EPIDERMIOLOGY
According to WHO, stroke is the third leading cause of mortality worldwide, accounting for approximately 4.6million deaths annually. Research, in Nigerian hospitals show that, stroke constitutes 3.7% of emergency admission, 8.7% of medical admission and 4-17% of medical deaths.
PATHOPHYSIOLOGY OF STROKE
There are primarily two types of stroke:
• Ischaemic stroke
• Haemorrhagic stroke
Ischaemic stroke is caused by blood clots that block an artery supplying the brain, either in the brain itself or in the neck (carotid artery). It is subdivided into: Cerebral thrombosis; clots are often formed due to hardening(atherosclerosis) of brain arteries or Cerebral embolism; blood clot from elsewhere in the circulatory system breaks free and becomes lodged in an artery supplying the brain, either in the brain or in the neck.
Hemorrhagic stroke occurs when a blood vessel bursts around or in the brain. It can be sub divided into: Subarachnoid and Intracerebral hemorrhage.
Transient ischemic stroke (TIA) is a temporary blockage of blood supply to the brain, typically caused by embolus and usually lasting 10mins or less during which dizziness, blurring of vision, numbness on one side of the body and other symptoms of stroke may occur.
RISK FACTORS (NON MODIFIABLE)
• Age
• Race
• Heredity
• Gender
• Prior transient ischemic stroke
RISK FACTORS (MODIFIABLE)
• Hypertension
• High cholesterol
• Obesity
• Diabetics
• Smoking
• Cardiac disease
• Sicke cell disease
WARNING SIGNS OF STROKE
• Numbness, weakness or paralysis of the face , UL and LL
• Blurred vision
• Dysphagia
• Disarthria
• Dizziness
• Loss of balance
• Sudden, severe unexplained headache
• Sudden confusion
COMPLICATIONS OF STROKE
• Pain
• Contractures
• Spasticity
• fatigue
• Facial weakness
• Dysphagia
• In coordination and balance
• Weakness or paralysis of one side of the body
• Incontinence
• Anxiety and depression
• Seizure
• Vision problems
• Deep venous thrombosis
• Pressure ulcer
DIAGNOSIS
• CT scan
• MRI
• Angiography
• ECG
• Transcranial Doppler
PROGNOSIS
• The prognosis of a stroke patient depends on the severity of brain damage
• 50 – 70% of survivor regain near-normal status
• 15 -30% become permanently disabled
• 20% require specialized health care
• 14% of those who survive a TIA will have a subsequent one in a year
• 22% of men and 25% of women who have TIA will die in a year. the rate is higher among those above age 65
PREVENTION
• Control blood pressure
• Control cholesterol
• Control diabetes
• Quit smoking
• Control alcohol use
• Treat circulation problem
• Eat a healthy diet
• Exercise regularly
PHYSIOTHERAPY MANAGEMENT
Stroke rehabilitation; is the process by which patients with disabling strokes undergo treatment to help restore function with the goal of maximizing a person’s ability to achieve fullest functions possible. Acute stroke patients are usually attended to by physicians, until they are medically stable rehabilitation program starts with musculoskeletal and system assessment.
ASSESSMENT PROCEDURES
• History taking
• Physical Examination
TREATMENT AIMS IS TO:
• Relieve pain
• Reduce muscle spasm and stiffness
• Prevent contractures
• Improve ROM
• Improve balance and coordination
• Improve strength and endurance
• Improve gait pattern
• Correct facial deviation
• Improve muscle tone
• Prevent muscle atrophy
• Maintain the physiological properties of muscles and soft tissues
MEANS OF TREATMENT
Modalities for pain relieve
• IRR (10-15 minutes can be used)
• STM with topical NSAIDs
Modalities to improve ROM
• PM, AAROM, PNF and isotonic exercises
Modalities to improve endurance and loss of muscle power
• Treadmill, cycle ergometer
• Step climbing
• Bridging exercises and call up for trunk strengthening
Modalities to correct facial paralysis
• Electrical stimulation (ES)
• IRR (10-15minutes)
• Tactile stimulation to the facial muscles
Modalities for gait training
• Standing reeducation
• Walking reeducation
• Proper Positioning
Modalities for balance training
• Walking within the parallel bar
• Balance sitting exercises
• Ipslateral monopedal loading
• Rhythmic isometrics, alternate stabilization
• Bobath’s technique
• Frenckel’s exercises
CONCLUSION
In conclusion, a research carried out in Bayelsa State showed that hypertension was the major cause of stroke affecting active social group (40-70 years) in the state. There should be renewed emphasis on access to safety, effective medication, lifestyle change and primary prevention of stroke and its risk factors in the state (Oni, Eweka, Otuaga and Prefa; 2008).
BY HALIMA BUKAR TARFA
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