EXERCISES FOR STROKE VICTIMS

NOOR MAZIAH BINTI ISMAIL

2009420814

FACTS ABOUTS STROKE stroke is the third most common causeof death, after cancer and

ischemic heart disease. It is also the most prominent cause of physical deformity Stroke has a yearly incidence of180-300 per 100,000,in the United

States. Its incidence is accelerating in developing countriesdue to unhealthy

lifestyles. 2/3 of stroke victims are above60 yearsold.1/5 of the victims die

within a monthof its occurrence. Half the survivors become physically deformed.

A damage in the left side of the brain may result in paralysis of the right side of the body;a damage on theright side, paralyzes the left side.

Hypertensionaccounts for 30-50% of stroke risk. Patients with diabetes mellitus are 2-3 times more predisposed to

stroke. Stroke can occur due to adisruption in blood supplyor due to a

blood vessel damage

HOW STROKE OCCURS Who has Strokes Strokes most often occur in the elderly, people

with high blood pressure, obesity and diabetes. Smoking and alcohol use also increase the risk for strokes. Diets high in cholesterol can contribute to the build of blockages in the arteries. Lack of exercise can lead to hypertension and poor circulation, both of which can contribute to strokes. Patients suffering from atrial fibrillation (irregular pulse) are the most at risk to suffer from a stroke.

Bleeding Into the Brain There are two types of strokes. The first is a

hemorrhagic stroke. This occurs when a blood vessel inside the brain ruptures and causes bleeding. This type of stroke is usually the result of a head injury. Another reason a hemorrhagic stroke can occur is if the blood vessels grow too thin--this may cause a bulge, called an aneurysm. Aneurysms can develop slowly over several years and will eventually grow so weak that they break, causing bleeding. If the bleeding is near the surface of the brain it is called a subarachnoid or a subdural hemorrhage. If the bleeding is deeper inside the brain it is called a intracerebral hemorrhage. Hemorrhagic strokes are less common than ischemic strokes, but they are more likely to result in death.

Blocked Artery The second type of stroke is an ischemic stroke. This

results when an artery in the brain becomes blocked. One possible cause of the blockage is thickening of the blood resulting in a blood clot. The clot can travel through the circulatory system until it becomes lodged in a narrow artery in the brain. The other cause is if the arteries become weakened, narrowed or hardened. Cholesterol can form plaque that sticks to the walls of the artery, gradually making the artery narrower over time. Plaque usually builds up in the arteries of the neck, so when they become fully blocked one entire hemisphere of the brain is affected by the stroke.

Brain Damage Without blood oxygenating the brain, the cells suffer

damage. In an attempt to compensate, the body will enlarge other nearby blood vessels to try and restore blood flow to the affected areas. If blood flow is blocked for more than four minutes brain cells begin to die. The brain can not regenerate dead brain cells. Because different areas of the brain control different functions, symptoms of a stroke may vary. Paralysis may occur on one side of the body, there may be blurred or lost vision, trouble communicating or drooping on one side of face. Even if treated quickly the patient may still suffer long term disability.

HAND EXERCISES FOR STROKE PATIENTS Hand exercises for stroke patients is the most practical approach to hand recovery after stroke as

it can be done at home. It is composed of a range of motions focused on one area, the hand, as with other exercises for stroke patients. Meant to retrain the brain, hand exercises should be done several times a day for mastery and to redevelop coordination.

Here are some hand stretching exercises, arranged sequentially, that you might want to try: 1. Massage the affected hand with the unaffected hand, beginning with the base of the thumb by

the palm, to the tip of the thumb. Repeat for all fingers. 2. Stretch each finger of the affected hand with the unaffected hand. You could also move each

finger of the affected hand in circular motions with the unaffected hand. 3. Close and open the affected hand, beginning one finger at a time until you form a fist and vice

versa. Alternate by closing and opening all fingers at the same time to form a fist and vice versa. 4. With palms face down on a flat surface, lift thumb and gently return to position. Repeat on all

fingers. 5. With palms face down again, lift hand while bringing each finger tip slowly gliding towards each

other to a close. Reverse action. Repeat 5 times. 6. Stretch fingers as far as you can while palm is faced down on flat surface. Hold in position for 5

seconds. Release. Repeat 5 times. Once you're done stretching, here are hand activities to practice your grip and enhance flexibility: 1. Practice counting with your fingers in sets of 5. From a closed fist, count with the pinkie first

going to the thumb. Begin the next set of numbers with an open hand. Then close the hand to form a fist beginning with the thumb going to the pinky.

2. Form the letters of the alphabet using your hand. Also known as finger spelling, here's a chart you can follow.

3. Crumple pieces of paper. Throw them all in the air as you would with confetti, such that they fall on the table. Pick each crumpled paper and throw into a trash can as you would in basketball.

4. Play pickup sticks or pickup objects of various sizes. 5. Play with a stress ball.

WHAT IS POST-STROKE REHABILITATION? Rehabilitation helps stroke survivors relearn skills that

are lost when part of the brain is damaged. For example, these skills can include coordinating leg movements in order to walk or carrying out the steps involved in any complex activity. Rehabilitation also teaches survivors new ways of performing tasks to circumvent or compensate for any residual disabilities. Patients may need to learn how to bathe and dress using only one hand, or how to communicate effectively when their ability to use language has been compromised. There is a strong consensus among rehabilitation experts that the most important element in any rehabilitation program is carefully directed, well-focused, repetitive practice - the same kind of practice used by all people when they learn a new skill, such as playing the piano or pitching a baseball.

Rehabilitative therapy begins in the acute-care hospital after the patient's medical condition has been stabilized, often within 24 to 48 hours after the stroke. The first steps involve promoting independent movement because many patients are paralyzed or seriously weakened. Patients are prompted to change positions frequently while lying in bed and to engage in passive or active range-of-motion exercises to strengthen their stroke-impaired limbs. ("Passive" range-of-motion exercises are those in which the therapist actively helps the patient move a limb repeatedly, whereas "active" exercises are performed by the patient with no physical assistance from the therapist.) Patients progress from sitting up and transferring between the bed and a chair to standing, bearing their own weight, and walking, with or without assistance. Rehabilitation nurses and therapists help patients perform progressively more complex and demanding tasks, such as bathing, dressing, and using a toilet, and they encourage patients to begin using their stroke-impaired limbs while engaging in those tasks. Beginning to reacquire the ability to carry out these basic activities of daily living represents the first stage in a stroke survivor's return to functional independence.

For some stroke survivors, rehabilitation will be an ongoing process to maintain and refine skills and could involve working with specialists for months or years after the stroke.

WHAT DISABILITIES CAN RESULT FROM A STROKE?

The types and degrees of disability that follow a stroke depend upon which area of the brain is damaged. Generally, stroke can cause five types of disabilities: paralysis or problems controlling movement; sensory disturbances including pain; problems using or understanding language; problems with thinking and memory; and emotional disturbances.

PARALYSIS OR PROBLEMS CONTROLLING MOVEMENT (MOTOR CONTROL) Paralysis is one of the most common disabilities

resulting from stroke. The paralysis is usually on the side of the body opposite the side of the brain damaged by stroke, and may affect the face, an arm, a leg, or the entire side of the body. This one-sided paralysis is called hemiplegia (one-sided weakness is called hemiparesis). Stroke patients with hemiparesis or hemiplegia may have difficulty with everyday activities such as walking or grasping objects. Some stroke patients have problems with swallowing, called dysphagia, due to damage to the part of the brain that controls the muscles for swallowing. Damage to a lower part of the brain, the cerebellum, can affect the body's ability to coordinate movement, a disability called ataxia, leading to problems with body posture, walking, and balance.

SENSORY DISTURBANCES INCLUDING PAIN

Stroke patients may lose the ability to feel touch, pain, temperature, or position. Sensory deficits may also hinder the ability to recognize objects that patients are holding and can even be severe enough to cause loss of recognition of one's own limb. Some stroke patients experience pain, numbness or odd sensations of tingling or prickling in paralyzed or weakened limbs, a condition known as paresthesia.

Stroke survivors frequently have a variety of chronic pain syndromes resulting from stroke-induced damage to the nervous system (neuropathic pain). Patients who have a seriously weakened or paralyzed arm commonly experience moderate to severe pain that radiates outward from the shoulder. Most often, the pain results from a joint becoming immobilized due to lack of movement and the tendons and ligaments around the joint become fixed in one position. This is commonly called a "frozen" joint; "passive" movement at the joint in a paralyzed limb is essential to prevent painful "freezing" and to allow easy movement if and when voluntary motor strength returns. In some stroke patients, pathways for sensation in the brain are damaged, causing the transmission of false signals that result in the sensation of pain in a limb or side of the body that has the sensory deficit. The most common of these pain syndromes is called "thalamic pain syndrome," which can be difficult to treat even with medications.

The loss of urinary continence is fairly common immediately after a stroke and often results from a combination of sensory and motor deficits. Stroke survivors may lose the ability to sense the need to urinate or the ability to control muscles of the bladder. Some may lack enough mobility to reach a toilet in time. Loss of bowel control or constipation may also occur. Permanent incontinence after a stroke is uncommon. But even a temporary loss of bowel or bladder control can be emotionally difficult for stroke survivors.

PROBLEMS USING OR UNDERSTANDING LANGUAGE (APHASIA)

At least one-fourth of all stroke survivors experience language impairments, involving the ability to speak, write, and understand spoken and written language. A stroke-induced injury to any of the brain's language-control centers can severely impair verbal communication. Damage to a language center located on the dominant side of the brain, known as Broca's area, causes expressive aphasia. People with this type of aphasia have difficulty conveying their thoughts through words or writing. They lose the ability to speak the words they are thinking and to put words together in coherent, grammatically correct sentences. In contrast, damage to a language center located in a rear portion of the brain, called Wernicke's area, results in receptive aphasia. People with this condition have difficulty understanding spoken or written language and often have incoherent speech. Although they can form grammatically correct sentences, their utterances are often devoid of meaning. The most severe form of aphasia, global aphasia, is caused by extensive damage to several areas involved in language function. People with global aphasia lose nearly all their linguistic abilities; they can neither understand language nor use it to convey thought. A less severe form of aphasia, called anomic oramnesic aphasia, occurs when there is only a minimal amount of brain damage; its effects are often quite subtle. People with anomic aphasia may simply selectively forget interrelated groups of words, such as the names of people or particular kinds of objects.

PROBLEMS WITH THINKING AND MEMORY

Stroke can cause damage to parts of the brain responsible for memory, learning, and awareness. Stroke survivors may have dramatically shortened attention spans or may experience deficits in short-term memory. Individuals also may lose their ability to make plans, comprehend meaning, learn new tasks, or engage in other complex mental activities. Two fairly common deficits resulting from stroke are anosognosia, an inability to acknowledge the reality of the physical impairments resulting from stroke, and neglect, the loss of the ability to respond to objects or sensory stimuli located on one side of the body, usually the stroke-impaired side. Stroke survivors who develop apraxia lose their ability to plan the steps involved in a complex task and to carry the steps out in the proper sequence. Stroke survivors with apraxia may also have problems following a set of instructions. Apraxia appears to be caused by a disruption of the subtle connections that exist between thought and action.

EMOTIONAL DISTURBANCES Many people who survive a stroke feel fear, anxiety,

frustration, anger, sadness, and a sense of grief for their physical and mental losses. These feelings are a natural response to the psychological trauma of stroke. Some emotional disturbances and personality changes are caused by the physical effects of brain damage. Clinical depression, which is a sense of hopelessness that disrupts an individual's ability to function, appears to be the emotional disorder most commonly experienced by stroke survivors. Signs of clinical depression include sleep disturbances, a radical change in eating patterns that may lead to sudden weight loss or gain, lethargy, social withdrawal, irritability, fatigue, self-loathing, and suicidal thoughts. Post-stroke depression can be treated with antidepressant medications and psychological counseling.

"PASSIVE RANGE OF MOTION EXERCISES" if the stroke victim has suffered paralysis of one side of the

body, passive range of motion exercises are done for the shoulder, elbow, wrist, fingers, hip, knee, ankle, foot, and toes by the physical therapist at bedside. Passive range of motion means that the therapist supports and moves the body part through the full range of motion. These exercises maintain good blood flow and keep the muscles and tendons flexible, preventing the joints from tightening. For example, if the shoulder joint is not stretched, the patient can develop a "frozen shoulder syndrome" which can be very painful. It is important to prevent range of motion limitations because this impairs function and tends to cause pain. After the patient is discharged, a Home Health Physical Therapist will provide a Home Exercise Program with clear written instructions and illustrations and will train a family member how to carry out these exercises.

"ACTIVE RANGE OF MOTION EXERCISES" If the stroke victim starts to recover and

begins to have voluntary muscle strength on the involved side then the physical therapist may instruct the individual in active exercises. "Active exercise" means the patient will lift or move the body part through the range of motion against gravity without help. These exercises help to strengthen the muscles on the weak side, but also should be done on the good side

"CONSTRAINT-INDUCED MOVEMENT THERAPY (CIMT)" CIMT is being used in some stroke

rehabilitation centers. It involves constraining the unaffected limb in order to force the patient to use the affected limb.

"BALANCE AND TRANSFER EXERCISES" With the assistance of a physical

therapist, the patient will practice moving from lying to sitting position and then practice sitting balance. Next they will learn to transfer from bed to wheelchair and back to bed sometimes using a sliding board if necessary.

"GAIT (WALKING) TRAINING EXERCISES" The patient generally starts practicing standing up

in the parallel bars with the assistance of a physical therapist. Next the patient learns to shift weight from one leg to the other, shifting both from side to side and from front to back. After this the patient walks a short distance between the parallel bars using the bars for support. Next, with the assistance of a physical therapist, the patient will walk outside the bars using a quad cane or walker if needed. The therapist places a wide canvas belt, called a "gait belt", around the patient's waist to provide a way of holding on to him or her and a way to adjust balance and prevent falls.

"HOME ASSISTIVE DEVICES" Once the patient is at home, a Home

Health Physical Therapist will visit and make recommendations for creating a safe and supportive environment. Items of concern might be the need for hand-hold bars and/or seats in showers and tubs, toilet adapters to raise the seat level, clear areas around beds and through the house so that the patient does not fall, etc.

HOW TO USE PHYSICAL THERAPY TO REHABILITATE A STROKE VICTIM

HOW TO GET A STROKE VICTIM TO EXERCISE

Encourage, encourage, encourage. There is nothing worse for a person that is in a bad situation then when they get no encouragement from the people around them, especially their loved ones. If a stroke victim is partially paralyzed, the smallest triumph deserves praise. It’s not a situation for anyone involved in it, but a little happiness and a lot of positive reinforcement can go a long way.

Give them a stress ball. After a stroke victim’s body has become weakened, it can be a long and arduous task to getting it back on track so it’s a good idea to start off small and simple. That little stress ball can do wonders, especially between physical therapy and/or when the person is confined to their bed. Not only is the stress ball good for their hands, but it’s good for the persons arm muscles. A stress ball is easily accessible to do at any time and it's small so they can do it wherever they are.

Consider giving them small 1 lb. weights. While it may not seem like much, after the muscles are weakened, having them use a 1 lb. weight can be quite a bit of help. There are 1 lb. ankle weights and 1 lb. arm weights which can be bought for very cheap. Give them a certain amount to do and count down with them as they finish their reps. Be there with them and cheer them on as they finish.

Consult the stroke victims doctor and see what you can have your loved one use on their off physical therapy hours to help them work out their body. Sometimes you have to ask in order to get any answers. Also, if you see anything that you think would be beneficial for your loved one to use, don’t hesitate to ask their doctor if it would be appropriate for them. Make sure you ask the doctor first before having the stroke victim do any type of exercise.

Have patience, show compassion, but exhibit tough love. You don’t totally know what the stroke victim is going through unless you’ve been in their position. However, sometimes a little tough love is needed. Your loved one may need a reminder that they need to work harder in order for them to get better at all, so a little kick in the butt by the people that they care about may be needed.