By: Rukhsar Jabbar. M.Sc. Physiotherapy. Freelance Health Writer and Datelinehealth Africa (DLHA) volunteer. Medical review and editorial support provided by the DLHA Team.

 

Black physiotherapist at work. Image by Freepik

 

 

Introduction

 

The most common cause of neurological impairment in adulthood worldwide is stroke. Almost everyone who has a stroke will need support as they heal. Family caregivers  play a crucial role in providing community support for those who have suffered a stroke. As strokes happen suddenly, caregivers might feel unprepared or doubt their own abilities. Caregivers may consequently see a reduction in their general well-being, social life, and physical and mental health. [1]

 

The World Health Organization's guidelines for stroke advocated for the application of a comprehensive biopsychosocial model, which takes the environment into account and sets the rehabilitation objective as the individual's activity and engagement in society. A person's home and neighborhood are just two examples of the physical, social, and attitude factors that make up their environment and have an impact on their functioning.

 

A mismatch between a person's functional level and the demands of their surroundings might make it difficult for them to engage in daily activities and maintain their quality of life, which can harm their health.

 

People with persistent illnesses are particularly susceptible to demands in their home and community settings (such as stairs and uneven pathways) because of functional restrictions. Healthcare professionals (HCPs) must therefore be aware of both the opportunities and constraints presented by the environment to assist recovery and help an individual lead an active and meaningful life.²

 

The article aims to -

• To give stroke victims a comprehensive grasp of the procedure and significance of post-stroke therapy.

• To provide an overview of the different elements and methods of physiotherapy, occupational therapy, therapy for speech, and psychological support that are part of post-stroke rehabilitation.

• To highlight how important it is for interdisciplinary medical teams, caregivers, and support systems to assist stroke survivors as they go through the phases of rehabilitation.

 

 

A brief overview of what a stroke is

 

Stroke ranks as the second most common cause of death and disability in the world. Stroke is not a single disease; rather, it is a result of numerous risk factors, illness processes, and disease mechanisms. The most significant modifiable risk factor for stroke is hypertension, albeit its impact varies depending on the kind. [3]

 

To read about more stroke and its types, risk factors diagnosis, treatment and prevention, go to the links below-

· Stroke in Africa: What you need to know

· Risk factors for stroke

· What are the types of stroke?

· Stroke treatment in Africa

 

Common effects of stroke on the body and daily life

1. Muscle mobility issues

2. Cognitive, thinking, or memory issues

3. Difficulties speaking or understanding speech

4. Emotional issues

 5. Issues with pain and sensation  [4]

 

 

What is Post-Stroke Rehabilitation?

 

A variety of therapies are used in stroke rehabilitation to help patients regain skills that they may have lost following a stroke. Rehabilitation might support you with your strength, mobility, speech, and everyday living skills, depending on which areas of your brain were damaged by the stroke. You can enhance your quality of life and restore your independence with the aid of stroke rehabilitation. [5]

 

The range of stroke consequences is as diverse as the post-stroke recovery rates of individual patients. It has been discovered by researchers that participants in targeted stroke rehabilitation programs outperform most individuals without stroke rehabilitation. As a result, post-stroke therapy is advised for all stroke victims. [5]

 

Benefits for post-stroke rehabilitation include -

• Improved functional abilities

• Increased independence in daily activities

• Improved quality of life for stroke patients and their families

 

 

Components of Post-Stroke Rehabilitation

 

• Physical Therapy

 

For most stroke victims, physical therapy is the primary mode of recovery. Physical therapy aims to assist individuals in relearning basic motor skills, including walking, sitting, standing, lying down, and transitioning between different movement types. Physical therapists employ exercises and training to help patients regain their movement, balance, and coordination.

 

Research on walking ability pos-stroke demonstrated that individuals who underwent at-home physical therapy after a stroke were able to regain their walking abilities to an equivalent degree as those who received treatment with a locomotor training program. Researchers in the study also discovered that patients' recovery could last up to a year following a stroke, challenging the belief that recovery starts early and usually ends after six months. [4]

 

Physical activities might include:

• Motor-skill exercises. Body-wide muscle strength and coordination can be enhanced with exercise. These can include the muscles involved in walking, swallowing, and balance.

• Mobility training. You may pick up the usage of mobility aids like an ankle brace, wheelchair, canes, or walkers. While you retrain your ankle to walk, the ankle brace can help strengthen and stabilize it, supporting your body's weight.

• To help the injured limb operate better, you practice moving it while the unaffected limb is immobilized. Forced-use therapy is another name for this kind of treatment.

• You can restore range of motion and reduce muscle tension (spasticity) using specific workouts and therapies. [5]

 

Among the physical activities aided by technology is functional electrical stimulation. Weakened muscles contract when they are exposed to electricity. Your muscles may benefit from the electrical stimulation for reeducation.

• Technology involving robots-repetitive motions can be performed by injured limbs with the aid of robotic devices, which can help them regain strength and function.

• Technology based on Wi-Fi - Using an activity monitor may assist you in becoming more active after a stroke.

• Virtual reality - Playing video games and using other computer-based therapies requires the patient to interact with a real-time, virtual environment.⁵

 

• Occupational Therapy

 

Those who need assistance with relearning daily functions like eating, drinking, and swallowing, dressing, bathing, cooking, reading, and writing, as well as using the restroom, can benefit from occupational therapy. This kind also includes training and exercise. Occupational therapists can provide recommendations for changes to the home or place of employment that will enable the client to return to a semi-independent or independent lifestyle. [4]

 

• Speech Therapy

 

People recovering from a stroke can learn new ways of communicating or rediscover language and speaking abilities with the aid of speech therapy. People, who struggle with speech formation or interpreting written words, but not with cognition or reasoning, might consider speech therapy. Individuals receiving speech therapy might also learn coping mechanisms to manage the frustration of their limited communication abilities.

 

Speech therapy can assist a stroke victim in regaining some, or occasionally all, of their language and speaking abilities with time and patience. [4]

 

• Vocational therapy

 

It helps people return to their jobs. About a quarter of all stroke cases occur in people between the ages of 45 and 65. Most people in this age group are rather anxious about returning to the workforce. It can entail taking up new skills for a different role or relearning the more challenging ones utilized on the job. Vocational therapists can help people with permanent disabilities identify their strengths and job-related skills so they can locate new career opportunities. [4]

 

• Psychological or Psychiatric therapy

 

It can help a lot of people recover from stroke. Those who have had a stroke frequently experience problems like depression, anxiety, frustration, and aggression. In addition to medication, therapy can help alleviate some of the psychological and emotional issues that follow a stroke. Family members may find it helpful to get psychological or psychiatric assistance for themselves from time to time. [4]

 

Among the cognitive and affective activities are:

• Cognitive disorder therapy. You’re lost cognitive abilities-such as memory, processing speed, problem-solving skills, social skills, judgment, and safety awareness can be helped by occupational therapy and speech therapy.

• Treatment for problems with communication. You can regain lost skills in speaking, listening, writing, and comprehension with the aid of speech therapy.

• Psychological assessment and intervention. You may be asked to adjust emotionally. Additionally, you can attend counseling or take part in a support group.

• Prescription drugs. Your physician may prescribe an antidepressant or a drug that alters agitation, mobility, or attentiveness.⁵

 

 

Challenges and Considerations

 

According to different research and findings, some of the challenges of stroke rehabilitation in Africa are more common than others, and they comprised of the following:

• Low awareness of the ailment;

• Limited access to healthcare;

• Exorbitant treatment costs, which are typically covered out of pocket

• Insufficient access to rehabilitation treatments;

• inadequate medical emergency calls and transportation services;

• inadequate research; poor nutrition;

• Cultural views and practices; and

• A lack of skilled healthcare workers with experience treating strokes

 

When you survive a stroke, it develops into a crippling, chronic illness that needs to be properly treated due to its negative effects on quality of life.

 

It takes skill to handle these obstacles. However, it's critical to address them in order to lower the incidence of stroke and enhance the prognosis for stroke survivors in sub-Saharan Africa.

 

 

Conclusion

 

In conclusion, post-stroke rehabilitation plays a crucial role in the recovery journey of individuals affected by stroke, particularly in regions like Africa where the burden of stroke is significant.

 

One key takeaway is the need for increased awareness and education about stroke and its rehabilitation among both healthcare professionals and the general population. This can help to ensure that individuals receive timely and appropriate rehabilitation services, ultimately improving their outcomes and quality of life post-stroke.

 

 

References

1. Kokorelias KM, Lu FKT, Santos JR, Xu Y, Leung R, Cameron JI. “Caregiving is a full?time job” impacting stroke caregivers’ health and well?being: A qualitative meta?synthesis.Health Soc Care Community 2020. 28(2), 325-340. https://doi.org/10.1111/hsc.12895 Available from: https://onlinelibrary.wiley.com/doi/10.1111/hsc.12895

2. Kylén M, Ytterberg C, Von Koch L, Elf M. How is the environment integrated into post?stroke rehabilitation? A qualitative study among community?dwelling persons with stroke who receive home rehabilitation in Sweden. Health Social Care Comm.  2022 30(5).1933-1943. https://doi.org/10.1111/hsc.13572. Available from: https://onlinelibrary.wiley.com/doi/10.1111/hsc.13572

3. Stephen JX. Murphy SJ, Werring DJ. Stroke: causes and clinical feature. Medicine, 2020. 48(9),561-566, https://doi.org/10.1016/j.mpmed.2020.06.002. Avilable from: https://www.sciencedirect.com/science/article/pii/S1357303920301389

4. Stroke. What is a Stroke? National Institute of Neurological Disorders and Stroke [Internet. Last reviewed Nov. 28, 2023]. [cited 2024 Feb 3]. Available from: https://www.ninds.nih.gov/health-information/disorders/stroke

5. Mayo Clinic. Stroke rehabilitation:  What to expect as you recover. [Internet. May 18, 2022]. [cited 2024 Feb 3]. Available from: https://www.mayoclinic.org/diseases-conditions/stroke/in-depth/stroke-rehabilitation/art-20045172

 

Related:

· Best physical exercise for stroke patients

· Musculoskeletal disorders following stroke - An explainer for Africans

 

 

Published: February 6, 2024

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