What is a stroke?
Stroke is the 4th leading cause of death in Singapore and out of 100,000 Singaporeans, 155 of them are affected. A stroke occurs when blood supply to the brain is interrupted either due to a blockage (ischaemic stroke) or a rupture to the blood vessels (haemorrhagic stroke), and it can result in brain damage. When you have a stroke, the side of your body opposite to the brain, may become weak and numb. The size and location of the brain damage will affect the rate and extent of recovery of the stroke survivor.
Recovery from a stroke
Treatment of stroke depends on the type and location of the clot, obstruction or bleeding that caused it. A stroke is an emergency and your doctor will administer the most appropriate treatment option, one of which is anti-clotting medication, as soon as they determine what is the cause of the stroke, in order to minimise damage to your brain cells which can occur within minutes of a stroke attack.
Stroke rehabilitation is important to retrain your brain as much as possible to recover the abilities that may have been lost after a stroke. Rehabilitation may commence as soon as 24 – 48 hours after a stroke, or once you are deemed as medically stable by your doctor. Rehabilitation will include exercises as well as functional mobility training such as walking and performing activities of daily living.
Stroke rehabilitation may take place in:
- A hospital
- A specialised rehabilitation ward
- An acute care unit
- An intermediate and long term care facility
- An outpatient facility
Stroke Physiotherapy Rehabilitation
Post-stroke physiotherapy will focus on regaining range of motions, physical strength, balance, coordination and movement abilities that were affected by the stroke. The physiotherapist will work closely with you on a mutually set functional goals and work towards regaining as much of the lost functions as possible. Post-stroke physiotherapy will typically include the following:
- Range of motion and strengthening exercises
- Static and dynamic balance training
- Gait re-training with appropriate walking aids and/or specialised equipment such as gravity assisted treadmill walking
- Equipping the patient and/or caregivers skills for safe transfers and home exercises to ensure a smooth transition from hospital to home
General stroke rehab
There are many other skills and abilities that may need to be relearnt post-stroke. Some of these skills include:
- Swallowing, speech and language. A speech therapist will assess the patient for swallowing disorders which may be impaired by stroke. The speech therapist will also train the patient to cope and overcome language and speech difficulties to articulate and coordinate their speech sounds and finding the right words in speech or writing to better express themselves.
- Re-integrating into society. An occupational therapist will work with you to master day-to-day tasks like bathing, dressing yourself or preparing food. The occupational therapist will also advise you on home modifications, such as grabbing bars and wheelchair ramps, to cater to your new functional status.
You may also work with a dietitian that is tailored to your situation, or an occupational therapist if your living and caring arrangements need to change.
The importance of stroke rehabilitation
Stroke survivors are always treated with the long-term goal of regaining as much control over their bodies as possible and returning to the highest possible level of independence in their lives. Stroke rehabilitation is an essential part of rewiring neural pathways and connections in your brain to achieve this goal. There is still an element of unpredictability with every stroke case, but often with the right rehabilitation in place, patients can make remarkable recoveries.
The facts about recovery
For every 100,000 Singaporeans, 155 are affected by stroke. Stroke is serious but often preventable, so it’s important to stay in good health and keep an eye on the warning signs. If you do suffer from a stroke, rehabilitation is necessary to give you the best chance of recovery. Research shows that around 10% of all patients make a full recovery, and a further 25% recover with only minor impairments.
Your recovery from stroke can be impacted by:
- How quickly rehabilitation is started
- The extent of the damage to the brain caused by the stroke
- Your age and overall health
- Your motivation and commitment to rehabilitation
The rehabilitation process for a stroke usually takes around 3 – 6 months depending on the severity of the stroke. Some patients will need care for much longer or for life. Though many stroke survivors need to make significant adjustments to their lives, rehabilitation should be ongoing. You can continue to undergo rehabilitation at home or as an outpatient, and many patients report seeing continued improvements in the years that follow.
It is important to follow the guidelines set by your doctor and rehabilitation team post-stroke. Supplementing your rehabilitation programme with home exercises and continuing to work on your recovery after the programme ends are likely to increase your chance of regaining your abilities.
Speak to your doctor or physiotherapist about:
- Home physiotherapy and exercises for balance, coordination and strength
- Brain training exercises
- Recreational activities such as swimming
- Practicing day-to-day tasks
Preventing a stroke
Strokes are more common in those with underlying conditions such as high blood pressure, high cholesterol and diabetes. Get regular exercise, eat a healthy diet, and maintain a good level of overall health to prevent the occurrence of a stroke.
Watch out for these symptoms:
- Loss of vision
- Weakness or numbness on one side of the body
- Loss of coordination, balance, speech, or understanding
- Dizziness or falling
- Loss of consciousness
If you or a family member exhibits any of these symptoms, go to the nearest accident and emergency (A&E) department immediately. Remember, the faster a stroke is treated, the less chance there is of permanent damage.
Article reviewed by Isaac Okumura Tan, senior physiotherapist at Mount Elizabeth Hospital
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