Stroke Rehabilitation in Penang & Kuala Lumpur

Malaysia Well Known Physiotherapy

What is Stroke About

Nowadays, cerebrovascular accident (CVA) which is commonly known as stroke was define as rapid neurological sign of disturbance of cerebral function, which lasting 24 hours or more, with no other causes than vascular origin.

There was two types of stroke, ischemic stroke (occlusion that affect cerebral blood flow), which is the most common type of stroke attack and hemorrhagic stroke (bleeding in brain area).

It was increasing in number among Malaysian population and not only affect adult with several medical illnesses such as heart problems, high blood cholesterol, diabetes mellitus, and hypertension but some cases was found among younger adult, with age range from 18 to 25 years old and adult without any medical illness, with unknown causes.

There are three main factors that can cause stroke, which are hypertension, high cholesterol, and low fruit and vegetables intake. Diabetes mellitus, physical inactivity, certain heart problems and previous stroke may be other risk factors to stroke attack.

Early signs of stroke can be detect by individuals themselves or by family member, which known as FAST; Face dropping, Arm weakness, Speech difficulty and Time to call 999 if any of these signs was detected.

Therefore, with increase in number of stroke survivals among Malaysian, the needs of post-stroke rehabilitation, which include physiotherapy, was crucial as early as possible after the onset of stroke.

The recovery phase begins in acute and sub-acute phase, which start by first week of stroke onset and up to 26th weeks or six months post-stroke. This time period is the best time for post-stroke rehab as the injury still new and other complication such shoulder sub-luxation, muscle tightness, skin pressure ulcer, and joint contracture, still not build up yet. Thus, help the recovery to happen faster.

After six month post-stroke, it called chronic phase and during this time period, recovery still can happen but slower and difficult.

How can stroke survivals recover? It’s because of neuroplasticity, which is define as the ability of brain to form new neural connection to compensate the injury or changes in the brain’s environments.

Neuroplasticity can be easily understood by imagine that our neuron as the road and the pulse as us in a car in the traffic jammed. When one road was blocked, we will try anyhow to find another alternative road to reach our destination, no matter how right? It is just like the pulse in the brain of stroke survival.

The pulse in the brain will be stimulated mainly by physical movements, either passively or actively moved.

Therefore, physical movements help neuroplasticity to happen and rehabilitation was important to reduced burden that may developed after onset of stroke, which include individuals themselves, their family and also their society.

Physiotherapy help in physical problems such functional mobility and balance, improve stroke survivals’ quality of life, improve emotional status by encouraged independent transfer and mobility, improve muscle strength and endurance, improve joint sensation which may lost after stroke onset, prevent post-stroke complications and also other illnesses that may developed if the stroke survivals were not active, such as deep vein thrombosis (blood clot) and skin disease.

The stroke survival also need to believe that they can do it as it will stimulate the pulses between brain and muscles that work to make the physical part, such as hand or leg move.

In another side of view, family support was really important. Stroke survivals may be more emotional and easily give up on themselves. Thus, family support was definitely crucial in stroke recovery process, even though they may say they don’t want to or they cannot do.

Positive environments will encourage stroke survival to recover faster, be more active and feels motivated to do rehabilitation.

Family members need to believe that stroke survivals will recover and can be independent, just the speed of recovery may vary among individuals and may affected by other factors such as age, disability levels, stroke phase (acute, sub-acute or chronic), presence of rehabilitation, environments and family support.

Stroke Type

ISCHEMIC - Occlusion that prevent blood flow

Most strokes are caused by a blockage cutting off the blood supply to the brain. This is called an ischaemic stroke.

Causes

A blockage can be caused by a blood clot forming in an artery leading to the brain or within one of the small vessels deep inside the brain. This is known as cerebral thrombosis.

Blockages in the brain can also be caused by a blood clot or other matter (such as an air bubble) moving through the blood stream from another part of the body. This is called a cerebral embolism.

Atherosclerosis occurs when fatty deposits build up on the inside walls of your arteries. They cause your arteries to become harder and narrower, making them more likely to become blocked.

Small vessel disease is when the tiny blood vessels within your brain become blocked. Deposits collect in the blood vessels, causing them to thicken and become less flexible.

Some heart conditions can cause blood clots to form in your heart, which can then move through your blood stream up into your brain.

Arterial dissection occurs when tears develop in the lining of an artery and allow blood to get between the layers of your artery walls. This can happen for no clear reason or it can happen because of an injury, such as whiplash.

Diagnosis

A stroke is a medical emergency and if you have one you need to call 999 immediately.

You may start off in accident and emergency or another assessment ward, but it is likely you will be quickly admitted to an acute (or hyper-acute) stroke unit. An acute stroke unit has a range of trained professionals who are experienced in stroke care.

The quicker your stroke is diagnosed and treated, the better your recovery will be.

A stroke is usually diagnosed using a brain scan: either a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. The scan will show whether your stroke has been caused by a blockage or by something else.

Treatment

If your ischaemic stroke is caused by a blood clot, you may be treated with a clot-busting medicine, known as thrombolysis.

Thrombolysis can break down and disperse a clot that is preventing blood from reaching your brain. However, for it to have the best effectr, it needs to be given within four and a half hours of your stroke symptoms starting.

Most people who have an ischaemic stroke will be given anti-platelet medication, which helps to prevent your blood from clotting.

HAEMORRHAGIC - Bleeding caused by blood vessel rupture

Although they are not as common, this kind of stroke can be much more serious than ischaemic strokes, which are caused by a blockage.

Causes

A haemorrhagic stroke can happen when an artery inside your brain bursts causing bleeding within your brain. This known as an intracerebral haemorrhage .

It can also happen because of bleeding on the surface of your brain. Your brain sits inside a cushion of membranes that protect it from your skull.

Between the layers of membrane is a space, which is filled with fluid. If blood vessels near the surface of the brain burst, blood can leak into this space. This known as a subarchnoid haemorrhage.

High blood pressure is the main cause of all strokes. High blood pressure weakens the arteries and makes them more likely to tear.

Anticoagulant medication helps to prevent your blood from clotting. If you have an irregular heartbeat (known as atrial fibrillation) it’s likely that you will be given this type of medication to help reduce your risk of stroke. However, if it is not carefully monitored it can sometimes cause bleeding.

Drugs such as cocaine, can irritate blood vessel walls making them weaker and more likely to rupture.

Diagnosis

A stroke is a medical emergency and if you have one you need to call 999 immediately.

The quicker your stroke is diagnosed and treated, the better your recovery will be.

Doctors will usually diagnose your stroke using a brain scan: either a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. The scan will show whether your stroke has been caused by bleeding or by something else.

If you have a subarchnoid haemorrhage then your doctors may carry out a lumbar puncture as well as a brain scan. To do this they remove a small amount of the fluid that sits around your brain and spinal cord, to see if any blood has leaked into it.

Treatment

If you have a haemorrhagic stroke you may need surgery to stop the bleeding, remove blood or relieve any pressure that has built up around your brain.

This is usually done with an operation called a craniotomy. This is when a surgeon cuts away a small piece of your skull so that he or she can get to your brain and the cause of the bleeding.

If your stroke was caused by a burst aneurysm, an operation may be needed to seal it and stop it bleeding again.

You may be given medication to lower your blood pressure or if your bleed was caused by anticoagulant medication, you will usually be given another drug to reverse the effects as soon as possible.

Symptoms of Stroke

FAST test

  • FACIAL WEAKNESS
    Can the person smile? Has their face fallen on one side?
  • ARM WEAKNESS
    Can the person raise both arms and keep them there?
  • SPEECH PROBLEMS
    Can the person speak clearly and understand what you say? Is their speech slurred?
  • TIME
    Is time to call 999 to seek immediate medical attention

Other symptoms of stroke

  • sudden weakness or numbness on one side of the body
  • difficulty finding word
  • sudden blurred vision or loss of sight
  • sudden confusion, dizziness or unsteadiness
  • a sudden, severe headache

Don't ignore a TIA

  • A transient ischeamic attack or TIA is similar to a stroke but the symptoms are temporary – usually lasting from a few minutes up to 24 hours. A TIA is serious and should not be ignored.
  • If you experience any of the symptoms desrcibed above, even for a short amount of time, you must call 999.

What Can I Do To Reduce My Risk?

Most strokes can be prevented. Although you cannot change some of the things that increase your risk of stroke, like your age, there are others that you can change.

Checking

Have regular check-ups

Lifestyle

Make some changes to your lifestyle

NO Smoking

Important factor to save your life

No Alcohol

Alcohol increases your risk of stroke

Weight

Stay a healthy weight

Exercise

Do more exercise