According to the World Health Organization, stroke is defined as the clinical symptom of local or overall dysfunction developed as a result of a disturbance of the cerebrum, which has lasted for more than 24 hours. Stroke is considered to be a global health problem affecting millions of people. Hypertension and cardiac diseases are the primary risk factors for stroke. Primary prevention of stroke is lifestyle modification to avoid the burden of the disease, considering the limited options in treatment.
Stroke can be categorized into ischemic and haemorrhagic strokes, accounting for 10% and 90% respectively. Haemorrhagic stroke occurs when blood flows into the outer spaces of cerebral tissue, thereby blocking the circulation. Ischemic stroke is due to the thrombus/clot blocking off the place (embolism).
If you find the above signs, do look for the global rule: Act F.A.S.T
F-Face: Is your face drooping to a side?
A-Arm: Is one arm weak or numb? Ask someone to raise both your arms. Does one drift downward?
S-Speech: Is your speech slurred?
T-Time: If you find any of the above symptoms, visit a doctor.
Effects of Stroke
Stroke limits the performance in activities of daily living, increases the risk of fall, risk in developing tightness /contractures / deformities, if left untreated. Also,
• Gait disturbance
• Speech disorders
• Motor and sensory impairments – spasticity/flaccidity
• Dysphagia (swallowing problems)
• Sexual dysfunction
• Bed rest induced deconditioning
Role of physical activity: Post Stroke
Research proves that participating in leisure time activities, ensuring regular physiotherapy, and medical treatment (until prescribed), produces effective results.
The main aim of including physical activity in stroke rehabilitation are:
• Improving aerobic capacity
• Improving sensory-motor function
• Improving daily activities
• Improving the quality of life
• Improving cardiovascular fitness
Several other important factors have been documented in research on how physical activity is proven effective as a preventive part of treatment.
• Lowers BP and improves lipid profiles
• Plays an anti-thrombotic role
• Improves muscle strength
• Improves coordination and sensory segments of the ailment
• Improves oxygen supply to the brain
• Physiological improvements
• Psychological strength
• Improved neuromuscular co-ordination
Exercising for 20-30 minutes a day, for 5 days a week, incorporating moderate aerobic activity like walking on a treadmill, cycling or elliptical training 46 can produce good results.
According to the observational research. In the Netherlands, it is prescribed that daily implementation of moderately intense physical activity is sufficient to achieve risk reduction for both total stroke and stroke subtypes. A physical therapy regime includes:
• Passive range of motion exercises
• Active assisted range of motion exercises
• Active range of motion exercises
• Resistance exercises
• Gait rehabilitation
• Being active in daily life
Prescribed physical activity for stroke victims
A physical therapist has an important role in rehabilitating a stroke patient. The aim of a neurological physiotherapist is ‘RAMP’ (Restore – Adapt – Maintain – Prevent). He further aims to improve the quality of life for each individual. His core strength includes assessing, designing, executing and planning ahead a progressive schedule of exercises. Through a series of examination, he evaluates the patient and categorises the patterns of weakness into hemiplegic (one side paralysis) or hemiparetic (weakness).
(for patients who have already achieved Gr-3 in Oxford Manual Muscle Testing scale)
• Flexibility: Stretching all the major muscle groups. The goal is to increase the range of motion and to prevent contractures
• Aerobic component: Ensure that balance is above average to good. The goal is to increase independence, increase walking/gait modulation and improve cardiovascular strength. Treadmill for 10-15 minutes or Static cycle for 10-15 minutes or Seated stepper for 10-15 minutes is advised.
• Strength/resistance exercises: Lighter weights and higher repetitions are suggested. Use of resistance bands, ankle weights, stability balls. etc. can be included.
• Circuit training – Upper limb/lower limb alternate days
Weight training – Single muscle a day
PNF – (Assistive and resistive exercises) both upper/lower extremities:
Flexion, abduction and external rotation of shoulder with elbow extended and with wrist and finger extension.
Extension, abduction, and internal rotation of shoulder with elbow extended and with finger and wrist flexion.
Flexion, abduction, external rotation of hips with knee flexion and ankle dorsiflexion.
Extension, abduction, internal rotation of hips with knee extension and ankle plantar flexion.
Psychological support from both family and society is required for complete
Co-ordination and balance exercises
• Standing on single leg.
• Sliding heel on shin with eyes closed.
• Yoga exercises can also be incorporated.
• Water walking with support increases the balance and also strengthens the muscles.
• The buoyancy of water, eliminates pain and excess effort, and is therefore comfortable for the patient.
The Locomotor Experience Applied Post Stroke (LEAPS) trials results show that, 52% of the people who underwent either physical therapy or a home based programme that included “walking” on a treadmill (with body weight supported), had significantly improved functional walking ability after a year.