Non-Communicable diseases and their complications burden society with several challenges including morbidity, limitation in quality of life, loss of productivity and even in some instances mortality. They continue to be one of the leading causes of disability worldwide just second to accidents as reported by World Health Organization (WHO 2016).
Among the classifications of non-communicable diseases, the threat posed by cardiovascular ailments and their complications claim a greater share. One of these conditions that have baffled society and the minds of health professionals is stroke.
Stroke or cerebrovascular accident is a life threatening condition that results when the blood supply to a part of the brain is cut off. Hatano in 1976 technically describes a stroke as a clinical syndrome characterized by rapidly developing clinical symptoms and signs of focal and at times global loss of cerebral function, with symptoms lasting more than 24 hours, or leading to death, with no apparent cause other than a vascular origin. Simply put the symptoms and signs that result when the blood supply to a part of the brain stays over a day then the result is a stroke. Otherwise it is a Transient Ischemic Attack (TIA). The symptoms of a TIA stay less than a day and the individual is relieved of them. People who suffer TIA have a greater chance of suffering a stroke in life when the underlying cause is not addressed.
A stroke can be Ischaemic or Haemorrhagic. When there is a blockage in the flow of blood such as in a case of a clot hindering blood flow to the part of the brain, the cells of that region of the brain are denied oxygen and necessary nutrients hence they die. This result in a type of stroke is called Ischaemic. In Haemorrhagic stroke, increased tension/pressure in the blood vessels causes them to burst and spill the blood content on the brain denying their supplying brain cells of oxygen and killing them. Stroke can occur irrespective of age depending on the underlying cause. This implies that any condition that will hinder the flow of blood to the brain of an individual of any age can result in stroke.
The risk factors of stroke are classified into two; modifiable and non-modifiable. Inherent characteristics such as age, family history, ethnicity and race are non-modifiable risk factors.
Age reduces the elasticity of our blood vessels making them less resilient to increased blood pressure. Also, fat build-up in the blood vessels decreases the lumen thereby increasing the resistance against which the heart must pump blood resultantly increasing the resting blood pressure. Though age is directly proportional to blood pressure, the relationship is not absolute. Blood pressure and Diabetes can run in a family putting the members at a higher risk. Research also indicates that people from the black race have a higher risk of getting stroke than their white counterparts.
The modifiable risk factors are smoking, high blood pressure (Hypertension), Obesity, Hypercholesterolemia, Diabetes and excessive alcohol intake (NHS, 2016). Stroke can also occur in children more likely to be caused by Sickle cell Anaemia, health failure or HIV/AIDS. In Sickle cell Anaemia the “vaso-occlusive crises” cause red blood cells to coagulate and block small arteries especially at small arterial branches. Occurrence of this in the brain leads to Stroke. In heart failures, the heart either refuses to pump adequate blood to supply the brain or generate less pressure to meet the demand of the brain and other structures contained in the skull. HIV/AIDS weakens the immune system rendering the central nervous system weak to combat infections.
The signs and symptoms of stroke include loss of memory, muscle weakness of the face (facial palsy), weakness of half of the body (hemiplegia or hemiparesis), loss of taste, loss of smell, loss of vision, loss of hearing, drooping of the eyelid (ptosis), difficulty in swallowing (dysphagia), loss of balance, altered breathing and heart rate, loss of speech, altered walking and vertigo among others. It is important to note that the number of symptoms present will depend on the extent of damage and the side of the brain affected.
Full and fast recovery of a stroke patient demands a holistic care with each health professional, client/patient and caregivers giving their best. Stroke treatment starts just after its occurrence. For the purpose of the role the Physiotherapist plays, the recovery journey will be classified into three phases. These phases are not precise and one phase can over the other.
PHASE ONE.
This usually covers the early days to about two weeks after the onset of symptoms. The stage is the danger zone because the survival of the patient rests to a large extent at this stage. The medical states of patients are usually in a balance and the sole aim of care is to make them medically stable. The Physiotherapist has the role of eliminating health complications such as Deep vein thrombosis (DVT), joint stiffness, pressure sores which are life threatening. Patient positioning and regular turning are also some vital roles to be played as well as deep breathing exercises. Depending on the severity of the stroke and presence of the available symptoms the Physiotherapist will be called upon to render some services when needed.
PHASE TWO.
The target at this stage is to make the patient as functional as possible. The therapist has the role of working towards how to train the patient to transfer himself or herself from lying to sitting to standing and then to walking. Training on activities of daily living is also done during the stage. Building of the strength of weakened muscles that will translate into functional activity is also the therapist’s priority. This phase continues after the first till about six months of the condition.
PHASE THREE.
The last phase is a continuous phase and can last from about six months to 2 years or even more. It involves the fine tuning of the various successes obtained during the first six months of recovery in terms of strength and movement. The therapist also works at training fine motor skills at this stage. Balance, co-ordination and endurance are trained at this phase of the recovery process.
It is important to note that the physiotherapist spends a lot of time with the stroke patient than any other health professional. The stroke rehabilitation journey is a fairly short one but without a Physiotherapist it can be a long or a never ending journey or ending with deficits. “Movement really is life”.
