Rehabilitation after stroke: what it is and how it is performed.

A description of the rehabilitation measures used in patients after a stroke.

More and more people are suffering from strokes such as cerebral infarction, a condition caused by blockage of the Blood vessels of the brain due to narrowing of the arteries or clogging by a blood clot.

To prevent it, it is essential to lead a healthy life and avoid risk factors such as smoking or obesity. And above all, it is very important to tackle this type of stroke in time and to begin, as soon as possible, rehabilitation at all levels, so that the person can regain functional autonomy and return to daily life.

In this article we explain how rehabilitation is carried out after suffering a cerebral infarction and what activities are carried out in this process.

What is a cerebral infarction?

A cerebral infarction, also called ischemic stroke, occurs when there is a sudden reduction of blood supply to the brain, is produced when there is an abrupt reduction of the blood supply in the brain, generally caused by an obstruction in the blood flow.usually caused by a blockage or hemorrhage. This type of stroke occurs when a blood vessel ruptures or narrows (thrombosis), or when it becomes clogged by a clot (embolism), for example; and the consequence is that certain areas of the brain do not receive the oxygen and glucose they need.

Normally, cerebral infarctions occur suddenly and develop rapidly, worsening with the passage of time.They worsen over a period of hours if they are not dealt with quickly. Strokes are more frequent in people over 55 years of age, and are the most frequent cause of mortality among women, and the second cause in men. Bad habits such as smoking, a sedentary lifestyle or obesity also have a negative influence, increasing the risk of suffering a stroke.

People with a family history of stroke, diabetes and sleep apnea syndromes also have a higher risk of suffering a stroke of this type. Each year, about 130,000 people are affected by stroke.One third of them suffer sequelae ranging from motor difficulties to cognitive impairment and loss of functional autonomy.

However, there are two key elements in dealing with a phenomenon such as this: on the one hand, prevention, which involves raising awareness of the benefits of simple habits such as exercise and a healthy lifestyle; and on the other hand, early detection and rehabilitation. We will now discuss this second part, which is essential for the patient's recovery after a stroke.

Rehabilitation after a stroke

When a person is suffering a cerebral infarction, there are a number of characteristic symptomsNumbness or weakness on one side of the body, sudden confusion, difficulty walking and incoordination, and headache. When this occurs, emergency services should be activated quickly and the person should be taken to the nearest hospital. The person will then be referred to the Stroke Unit, which specializes in these disorders.

Once the necessary medical tests have been performed and a diagnosis has been made, the patient will remain in the hospital until he or she is clinically stable. The first few hours are very important, as signs may be evident that indicate more or less extensive injuries that will later be used to plan an adequate rehabilitation. Although the brain tries to recover damaged functions spontaneously (by restructuring healthy tissue), it is often (by restructuring healthy tissue), this is often only possible to a certain degree, and is not always achieved.

After medical discharge, the stroke patient will start the rehabilitation plan, which includes a multidisciplinary therapeutic approach that will vary according to the needs of each person. This must be initiated early and coordinated among the different healthcare professionals who will be part of the patient's life throughout the recovery process.

Physical rehabilitation

The physical rehabilitation of the patient will be based on the parts of the body and the physical abilities that have been affected after the stroke. The main objective is to recover, totally or partially, the functional autonomy and basic skills such as: walking, having a stable body, keeping balance, etc. and basic skills such as: walking, keeping the body stable, maintaining balance, etc.

The physical rehabilitation plan also includes physical activities that may include: mobility training (use of canes, ankle braces and mobility aids in general), fine and gross motor exercises (to improve coordination and muscle strength), constraint-induced therapy (restricting the unaffected area while practicing movement with the injured limb) and range-of-motion therapy (for patients with spasticity problems).

Nowadays, thanks to technology, new practices have been incorporated to address physical rehabilitation after stroke, such as: functional electrical stimulation, robotic technology, virtual reality or wireless technology. All of these technology-assisted physical activities are used to improve weakened muscles and to re-educate certain patterns of movement. and to reeducate certain movement patterns that have been affected by stroke.

2. Cognitive rehabilitation

Cognitive problems and alterations in language, memory, attention and concentration, among others, may appear after a stroke. The aim of cognitive rehabilitation is to slow down and reduce the negative impact of these alterations by stimulating the different cognitive functions that have been damaged by the stroke, by taking advantage of the brain's neuronal plasticity, which allows neurons to regenerate functionally and anatomically to form new connections. to form new connections.

In most strokes in which there is cognitive impairment, the patient experiences difficulties in orienting himself temporally and spatially. In this sense, therapies focused on orientation will facilitate that, in the early stages of rehabilitation, the person has a better personal and spatial-temporal location.

Cognitive stimulation tasks in patients with cerebral infarction can be performed on paper or assisted by technology (generally a computer or tablet), depending on each person's preserved abilities.

The neuropsychologist in charge of rehabilitation must pay attention not only to progress at the cognitive level, but also to the other contextual variables related to the family, social and/or work environment of the person who has suffered a stroke. Ultimately, the ultimate goal of this rehabilitation process is for the person to obtain the greatest possible functional autonomy and to be able to carry out daily life tasks correctly.

3. Speech therapy rehabilitation

Language alterations after a cerebral infarction are a great handicap for the patient, especially if they involve clinical manifestations such as aphasia, which involves an inability to utter or understand language; or dysarthria, which involves difficulties in articulating sounds and words.

The speech therapist is the professional in charge of that the patient recovers the functions of the language and his communicative skills.. Generally, reading, writing, expression and language comprehension exercises are performed, with methods ranging from verbalization of sentences at a certain rhythm, naming images or discrimination of phonemes.

In any case, the objective of speech therapy rehabilitation is for the patient to recover the linguistic capacity he/she had before the stroke; or, at least, to recover a certain functional autonomy that will allow him/her to communicate with others and interact with his/her environment in the best possible way.

4. Occupational therapy

Occupational therapy is part of the stroke rehabilitation process and its objective is to achieve the following the patient to regain the ability to perform basic and advanced activities of daily living, so that he/she can reintegrate into the community.so that he or she can be properly reintegrated into society after the stroke.

During the occupational therapy process, healthcare professionals assess the possible adaptations of the environment and the incorporation of support elements for the patient. Sometimes, people who suffer a stroke need to modify some elements of the home so that they do not have difficulties in their reincorporation: for example, by installing a stair lift in their doorway, modifying the furniture or replacing the bathtub with a shower tray.

Stem cells: the latest in rehabilitation

In recent years, a new therapy based on the implantation of neural stem cells has been studied to recover lost functions in patients who have suffered strokes. Studies have used mice with stroke that have been implanted with stem cells of mesenchymal origin.encapsulated in a harmless and biocompatible material, such as silkworm fibroin, a type of very fibrous protein.

In the experiments carried out, it has been observed that the animals to which animals to which this stem cell therapy was implemented significantly improved the motor and sensory abilities that had been affected after suffering that had been affected after suffering a cerebral infarction. Furthermore, it has been shown that encapsulation increases the survival rate of the implanted stem cells, thus positively influencing the repair of damaged brain tissue and preventing its extension after the stroke.

In short, the researchers are working on the future development of drugs that are capable of stimulating this type of stem cells found in the brain, so that they can multiply, move to the affected areas of the brain and begin the cell repair process.

Referencias bibliográficas:

• Brott, T., & Bogousslavsky, J. (2000). Treatment of acute ischemic stroke. New England Journal of Medicine, 343(10), 710-722.
• Patel, M., Coshall, C., Rudd, A. G., & Wolfe, C. D. (2003). Natural history of cognitive impairment after stroke and factors associated with its recovery. Clinical rehabilitation, 17(2), 158-166.
• Rodríguez García, P. L. (2014). Ictus isquémico: avances y proyecciones. Revista Cubana de Neurología y Neurocirugía, 4(1), 71-88.