Stroke rehabilitation

I thought in this post I shall discuss a little about stroke rehabilitation. A stroke can be devastating and causes significant morbidity and mortality. Stroke survivors are frequently left behind with neurological deficits. Common deficits include: motor (weakness on one side of the body usually arm and leg), speech deficits (patients may be left with a significant disorder of language. We call this aphasia and patients may have either difficully in comprehending speech or in the fluency of speech. Their speech may be slow and halting. At times they also have what we refer to as nominal aphasia also called anomia. These patients experience difficulty in naming things, like for example if you show them a pen, they would not be able to tell you that it is a pen. They shall know what it is used for but cannot get the name out). Patients may be left behind with residual numbness on one side of the body and depending upon the location of the stroke they may experience difficulty with seeing one half of their visual field (we call this a field cut). Some stroke patients are disabled by ataxia or unsteady gait, others may have disabling cerebellar symptoms.

Stroke rehabilitation plays a big role in the care of stroke patients. Contrary to popular held views, rehabilitation starts right at the onset of stroke and not once the acute stroke is over and the patient is been discharged. Now most of the big hospitals in the United States have acute stroke units. One of the biggest tenants of these acute stroke units is that rehabilitation is started soon after the patient presents to the hospital with an acute stroke. Studies have shown that the human brain has the maximum ability to heal and repair itself acutely (upto 6 months to a year) after a stroke. As time goes on, the brain loses this plasticity and the neurological deficits become more or less fixed. Thus  rehabilitation in the acute stroke setting plays a vital role. Usually patients are evaluated by physical medicine doctors (rehab doctors) while they are still in the hospital with the acute stroke. An assessment is made of their deficits and depending upon that we decide which rehabilitation services are needed. Patients may get physical and occupational therapy in the hospital. They may also be seen by a speech and language therapist so that speech therapy can begin.

Nowdays there are many different modalities of rehablitation therapy which have been proven to be of benefit to patients with stroke. One of the popular ones is constraint induced movement therapy. In this the good arm of the patient is immobilized so that the patient is forced to use the weak arm. Melodic intonation therapy has recently gained popularity too. This therapy uses a style of singing called melodic intonation to stimulate activity in the right hemisphere of the brain in order to assist in speech production in patients who have aphasia.

Stroke rehabilitation does not end once the patient is discharged from the hospital. Most of these patients benefit from ongoing rehab (as I stated earlier this mostly occurs in the first 6-12 months). Patients may either be discharged to a rehab unit or a sub acute rehabilitation facility where these therapies can be carried out in a less hospital like atmosphere.

It is Saturday afternoon New York time. I though pen this from across the seven seas (I am on vacation!!). Hope some of you find this useful.

Personal Regards,

Nitin Sethi, MD

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