Talofa Samoa and welcome back to your weekly health column! In one of our columns last year we looked at a few of the frequently asked questions for physiotherapists (what we do, what kind of patients do we see, how you can get stronger); this week we continue with one question I get frequently.

How do physiotherapists help patients who have had a stroke?

Throughout our undergraduate degree, we study various subjects relating to the human body. While our profession is commonly associated with sports, by the time we graduate every physiotherapist would have been given the building blocks for becoming an expert in the neurological field. 

We had to study neuro-physiology (how the nervous system operates), neuroanatomy (the various parts of the nervous system), neuro-pathology (diseases of the nervous system), and interventions for patients with neurological disorders. In our final year, we are placed in four different clinical settings which prepare us for independent practice when we graduate. In these settings, we gain hands-on experience with treating stroke patients and all our neuro-knowledge we’ve gained in the previous three years comes into play. 

Pathology of a stroke & how exercise changes the brain

There are two main types of stroke: Ischaemic Stroke, where a part of the brain gets its blood supply cut off by a blockage in a blood vessel, and Haemorrhagic Stroke, where a blood vessel in the brain gets ruptured and leaks blood where it isn’t supposed to go. 

Every stroke is different and people who have had a stroke are affected in different ways. For some people, the symptoms are quite mild and last a short time. Other strokes may cause more severe and lasting damage. After a stroke, some brain cells are damaged and others die.

Dead brain cells can’t start working again, but others may recover as the swelling in your brain caused by the stroke goes down. It’s also possible that some parts of the brain can learn to take over from the damaged areas. This is known as neuroplasticity. Most recovery happens in the first few months after a stroke, but some people can continue to recover for several years. 

Physiotherapists tap into this potential for neuroplasticity by challenging the brain and body with physical activity as early as possible. When you do rehabilitation activities, it encourages the brain to start making new connections in the healthy parts of the brain. Building up those connections makes your brain better at controlling your body, and lets you do more things you want to do. You can help this process by practicing rehabilitation activities. 

There is no time limit on neuroplasticity, and it doesn’t only happen during therapy. Every time you take an extra step, say a new word, or do a hand exercise, it helps the brain make new connections.

Physiotherapy after a stroke

In the early stages, physiotherapy will focus on preventing complications and helping a patient’s recovery. Later, physiotherapists help find ways to enable patients to do things that are important to them, such as getting in and out of bed, or doing sports. 

Physios might give equipment or find different movement patterns to help complete a task. A physiotherapist can also help adapt an activity or task so patients can do it more independently. During physiotherapy, a patient may do exercises to strengthen weak muscles and build up stability and stamina. Stretching exercises can reduce muscle and joint stiffness. Patients may also work on specific skills that need to improve. For example, if you are having difficulty keeping balance, you may be asked to stand up a lot. 

A physiotherapist will give exercises that patients can do either independently or with support from staff or family and friends. These exercises will be supported with written instructions, diagrams, or instructions that you can record on your phone. Although most people regain the ability to walk, some do not, and others are only able to walk short distances with support. If this is the case, a physiotherapist will provide walking aids such as crutches or ankle splint and, if necessary, a wheelchair and teach the patient and their family or Carers how to use them. 

When a patient starts physiotherapy, goals and exercises are set with the physiotherapist. Physiotherapy should finish when these goals are reached, such as walking or improving balance. It can also end if the therapist assesses that further therapy wouldn’t be beneficial.

 Stroke can be an intimidating condition to think about, but with physiotherapy and quality medical input, recovery from stroke doesn’t have to be difficult.

The author is a physiotherapist and can be contacted on telephone 28303 at Alec’s Health Specialist Centre should you need more information.