When someone has a stroke their brain’s blood supply is either interrupted or reduced. When this happens, brain tissues can’t get all the oxygen or nutrients they need, which can cause damage. Around 105 and 152/100,000 individuals have a stroke each year in India, and it is the fourth leading cause of death and fifth leading cause of disability. About 87% of strokes are ischemic strokes, which happen when a blood clot blocks blood flow in the brain. The remaining 13% of strokes are typically hemorrhagic strokes, which are caused by a blood vessel rupture in the brain. 

Stroke is dangerous and deadly, but you can avoid stroke by treating several of its main modifiable causes like High Blood pressure, smoking, Diabetes, High Cholesterol, Cardiovascular diseases, AVMs, Aneurysms, excessive alcohol intake, and Physical inactivity. But there are some risk factors that you can’t control like age, family history, gender, prior TIA, or heart attack. 

How to tell if someone is having a stroke? 

B.E.F.A.S.T. 

A helpful way to remember the signs of a stroke is by using the acronym B.E.F.A.S.T. 

B – Balance problems 

Is the person having trouble staying coordinated or balanced? Do they feel dizzy? Are they stumbling as they walk? 

E – Eyesight issues 

Does the person have blurry or blackened vision? Are they seeing double or having other eyesight problems? 

F – Face drooping 

Is one side of the face drooping or numb? Ask the person to smile and look to see if one side of their mouth is drooping. 

A – Arm weakness 

Is one arm weak or numb? Can the person raise both arms at the same time? If both arms are raised, does one slouch or sag below the other? Strokes often affect one side of the body, so arm weakness – or leg weakness – can be an important sign to watch for. 

S – Speech difficulty 

Is speech slurred or hard to understand? Is the person confused? Ask the person to repeat a simple phrase and listen for anything strange. 

T – Time to call Ambulance 

If someone is experiencing one or more of these stroke symptoms, it’s time to call Ambulance.  

How is Stroke Treated? 

A stroke can cause lasting brain damage, long-term disability, or even death. Signs of a stroke can range from mild weakness to paralysis or numbness on one side of the face or body. Other signs may include a sudden and severe headache, sudden weakness, trouble seeing, and trouble speaking or understanding speech. 

Stroke is a medical emergency, and seeking early treatment is crucial to ensure that the risks of brain damage and potential complications are minimized. The first minutes and hours after stroke symptoms begin is the time when certain treatments can be most successful in reversing damage and improving outcomes. That means accurately diagnosing a stroke so treatment can begin as soon as possible is the vital first step. 

At the Hospital 

When a patient arrives at the hospital, a stroke team immediately takes them to a nearby imaging room for a CT scan/MRI, which helps identify a stroke. The type of stroke helps determine the course of treatment. 

Treating Ischemic Stroke 

For ischemic strokes, often the first line of treatment is a clot-busting medication called tissue plasminogen activator (tPA). This medication can be extremely effective at reversing damage if given within a certain time.  

Treating Haemorrhagic Stroke 

For haemorrhagic strokes, medications can help control bleeding, but in some cases, surgery may also be needed. A mechanical thrombectomy which is also called endovascular therapy may also be performed. During this procedure, a special device is threaded through the blood vessels to the site of the stroke-causing blood clot in the brain. The device grabs the clot and removes it, restoring blood flow and dramatically improving patient outcomes. 

Right Practice at Right time is the Key (First 90 days are Important) 

After getting proper treatment during stroke attacks, the golden period for post-stroke rehabilitation is within 3-6 months. This period is very crucial because most of the neurological recovery happens currently. 

This is the reason that the golden period plays a significant role in the recovery of the patient. With the help of rehabilitation, the patient will relearn the skills that are lost when part of the brain is damaged. If getting proper rehabilitation treatment in the golden period, there is less chance of recurrent stroke, bed sores, aspiration, spasticity, and infections. Also, most neurological effects can be reduced if rehabilitation starts in this golden period. With the right rehab care, noticeable signs of improved functional outcomes in the activities can be seen that may also minimize the chances of issues like depression. 

When should stroke rehabilitation begin? 

Rehabilitation must begin as soon as possible to get maximum brain recovery. Rehabilitative therapy usually begins in the acute-care hospital after the patient’s overall condition has been stabilized after the stroke.  

The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills. 

How long does stroke rehabilitation last? 

The duration of stroke rehabilitation varies depending on the stroke’s severity and associated complications. While some recover rapidly, many require long-term rehabilitation, potentially lasting months or years post-stroke. Throughout your recovery journey, your rehabilitation plan will adapt as you relearn skills and your needs evolve. Consistent practice enables continued progress over time. 

Where does stroke rehabilitation take place? 

After getting discharged from the hospital patients have three destinations for rehabilitation to choose from in-patient rehabilitation, outpatient departments, and home care services. 

  • Inpatient rehabilitation units. These units are typically staffed by a multidisciplinary team, including physiotherapists, occupational therapists, and medical doctors specializing in neurorehabilitation.  

The advantage of an in-patient rehabilitation lies in its structured regimen and immediate access to medical interventions, making it a viable option for individuals with severe impairments or medical complexities. 

  • Outpatient units. Outpatient rehabilitation programs allow you to live at home while attending scheduled therapy sessions at a clinic.  

This provides the dual advantage of professional oversight without the need for hospital admission.  

Often less intense than inpatient programs, outpatient settings may be best suited for individuals who have made some initial recovery and are looking to maintain and refine their gains. 

  • Home-based programs. For patients who can’t sustain prolonged hospital stays or those who prefer the comfort of their own home, in-home therapies become an enticing alternative.  

Healthcare professionals can visit your residence to administer tailored therapies, ranging from physical exercise to cognitive training.  

One key benefit of this approach is the opportunity to integrate rehabilitation tasks within your daily routine, enhancing the functional relevance of therapeutic activities. 

The survey done by HCAH, filled by stroke survivors receiving post-stroke rehabilitation found that 92% of individuals who chose in-patient rehabilitation achieved recovery within 3 months, with 38% regaining their health in less than 20 days. In contrast, 70% of those who opted for outpatient rehabilitation experienced a recovery period exceeding 4 months, of which, 37% of them took more than a year to fully recover. 

Stroke Rehabilitation Team 

A Stroke rehabilitation team typically consists of various healthcare professionals who work together to provide comprehensive care and support to stroke survivors. 

Nursing Support 

Helps people with disabilities and helps survivors manage health problems like diabetes and high blood pressure and adjust to life after stroke. 

Physiotherapist 

Helps with problems in moving and balance, suggesting exercises to strengthen muscles for walking, standing and other activities. 

Occupational Therapist 

Helps with strategies to manage daily activities such as eating, bathing, dressing, writing, and cooking. 

Speech Therapist 

Help a person relearn how to use language or develop alternative means of communication and improve the ability to swallow. 

Dietician 

Teaches survivors about healthy eating and special diets low in sodium, fat, and calories. 

Psychological Support 

Can help with the person’s mental and emotional health and assess cognitive skills. 

Doctor 

Helps in prevention of future stroke events, infections, controlling co-morbidities, oversee the patient outcomes. 

Physiatrist 

Oversee comprehensive treatment plan, focusing on restoring function and mobility while managing medical issues. 

Things to consider when choosing rehabilitation facility. 

Now that your loved one’s life is saved, are you aware of the Recovery path? 

What are the relevant questions around this Recovery path that you should be asking while choosing the best rehabilitation center for your family member. 

Tick- mark the boxes which check in for the rehab you visit and choose accordingly. 

  1. What similar cases have been handled by the facility? Can you show the cases handled with recovery details? 
  1. Do you have a rehab program designed specifically for my loved one’s recovery? 
  1. In how much time should I expect recovery for my loved one 
  1. Do you have publications/ clinical data available to validate the recoveries facilitated by your center? 
  1. How does the facility ensure that we are being charged only for the services availed? 
  1. What about 24/7 Doctor availability? 
  1. Is there an Emergency Response Team on site? 
  1. Who are the experts in your rehab facility and what is their experience in treating my loved one? 
  1. What is the relevant equipment available for the recovery of my loved one? 
  1. Who drives the entire rehab care plan? 
  1. Are the Quality Accreditations available with the facility? 
  1. Does the center have Insurance coverage/ cashless facility? 
  1. We heard emotional wellness is an important component of recovery. How does the center cater to it? 
  1. Does the center have integrated rehab components viz. Ayurveda, Panchkarma, Yoga, meditation etc. as a part of the recovery program? 
  1. How will you keep the family members involved in the recovery journey of their loved ones? 
  1. How many centers do you have across the country? 
  1. How will you keep the primary physician for my patient, involved & updated during their recovery journey? 
  1. Since how long has the company been into recovery & rehabilitation? 
  1. Do you have flexible room options- Single, Shared or Wards? 
  1. Is there a care continuum available post- recovery,in case required? 

References 

  1. Stephanie P Jones , Kamran Baqai et al. Stroke in India: A systematic review of the incidence, prevalence, and case fatality. Int J Stroke. 2022 Feb;17(2):132-140. 
  1. Rashmi Kothari, Laura Sauerbeck et al. Patients’ Awareness of Stroke Signs, Symptoms, and Risk Factors. AHA. Volume 28, Issue 10, October 1997; Pages 1871-1875. 
  1. Christian Grefkes, Gereon R. Fink. Recovery from stroke: current concepts and future perspectives. Neurological Research and Practice. 2020; 2:17. 
  1. Steven C. Cramer, MD,1 Steven L. Wolf, PhD, FAPTA, FAHA et al. Stroke Recovery & Rehabilitation Research: Issues, Opportunities, and the NIH Stroke Net. Stroke. 2017 Mar; 48(3): 813–819. 
  1. Alex Todhunter-Brown, Gillian Baer et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev. 2014 Apr; 2014(4). 
  1. Jawaria Shahid, Ayesha Kashif. A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sci. 2023, 13(5), 717 
  1. Elaine L. Miller, Chair, Laura Murray et al. Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient. Stroke. Volume 41, Issue 10, 1 October 2010; Pages 2402-2448.