Stroke Rehab

What is a Stroke?

A stroke, medically termed a Cerebrovascular Accident (CVA), is a form of brain injury occurring from restricted blood flow to specific areas of the brain (Ischaemic Stroke) or bleeding within the brain tissues (Haemorrhagic Stroke) (Al-Qazzaz et al., 2014). 

Consequently, these regions are deprived of oxygen, disrupting normal neural function, and potentially causing motor or cognitive impairments (Heiss, 2012).

What does it do to you? 

The impact of a stroke varies depending on the specific area of the brain affected, potentially resulting in a range of impairments such as:

Motor dysfunction: 

• Hemiparesis: muscle weakness on one side of the body.
• Hemiplegia: loss of function on one side of the body.
• Ataxia: Impaired / loss of balance and coordination.
• Spasticity: increased muscle tone, leading to stiffness and impaired motor control. 
• Apraxia: difficult planning and executing movements.
• Dysphasia: difficulty with swallowing.
• Impaired gait patterns and thus reduced walking capacity.
• Impaired fine and gross motor skills. 

(Al-Qazzaz et al., 2014; Langhorne et al., 2000)

Cognitive impairments:

• Memory loss, confusion, and disorientation.
• Reduced attention span.
• Aphasia: difficulty with speech and language.
• Execution dysfunction such as impaired planning and decision-making.
• Emotional changes such as heightened anxiety or depression symptoms.

(Al-Qazzaz et al., 2014)

Why do Exercise and Physical Therapy Matter after you suffer from a stroke?

Engaging in exercise is an effective and viable way of enhancing both motor function and cognitive rehabilitation following a stroke. Exercise can promote and facilitate neuroplasticity in the brain (Xing & Bai, 2020). Neuroplasticity is the process by which our brain changes and adapts in response to various stimuli to learn a new behaviour or task. For example, through consistent practice of certain challenging movements following a brain injury, your brain has the ability to potentially reorganise itself, bypassing the damaged area, and allowing you to regain some function in hat impaired movement/skill. These results can be dependent upon the severity of your injury and the following rehabilitation (Kim, 2022; Xing & Bai; 2020). 

How will exercise help your day-to-day living?

• Promote motor function for improved ability to perform activities of daily living such as eating, manoeuvring around the house, and improving your ability to stand or sit when using the bathroom. 
• Reduce participation restrictions such as increasing your access to the community, and motivate you and improve your function to continue with recreational or social activities.

What exercises should be included? 

Any exercise that challenges you and is performed repetitively (i.e. multiple repetitions) to facilitate neuroplastic changes. 

The following are STRONG physical therapy recommendations published on the Stroke Foundation Guidelines: 

“For stroke survivors who have difficulty in standing up from a chair, practice of standing up should be undertaken” (Stroke Foundation, 2023). 

“For stroke survivors who have difficulty with standing, activities that challenge balance should be provided” (Stroke Foundation, 2023).

“Stroke survivors with difficulty walking should be given the opportunity to undertake tailored repetitive practice of walking (or components of walking) as much as possible” (Stroke Foundation, 2023).

**Client achievement at BodySmart Health**

Mr. X significantly enhanced his walking ability by doubling both the duration and speed of his treadmill exercise. He started walking for 1 minute at 0.8kph and progressed to walking for 2 minutes at 2kph after 4 months of physical therapy with an Accredited Exercise Physiologist. 

References: 

Al-Qazzaz, N. K., Ali, S. H., Ahmad, S. A., Islam, S., & Mohamad, K. (2014). Cognitive impairment and memory dysfunction after a stroke diagnosis: a post-stroke memory assessment. Neuropsychiatric disease and treatment, 10, 1677–1691. https://doi.org/10.2147/NDT.S67184

Heiss, W.D. (2012) The ischemic penumbra: how does tissue injury evolve? Ann N Y Acad Sci, 26–34. https://doi.org/10.1111/j.1749-6632.2012.06668.x

Kim Y. W. (2022). Update on Stroke Rehabilitation in Motor Impairment. Brain & NeuroRehabilitation, 15(2), e12. https://doi.org/10.12786/bn.2022.15.e12

Langhorne, P., Stott, D. J., Robertson, L., MacDonald, J., Jones, L., McAlpine, C., Dick, F., Taylor, G. S., & Murray, G. (2000). Medical complications after stroke: a multicenter study. Stroke, 31(6), 1223–1229. https://doi.org/10.1161/01.str.31.6.1223

Stroke Foundation. (2023). Clinical Guidelines for Stroke Management. Retrieved 26 March, 2024, from https://informme.org.au/guidelines/living-clinical-guidelines-for-stroke-management 

Xing, Y., & Bai, Y. (2020). A Review of Exercise-Induced Neuroplasticity in Ischemic Stroke: Pathology and Mechanisms. Molecular neurobiology, 57(10), 4218–4231. https://doi.org/10.1007/s12035-020-02021-1

About the Author: 

Prishani Laxman – Accredited Exercise Physiologist and is based out of our Beenleigh and Redcliffe clinics.

If you would like to make an initial appointment with any of our available Physiotherapists or Exercise Physiologists to assess you, and develop a treatment plan for your stroke rehabilitation, you can contact us on 1300 630 204 or email reception@bodysmarthealth.com.au