But for all this word salad do you ever discuss the appalling failure rate that only 10% fully recover?
A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals
1
Department of Physical Therapy, Ikram Hospital, Gujrat 50700, Pakistan
2
Center of Physical Therapy, Rayan Medical Center, Gujrat 50700, Pakistan
3
Department of Senior Health Care, Eulji University, Uijeongbu 11759, Republic of Korea
4
Research Institute of Environment & Biosystem, Chungnam National University, Daejeon 34134, Republic of Korea
*
Author to whom correspondence should be addressed.
Brain Sci. 2023, 13(5), 717; https://doi.org/10.3390/brainsci13050717
Received: 14 April 2023
/
Accepted: 21 April 2023
/
Published: 25 April 2023
(This article belongs to the Section Neurorehabilitation)
Abstract
Stroke is the fourth leading cause of mortality and
is estimated to be one of the major reasons for long-lasting disability
worldwide. There are limited studies that describe the application of
physical therapy interventions to prevent disabilities in stroke
survivors and promote recovery after a stroke. In this review, we have
described a wide range of interventions based on impairments, activity
limitations, and goals in recovery during different stages of a stroke.
This article mainly focuses on stroke rehabilitation tactics, including
those for sensory function impairments, motor learning programs,
hemianopia and unilateral neglect, flexibility and joint integrity,
strength training, hypertonicity, postural control, and gait training.
We conclude that, aside from medicine, stroke rehabilitation must
address specific functional limitations to allow for group activities
and superior use of a hemiparetic extremity. Medical doctors are often
surprised by the variety of physiotherapeutic techniques available; they
are unfamiliar with the approaches of researchers such as Bobath,
Coulter, and Brunnstrom, among others, as well as the scientific
reasoning behind these techniques.(And why are you referring to Bobath as a valid intervention?
Bobath should have been shitcanned since 2003.
My best therapist supposedly used it but I really think her competence came from her knowledge of anatomy.
Physiotherapy Based on the Bobath Concept for Adults with Post-Stroke Hemiplegia: A Review of Effectiveness Studies 2003)
1. Introduction
A
cerebrovascular accident (CVA), also known as a stroke, is a focal
neurological deficit that results from different vascular lesions that
interrupt brain function. Stroke is the leading cause of mortality [1,2], and for many patients, represents a major cause of disability affecting widespread areas of function [3,4,5].
Stroke is divided into two categories based on pathophysiology, of
which an ischemic stroke, also known as a cerebral infarction, results
from the occlusion of a major cerebral artery due to thrombosis or
embolus formation and is the most common type of stroke, affecting
approximately 80% of patients who suffer from a stroke [6].
The other type of stroke is a cerebral hemorrhage, which occurs when
blood vessels rupture causing blood leakage inside or outside the brain.
Its etiology is based on the history of hypertension, aneurysm,
anticoagulant therapy, trauma, or age. The incidence rate of this type
of stroke is 15–20% [7].
The risk of stroke can be greatly decreased by making lifestyle
changes. One can reduce his or her chances by controlling blood
pressure, quitting smoking, eating a healthy diet, and exercising on a
daily basis [8,9,10]. A stroke also has emotional and socioeconomic consequences for patients.
The
United States reports more than 600,000 new cases of stroke every year,
whereas the number of new cases per year is over 25,000 in Sweden [11].
A study was conducted on stroke patients in the Netherlands, and the
incidence rate of stroke was estimated to rise from 1.8 per 1000
individuals in the year 2000 to 2.8 per 1000 individuals in 2020 [12].
Evers et al. indicated the proportion of healthcare expenditure
associated with CVAs in six major states to be 3% on average [13].
Earlier studies claimed that in the United Kingdom, CVAs consume more
than this percentage, with total direct health expenses for stroke
sitting between 4 and 6% in the National Health Service [14]. According to one study, the number of stroke incidents per 1000 people ranged from 1.33 to 1.58 [15].
Annually, the victims of stroke spend approximately nine billion pounds
on matters directly or indirectly related to their stroke [16].
A survey conducted in 2012 found that the rate of prenatal discharges
with a stroke diagnosis was 34.2 per 100,000 births, with 2850 cases
reported. Incidence, death, and disability related to a
pregnancy-related stroke were higher than previously reported,
particularly among African American women who had a higher risk [17].
In China, 7672 individuals were diagnosed with stroke prevalence (1596
per 100,000) and 1643 were diagnosed with stroke incidence (345 per
100,000) per year in a survey population of nearly 480,687 people [18].
The
main objectives of rehabilitation treatment and physical therapy
interventions following a stroke are to enhance the patient’s functional
capabilities, foster self-reliance, and enhance their overall quality
of life [19,20].
There are numerous types of interventions available that are customized
to address the specific requirements of each patient [21,22,23].
Among these, physical therapy is one of the most prevalent types of
rehabilitative treatment provided after a stroke. Physical therapists
work with stroke patients to improve their strength, coordination, and
balance, with the goal of helping them regain the ability to perform
everyday activities such as walking, dressing, and bathing [24,25].
Therapy may include exercises, stretching, and range of motion
activities, as well as training on mobility aids such as walkers or
canes [26].
Occupational
therapy is another important part of post-stroke rehabilitation.
Occupational therapists work with stroke patients to help them regain
the ability to perform activities of daily living (ADLs), such as
cooking, cleaning, and personal grooming [27].
This may involve adapting the patient’s environment, such as installing
grab bars in the bathroom, or using adaptive equipment, such as a
specialized utensil for eating [28]. Speech therapy is also commonly used to help stroke patients recover their ability to communicate effectively [21].
Speech therapists work with patients to improve their speech and
language skills, as well as to address any swallowing difficulties that
may have arisen as a result of the stroke. Sire et al. highlighted the
necessity of incorporating specific oral interventions into
multidisciplinary rehabilitation programs for stroke survivors affected
by buccal hemineglect [29].
Other
rehabilitative treatments and physical therapy interventions for stroke
patients may include music therapy, recreational therapy, and cognitive
therapy [30,31,32].
The selection of interventions used will be based on the individual
needs and capabilities of the patient. In a nutshell, post-stroke
rehabilitative treatment and physical therapy interventions are
essential for enhancing recovery and improving quality of life for
stroke patients. A comprehensive approach that addresses the physical,
occupational, and speech therapy needs of each patient can help maximize
their functional abilities and promote independence [33].
The primary objective of this paper is to raise awareness of the
crucial interventions and strategies involved in managing stroke
patients during different stages of recovery, and to highlight the
critical role that physical therapists play in helping patients regain
function after a stroke. The review outlines several evidence-based
physical therapy interventions that have been shown to produce
significant improvements in various stages of CVAs.
More at link.
