical therapists use for post-stroke recovery:
1. Mirror Therapy
Mirror therapy involves placing the healthy hand or foot in front of a mirror and hiding the affected limb behind the mirror.
By moving the healthy limb and seeing its reflection, you can trick your brain into thinking that the affected limb is moving as well. That activates the nerves in the affected limb and helps you relearn movement patterns.
Generally, mirror therapy sessions last for 15-60 minutes and you can do it 5-7 times a week. The best part of this technique is that patients with stroke can easily do this at home.
So far, medical studies haven’t reported any adverse effects of mirror therapy.
Research has proven that it improves motor function by activating the nerves and helps the patient perform activities of daily living. (Reference)
2. Developing Movement Mind Maps
Physical therapists use this technique to help stroke patients who can’t move their affected limb or have incredible difficulty doing so.
It helps the brain rewire itself in preparation for actual movement. It includes closing your eyes and visualising your hand or your leg moving. You can imagine that you’re walking, holding a glass of water, or bending your knee.
Mental practice is usually combined with other post-stroke rehab techniques such as mirror therapy and CIMT.
Multiple studies have shown that mental practice is effective in helping patients recover quicker. But you need to do it under the supervision of trained physiotherapists. (Reference)
3. Constraint-Induced Movement Therapy (CIMT)
Stroke often affects one side of the brain and its symptoms: muscle weakness, paralysis and such, appear on the opposite side of the body.
After a stroke, patients tend to ignore the affected limb and decrease its use in daily activities. That leads to a phenomenon called learned non-use which causes even more weakness in the affected limb.
To combat that, physical therapists restrict the healthy limb to forcefully encourage you to use the affected side. That could mean putting on a glove or oven mitts on your healthy arm for a few hours of the day so you use the affected hand for activities.
Once that’s done, you have to repetitively perform activities with the affected side to retrain the muscles and nerves for those activities.
CIMT isn’t for all stroke patients. You qualify for it if you have some motor activity in your affected limb and can perform movements on command.
Current research shows that CIMT is great for regaining balance. But for improving functional mobility, it’s equally effective as some other post-stroke rehab techniques. (Reference)
4. Task-Oriented Functional Training
Task-oriented training includes repetitively performing activities that you would usually do in a day. This includes walking, eating, picking up a glass of water, using your phone, opening a door, and so on.
You practice these functional movements over and over again to retrain your brain to learn these activities and make them a part of your muscle memory.
The best thing about task-oriented training is that you can see the results quickly. The requirement, however, is that you have to put in the time and repetitively do those activities in the same pattern.
Research tells us that task-oriented functional training is quite beneficial for upper limb mobility. You could start seeing results after just 10 hours of practice.
5. Stroke Rehabilitation and Strengthening Exercises
As we’ve said above, patients with stroke tend to neglect their affected limb and use the healthy limb for most of their activities. That can lead to atrophy of the affected side. Hence strengthening exercises became a necessity for post-stroke rehabilitation.
Repetitive movements such as those which you do while performing strengthening exercises rewire the brain and signal the muscles to relearn their previous activity patterns. (This phenomenon is called neuroplasticity).
Physical therapy exercises help stroke patients improve muscle strength, relearn movement patterns and gain independence after stroke.
These exercises include:
- Doing ankle circles
- Knee flexion and extension (bend and open)
- Hip mobility exercises
- Forward bending of the trunk in sitting then in standing
- Hand and arm stretches
- Shoulder and chest stretches
- Wrist flexion and extension with a small weight in your hand
- Finger flexion and extension exercises
You need to make your affected hand your focus during strengthening exercises.
In most post-stroke rehab cases, the hand takes the longest to recover. So you should perform task-oriented activities and strengthening exercises on your hand even after your rehab for the rest of the body is complete.
6. Electric Stimulation of Nerves and Muscles
Electric stimulation for post-stroke rehab includes transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES).
It prevents atrophy, moves paralysed muscles, reduces spasticity (abnormal stiffness), activates nerves and trains healthy parts of the brain to take over the functions of the damaged part.
A physiotherapist will place electrodes on your skin and turn the device on. It’s usually painless for stroke patients but you might feel tingling while the current is passing through the electrodes to your skin.
Electric stimulation is rarely used alone. It’s usually applied with post-stroke rehabilitation exercises and other techniques for recovery of motor function.
Medical studies show short and long-term positive effects of electrical stimulation on the human nervous system.
7. Virtual Reality
Virtual reality (VR) is a computer-generated 360o environment in which you can move around and touch objects. You experience it by putting on a headset and connecting it to a device.
VR is another form of mental practice and imagery. Research has found that using VR along with the conventional treatments that physical therapists use to help stroke patients is far better than using VR alone, or conventional therapies alone.
VR mostly improves the rehab outcome for activities of daily living that involve the hands and the upper extremity.
It involves placing a headset on the patients’ eyes and giving the controllers in their hands.
It’s best to use an environment that the patient is familiar with so you could set the images of a park or a kitchen in the headset. And the patient will move things around in the virtual environment by moving their hands and fingers in the real world.
Similarly, you could have the person ride a bicycle in VR and have electrodes connected to the legs and thighs to give the patient the feeling of riding a bicycle.
8. Home Aid Recommendations
Physical therapists help stroke patients be independent at home by prescribing necessary assistive devices. This includes walkers, a cane, a wheelchair, orthosis for the hand or the foot, and a brace for the back.
Your physio will teach you the proper positioning that you should maintain at home and transfer techniques for moving from bed to wheelchair.
Some physiotherapists also guide caregivers in how they can help the patient at home.
In 2020, 1 in 6 cardiovascular disease-related deaths were because of a stroke. 1 in 4 people has a second stroke sometime in their lives.
Although a few risk factors for stroke are non-modifiable, there’s still a lot you can do to decrease the chances of suffering from a stroke. Read this post to learn about how cardiovascular physiotherapy can help you lead a healthier life and reduce the risk of stroke and heart problems.
What Are the Physical Therapy Rehab Goals for Stroke Patients?
Patients with stroke begin to recover naturally after a stroke. But joining a structured physical therapy program ensures faster recovery with better results.
Otherwise, you could adapt compensatory movement patterns and live with those for the rest of your life.
Here are the goals that physical therapists try to achieve through post-stroke PT:
- Retrain nerves and rewire the nervous system
- Restore function & decrease disability in walking and activities of daily living
- Reduce spasticity and normalise muscle tone
- Improve standing balance and independent walking
- Balance muscle power on both sides of the body by strengthening the weak muscles
How Soon After a Stroke Can You Start Physical Therapy?
Post-stroke physiotherapy begins 1-2 days after the stroke when the patient is medically stable.
Your physical therapist will encourage active movement on the affected side of your body. They will change your position while you’re laying in bed and mobilise you by sitting you up with your legs on the bed or hanging on the side.
And if you’re feeling up to it, your physio will help you move out of bed, support your weight and walk as much as you can manage.
Your physiotherapy continues after discharge from the hospital. You can choose to visit a physiotherapy clinic for your PT sessions or hire a home physiotherapist.
Physical Therapy for the Rehab of Stroke Patients: In a Nutshell
Physical therapists help stroke patients get back to life and routine.
Each patient with a stroke suffers from a different level of impairment. Hence, licensed physical therapists design individualised rehab programs based on your specific goals, home environment, and level of motor control.
Enrolling yourself in a physiotherapy program after a stroke is incredibly necessary. Patients who don’t tend to live their entire lives with altered movement patterns and impairments which restrict their activities.
Even if you’ve not received intensive physical therapy immediately after suffering from a stroke, you can still benefit from PT so you should visit a physio and get an assessment done to figure out the level of recovery you can expect.