Stroke, also known as cerebral vascular accident (CVA) or brain attack, is the third leading cause of death in the United States. It is also one of the most debilitating diseases, causing massive and often permanent physical and cognitive disabilities. One of the most important factors in the rehabilitation of a stroke patient is an exercise regimen that focuses on deficits caused from injury to the brain.
Sensorimotor Exercise
Stroke can cause physical symptoms such as flaccid or spastic limbs and generalized weakness. Fourteen percent of stroke patients make a full recovery. Twenty-five to 30 percent require assistance with activities of daily living, such as dressing, brushing teeth, bathing and eating. Fifty percent have at least partial paralysis for the remainder of their life. Exercises that isolate the effected extremity are suggested. These include things like touching the fingers and thumbs together in succession, grasping and letting go of objects, and general range-of-motion exercises. The goal is to increase the damaged neuropathway connections with the muscles of the extremities.
Strength Exercise
The stroke patient may have hemiplegia, meaning one side of the body has limited function. Muscle atrophy is a common finding in this instance, as are spasticity and rigidity of the affected extremity. Decreased circulation from lack of movement can increase the risk for blood clots, or deep vein thrombosis. Treadmill training is a common exercise for increasing overall strength and cardiovascular health. The goal is to maintain and possibly build muscle that has been lost due to the injury. For those with limited ability to stand, the use of hand rails and harnesses can assist or partially lift, so that the movement is challenging but safe.
Functional and Speech Exercise
Exercises to regain speech ability are an important part of stroke rehab. Hemiplegia can affect muscles on one side of the face and neck, as well as the voice box. This can cause slurred speech and a risk for swallowing difficulties while eating and drinking. A speech pathologist works with helping people recover from these difficulties. If a swallowing problem is suspected, consult your doctor immediately. Aspiration, or food entering the trachea, can lead to pneumonia, choking and death.
Endurance Exercise
Stroke patients may have an extended period of bed rest. This puts the person at risk for deconditioning and muscle atrophy. Increasing aerobic endurance is important after CVA. Walking is a way to rebuild aerobic conditioning. Stroke patients require increased oxygen consumption to perform actions after a stroke. Sometimes, twice as much oxygen is required for the same movement. Improving physical fitness can aid the patient for long-term recovery, even when full recovery is not achievable.
Communication Difficulties
Stroke patients are subject to diminished cognition and coping skills. Aphasia, the inability to communicate, may be present. This deficit can be either expressive aphasia, meaning that the person recognizes the request but cannot react or respond appropriately, or receptive aphasia, meaning that the interaction is not processed. Either one of these can hinder the ability to exercise. Depression is also a common finding related to the loss of independence and identity changes.
Other Factors
Include and encourage the patient's family and support system with the exercise program and the current goals of the therapy. It's important to begin rehabilitative exercises as soon as possible. The patient's mood and self-identity may be better maintained with an expedited plan for recovery. Other factors must be considered in the overall plan of care. Comorbidities, such as congestive heart failure, diabetes and sometimes blindness, can hinder or postpone an aggressive rehab plan. Consult your physician or rehab professional for any medically related concerns or questions.
