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Stroke and the role of the physical therapist

MARIA YOST

Unfortunately, in our area, we see the impacts of a stroke all too often. Higher risk has been identified for people over a certain age (about 50, but the trend is showing that people even younger are being impacted more), gender (male more than female) and race (African Americans have a higher risk). Those are some of the risk factors that you cannot change.

There are many risk factors that you CAN change!

  • You can stop smoking now.
  • You can make healthy changes to your diet.
  • You can start exercising regularly.

These are just a few, but the impact is significant. And the list is not overwhelming. Choose one thing to change, and you have improved your risk. The even better news is that changing these things makes a huge impact on health overall. Chronic disease responds to healthy changes in your lifestyle.

You can get help to quit smoking. It is not easy, but your medical provider will be glad to help you. Positive effects can begin just 20 minutes after quitting. Enlist the people around you to help. The more support you build into your day, the more successful you will be.

Healthy changes to your diet are easier than you think. Many people find it very easy to cut out soft drinks and increase intake of water. Add more fresh fruits and vegetables to your day. When you make your meal, vegetables should be the largest portion on your plate. Choose meats that have a lower fat content, and prepare them grilled or baked rather than fried. Very simple changes make a huge impact.

Exercise means something different for each person. General guidelines for healthy adults include 150 minutes of moderate exercise activity each week. Research has shown that you can space this out over the whole week and even throughout each day to accomplish the goal. The key is to find something you like (or at least don’t hate) to do. Find a friend to walk with. Dance (by the way, it is hard to dance moderately for that long, but if you can then go for it). Exercise is whatever movement you can do at a level that would be considered moderate intensity. This is different for everyone, meaning what is moderate for me is different than what is moderate for you. If you finish exercise and you don’t feel like you did much — you are right, you didn’t.

As a physical therapist, for 24 years I have helped people who have suffered from the effects of a stroke and have residual functional deficits. People who have already suffered a stroke need to make lifestyle adjustments immediately, with the help of their healthcare team. If you have had one stroke, you have a much higher risk of having another one. Depending on where (in the brain) the stroke occurred, the deficits can range from mild to severe.

Paralysis of the face, arm or leg (usually on one side of the body) can occur. This can cause significant limitations in basic mobility, transfers and can alter walking patterns. Physical therapists work to facilitate the return of muscle function and assist the patient in returning to independence. We facilitate new movement patterns by using different hand placements, electrical stimulation and repetitive movements. There has been some research that shows that strengthening the uninvolved side can actually have some carry over to the affected side. Many times the “weakness” felt after stroke is that it is not exactly weakness, but the pathway from the brain to the affected arm or leg has been disrupted. Our interventions work to realign those pathways.

There are also times that there is return of muscle movement, but the proper pattern of movement is interrupted. Physical therapy intervention would focus on improving coordination and control during mobility. We address speed and accuracy of movements of the arms and legs and how they coordinate with trunk movements. Balance in sitting and standing are impacted many times and those foundation movements impact walking and transfers.

Stroke can also cause impairment of sensory function. For some, that means numbness of the affected side. Others may have decreased awareness of that side. This causes safety concerns when the patient may not even acknowledge the affected side. It impacts awareness of body position. Physical therapists can use verbal, tactile and visual feedback to help retrain these pathways.

Rehabilitation should start as soon as possible, once the patient is medically ready to participate. Recovery from a stroke varies from person to person. The fastest portion of recovery is in the first six months after the stroke, but can occur up to 1 1/2 years after the stroke. Compliance with the program for recovery is a key component in getting the most out of recovery. The program is more than just physical — the lifestyle components are very important for future health.

Physical therapy, occupational therapy and speech therapy work closely with the patient and their provider to optimize recovery. This has focused on physical therapy, but, honestly, the patient benefits from the expertise of all disciplines working together. The Rehabilitation team works to address all needs of the patient, progressing towards the patient’s goals!

Maria Yost, PT, CLT, MBA, is manager of rehabilitation services at Vidant Beaufort Hospital and can be reached at 252-975-4395.