Stroke and physiotherapy management

 By Dr Md Faruqul Islam ::

Mr Nahid Imran, a 30 years old gentleman, just completed his masters degree in information technology. Few months back he was in the Skype, chatting with his friend, suddenly he felt down; means loss of consciousness and speech along unable to move right side of his body. Then immediately he was taken to a nearby hospital. After examination, it was confirmed that he got massive haemorrhage in his left brain. All of a sudden his life got stuck. Like Mr Imran, there are many stroke sufferers in our community; the question is how much are we taking care of them.
The World health Organisation (WHO) and World Bank reported for developing countries having overall disabilities about 10% of population. The prevalence of disability among stroke survivors is between 24–54%.
How you will understand about stroke?
Stroke affects brain and can happen any time in any of ages, but more common in older age. You may feel numbness (lack of sensation or feelings), facial weakness, weakness or paralysis of body (usually one side of the body), slurred speech (difficulty to speak), blurred or unclear vision, confusion and sometimes severe headache or vomiting.
Management of stroke
Stroke is a preventable and treatable disease at any ages. So more effective primary and secondary prevention strategies should be taken at all level of care — not only at individual’s life but also at family and community level. Early recognition of stroke leads to a better outcome.
How can one prevent stroke?

The good news is that most strokes can be prevented by working with your health care team to reduce your risk. You can help prevent stroke by making healthy lifestyle choices.
When should you start physiotherapy for stroke rehabilitation?
Physiotherapy should start from the next day of a stroke attack, where a physiotherapist will teach how to deal with patient positioning in bed or wheel chair. Sometimes patients need respiratory physiotherapy.
The protocol usually used are: assessment > problem identification > short term goal > long term goal > re-evaluate > discharge and follow up.
Position of patients while lying
Acute stage or immediately after stoke, the patients’ position or posture is key to prevent further complications such as developing good neuroplasticity, joint alignments and maintaining muscles or soft tissues length, furthermore, preventing pressure sore.
Taking care of affected shoulder and hand
Shoulder is a very common site to be affected after stroke, for example shoulder subluxation and pain can happen if there is wrong handling or not taking proper precautions during patient transferring.
Patient management
After becoming medically stable, a stroke patient will be introduced to nerve facilitatory exercises for instance the Bo-bath concept. It is one the modern concept used globally to rehabilitate stroke patients, including postural rearrangement, using base of support and center of gravity.
Based on the basic principles, a skilled physiotherapist will design the exercise protocol throughout the day. Interestingly it is often found that most of patients use some electrical modalities such as IRR, UST or TENS and others.
Clinical bottom line
Stroke is very critical and life-threatening — patients need care very urgently from acute hospital to rehabilitation. Multi-disciplinary team should be introduced at all level of the hospitals including neurologist, physiotherapist, occupational therapist, speech and language therapist.

The writer is a physiotherapist at CRP, Mirpur, Dhaka. Email: faruqch6@yahoo.com