Stroke Management With Physiotherapy | Hong Kong

Stroke Management With Physiotherapy | Hong Kong
20 January 2023 PhysioCentral

Strokes are a growing problem here in Hong Kong. New research from the University of Hong Kong’s Faculty of Medicine shows a 30% increase in strokes among adults aged 18 to 55 years. Suffering a sudden and unexpected stroke event has the potential to change the course of a person’s health and physical function across their lifetime. 

Physiotherapists are trained to work with those affected by stroke, to help them optimise their physical function and independence. Here’s how you can identify a stroke, how it can affect you, and how we can help.

 

What Is A Stroke?

Strokes occur when blood flow to a part of the brain is interrupted. Normally, blood carries oxygen to your brain to enable it to function properly, so when anything disrupts the oxygen levels in the brain, brain cells can become damaged, and areas of the brain stop working as they usually would. 

Different portions of our brains are responsible for controlling different functions including movement, senses, emotions and thoughts, so the effects of a stroke will depend on which part of the brain has been damaged and how severe this damage is. This means that a stroke may affect your ability to walk, talk, eat, see, read, perceive temperature, or do things you were able to do easily before the stroke.

 

There are three types of strokes:

 

  • Haemorrhagic stroke: also called a cerebral haemorrhage, this type of stroke occurs when a blood vessel in the brain bursts and leaks blood into the brain. Haemorrhagic strokes can cause damage to several areas of the brain, and lead to more loss of function, as certain parts of the brain become deprived of blood, some become irritated by the leaked blood, and others are damaged by swelling and pressure. 
  • Ischaemic stroke: ischaemic strokes occur when a blood clot blocks a large blood vessel in the brain. It is the most common type of stroke, particularly in older people, and is linked to high blood pressure, high cholesterol, diabetes and smoking.
  • Embolic stroke: embolic strokes occur when a blood clot or piece of plaque made from cholesterol or calcium breaks off the wall of an artery and travels to the brain. This can block the flow of oxygen-rich blood to the brain and cause brain cells to become damaged, potentially leading to various effects on the body.

 

Can You Identify When Someone Is Having A Stroke?

One of the best ways to help someone suffering from a stroke is being able to recognise the signs, so you can get help urgently – especially as strokes can develop quickly and without any warning signs. The Hong Kong centre for health protection lists the common stroke symptoms as:

  • Sudden weakness, numbness and/or tingling of the face, arm or leg
  • Sudden slurring or loss of speech
  • Sudden blurring of vision
  • Sudden onset of severe headache
  • Sudden unsteadiness or falls

There’s also an acronym that may help you identify a stroke FAST.

  • Face: Check their face. Has their mouth drooped?
  • Arms: Can they lift both arms?
  • Speech: Is their speech slurred? Do they understand you?
  • Time Is critical. If you see any of these signs, you must call for help by phoning 999 straight away.

 

What Can You Expect After A Stroke?

How a stroke affects you will depend on which parts of your brain have been effected and to what extent. The effects can be mild to severe, and some people recover quickly, while others have more ongoing challenges. If the stroke only occurred in one half of the brain, one side of the body is often more affected than the other. 

Research has found that 73% of patients recovering from a stroke experience at least one fall within the first six months of recovery, take half as many steps as the general population, and have longer periods of sedentary behaviour in their day. The effects of a stroke can also include: 

  • Paralysis, muscle weakness, or heaviness, usually on the affected side of the body
  • Numbness in the hands, feet, arms or legs
  • Difficulty speaking and closing the mouth fully
  • Difficulty swallowing and drinking
  • An uneven facial appearance due to the loss of muscle function on one side
  • Difficulty lifting, standing or picking up objects due to muscle weakness
  • When one side of the body is weaker, the other side often compensates by becoming stronger and more dominant, causing difficulties with balance and coordination

 

Strokes: How Can Physiotherapy Help?

Physiotherapy plays a crucial part in recovering from a stroke. We can help support you in movement and exercises that help the brain reorganise or rewire cell functions to new, healthy areas of the brain. This ability of the brain to form new neural connections and pathways is known as neuroplasticity. Physiotherapy can help patients who have experienced a stroke gain new skills, while improving and re-obtaining skills they had before. Immediately following a stroke, some areas of the brain do recover on their own, and after that, changes and improvements are due to neuroplasticity which is facilitated through physiotherapy.

Thankfully, neuroplasticity has no time limit. Historically, some doctors believed that recovery time after a stroke was limited, but studies have now found that just 2-12 weeks of physiotherapy can create long-lasting improvements in people who experienced strokes many years ago., This includes improving walking speed and distance, or better coordination in an affected hand. This means that even if you suffered your stroke years earlier, physiotherapy is a viable and recommended therapy for you to explore.

Currently, the recommendations for preventing a second stroke, and reducing stroke complications, include at least 30 minutes of daily aerobic exercise, but it can be very difficult for a person who has suffered a stroke to reap the benefits from aerobic exercise as they don’t often have sufficient muscle strength to raise their heart rate, and loss of balance and coordination can also make exercising difficult. This means that regaining strength and endurance for exercise becomes a key factor that physiotherapists focus on. 

We also work on helping you achieve the independence to do every day tasks that are important and enjoyable for you. Beyond the early stages of physiotherapy, which may concentrate on basics such sitting up from a lying position, guiding the movement of a limb, and practising standing, your individual goals may include getting dressed, showering, preparing meals and going for walks, as well as attending work, participating in sports or leisure activities, or driving a car. In relearning these tasks, researchers have found five key principles that physiotherapists use to successfully increase the potential for neuroplasticity and recovery after a stroke. These include: 

 

  • Use it or lose it: Studies show that the brain can regain control of an area that was previously lost, which means it’s important to use your affected arm and leg, and do tasks that involve both hands and legs. 
  • Use it and improve it: Once you’ve used your affected arm or leg and made improvements, make the task harder to continue to challenge yourself.
  • Specificity: Focus on a specific task. Simply opening and closing your hand is not very specific, but reaching to grasp a mug or trying to play the keys on the piano will create better results.
  • Repetition: Practice, practice, practice 
  • Make it meaningful: Movements need to be relevant to you. If the goal is to reach and grip with your hand, try to pick up a bridle if you’re a horse rider. If you enjoy gardening, practice picking up a garden fork, and if putting on makeup is important to you, practice reaching for your foundation.

 

 

Summary

  • The prevalence of strokes in adults aged 18-55 years has increased by 30% in recent years
  • Strokes occur when blood flow to the part of the brain is interrupted
  • Strokes can occur from blood leaking into the brain, blocked blood vessels, or when blood clots travel to the brain and cause a blockage
  • If you see someone slurring their words, unable to speak and looking unsteady, check them FAST (Face, Arms, Speech, Time)
  • Strokes can affect a person in a range of different ways, depending on which parts of the brain have been affected. A stroke may affect your ability to walk, talk, eat, see, read, perceive temperature, and more.
  • Physiotherapy is proven to help support those recovering from a stroke, regardless of whether your stroke is very recent or occurred years earlier.
  • Regular exercise can help prevent a second stroke. If exercising is difficult for you, your physiotherapist can help.

 

References

1 – https://www.med.hku.hk/en/news/press/20221027-increase-in-young-stroke

2 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453197/

3 – https://pubmed.ncbi.nlm.nih.gov/18948606

4 – https://pubmed.ncbi.nlm.nih.gov/17077374

5 – https://pubmed.ncbi.nlm.nih.gov/21612471

6 – https://pubmed.ncbi.nlm.nih.gov/20826872

7 – https://pubmed.ncbi.nlm.nih.gov/20966421

8 – https://pubmed.ncbi.nlm.nih.gov/21876848

9 – https://www.jsmf.org/meetings/2008/may/Kleim%20&%20Jones%202008.pdf