By Karolina Kozlova, PT, DPT, Neurologic Clinical Specialist
What causes Cerebrovascular Accident (stroke)?
A cerebrovascular accident (CVA) is a medical emergency involving the brain and the blood vessels supplying it. This is known as a stroke and can occur when a clot blocks blood flow to a region in the brain, depriving it of oxygen and the nerve cells die or a blood vessel bursts causing bleeding into and around the brain. Strokes usually result in significant disability, decreased function, and sometimes death. Approximately two-thirds of individuals survive and some need to undergo rehabilitation.
Diagnosis/functional limitations summary
Once stabilized and diagnosed by their physician, most patients undergo inpatient physical rehabilitation with the main goal for returning to independent activities at home, work and in the community. However, upon discharge, therapy isn’t always a daily priority and functional gains can decrease. Patients can have difficulty with walking, moving from various surfaces, balance, reaching and daily tasks, such as cooking, grocery shopping, and/or recreational activities.
Recommended activity levels/precautions
Post stoke, in the hospital setting, physical therapists teach movement strategies to stand, sit, walk, and ascend/descend stairs safely, as well performing some form of exercises. Upon gaining better mobility, the patient can progress into more strengthening and walking/balance activities. Depending on the level of the stroke, severity and residual functional limitations, outpatient neurological physical therapy recommendations include daily and weekly aerobic exercise and constant repetition of functional activities (stairs, walking, house/outdoor tasks), and an individualized exercise plan. Precautions can include: control of high blood pressure, fall prevention strategies, and/or maintenance of weight or diabetes.
Recent evidence to support exercise
With specific therapeutic training, your brain has the ability to change and repair itself after injurythrough a concept known as neuroplasticity.
There is current strong evidence that once discharged home, patients who are >6 months post-acute onset of stroke should engage in: walking training at moderate to high intensities and/or virtual reality-based training for those who are more ambulatory.
Typically, spontaneous recovery is more apparent within the first 2-3 months post stoke and little recovery is expected beyond 6 months, but neuroplasticity can still occur.
Research has shown (and it is strongly recommended) that patients should engage in exercise therapy during chronic phases of stroke to improve balance capacities with exercise regimes that include individualized balance, weight shifting and gait training.
Breakdown of types of exercises that will be addressed with therapy
Depending on initial neurological evaluation, treatment will address disabilities related to motor and sensory impairments such as problems with movement, balance, and coordination. Your program may also include exercises to regain range of motion, strengthening of muscles and therapeutic techniques to help with neuroplasticity.
Summary of progression/therapy expectations/outcomes
Therapy can include various techniques such as constraint induced therapy thereby restraining your stronger arm, you are “forced” to utilize the affected arm to perform daily tasks and build strength/control. Therapy can also include education and practice with proper positioning of limbs to help reduce any muscle pain, spasms, and or stiffness, as well as practice with motor imagery and mental stimulation.
Initial evaluation may include measurements that may be evaluated can include testing of endurance, walking speed, functional gait and strength as well as an assessment of your balance confidence via a subjective scale. Based on scores, goals will be set, and progress measured/updated, as therapy progresses. The most functional gains are made within 6 months post stroke, but gains can be made years post CVA with consistency and repetition.