Stroke is ranked as the second commonest cause of death in the world and the third most common cause of disability-adjusted life years according to the Global Burden of Disease, Injuries and Risk Factors study of 2010.
The effect of a stroke on a person depends on the area of the brain affected by the stroke. Some patients may become hemiplegic with some loss of sensation while some may lose the ability to comprehend speech or express themselves. Stroke can be mild in that it may cause minimal weakness affecting only the hand or it can be severe causing profound disability or even death.
The main type of disabilities that a stroke can cause include:
- Sensory loss
- Communication difficulties- inability to talk/express oneself or inability to understand speech or both
- Difficulties in though process
- Memory problems
Stroke rehabilitation is an important part of recovery after stroke. There is currently no medication which has shown good evidence of reversing the disability from stroke. The goal of stroke rehabilitation is to help the stroke patient relearn skills lost due to a stroke. Research has shown that participating in a focused stroke rehabilitation programme helps stroke patients perform better than those who do not.
The type of rehabilitation programme depends on:
- The disability caused by the stroke
- The severity of the stroke
- Other medical problems the stroke patient has
- Family and community support
Stroke rehabilitation is best when carried out by a multi-disciplinary team of health professionals such as physiotherapists, occupational therapists and speech therapists under the leadership of doctors trained in rehabilitation medicine. Stroke rehabilitation works best when the patient, family and rehabilitation team work together. There should be achievable goals decided mainly by the patient and family with guidance from the team. The therapy is then designed to meet these goals which are reviewed regularly by the team, patient and family to ensure the goals are met, readjusted if not met and to make new goals. There should be an agreed time frame for these goals. Thus each programme is individualised to meet each person’s specific needs.
Some general treatment components include:
Treating complications of stroke such as spasticity, difficulty swallowing, pressure sores and pain
Improving the function of a person in terms of self care, ability to perform house work and at work
Providing adaptive equipment and ensuring the environment is safe such as grab bars in toilet and shower chairs in the bath.
Stroke rehabilitation should be started as soon as possible after acute medical care to stabilise the patient. It is then continued as an inpatient until the patient is stable enough to go home. The patient can also be transferred to a rehabilitation hospital to continue rehabilitation as an inpatient or at a rehabilitation centre as an outpatient such as our centre in KPJ Tawakkal Health Centre. A rehabilitation centre would have the expertise as well as the necessary equipment to enable the patient to be become as independent as possible. Our centre also has Rehab Independent Living Units (RILU) where the patient can be trained to be independent in a home-like setting. This would enable patients to be independent not only in personal care such as grooming or toileting but also to do domestic activities of daily living such as preparing their own meals and cleaning up. The discharge destination as well as the type of rehabilitation service is dependent on the severity of the stroke as well as the rehabilitation potential of the patient. It should ideally be done after being assessed and discussed with a rehabilitation medicine specialist.
Stroke rehabilitation can help a person recover from the effects of a stroke, relearn skills and develop new ways to do things. However the patient must be motivated and realise that the process takes time. A good relationship with the rehabilitation team is vital for the success of the stroke rehabilitation programme.