Stroke and Rehab

What is a stroke?

Every year, 200,000 people in USA fall ill with a stroke (apoplexy, stroke). The disease is due to a sudden circulatory disorder in the brain. Affected brain cells do not receive enough oxygen and nutrients for the moment, which is why they are damaged and die in extreme cases. The consequences for the patient are serious. Speech disorders, loss of sight and paralysis in different parts of the body can occur. If the person concerned is treated quickly and professionally, the symptoms can improve significantly. In many cases, the stroke patient has to deal with the consequences of the disease throughout his life. Up to 25 percent of those affected die within the following year. In the cause of death statistics is the stroke.

General facts about the clinical picture of stroke

Children or young people can have a stroke (apoplexy), but the risk increases with age. The age-related wear of blood vessels in the brain (arteriosclerosis) is often the reason for a stroke. Sudden symptoms of brain function appear. If the symptoms persist for more than 24 hours, doctors speak of a completed apoplexy. Nerve cells are already damaged. If the symptoms resolve spontaneously, it is a transient ischemic attack (TIA).

Stroke: causes/prevention

A stroke arises from a circulatory disorder in the brain. This is either due to a blood vessel closed by deposits on the inner wall (ischemic infarction) or to a blood clot (thrombosis) that can suddenly close a vessel. For example, the thrombus comes from the heart or from one of the large blood vessels on the neck. Around 15 percent of patients suffer a stroke due to a cerebral hemorrhage. A blood vessel bursts due to signs of aging or malformations (aneurysm).

Preventive measure

Certain risk factors can be directly influenced in order to possibly avoid a new infarction or a first infarction. Smoking, extreme obesity and lack of exercise increase the risk of suffering a stroke. Hypertension, diabetes mellitus and heart disease are also known risk factors.

The symptoms of a stroke

A stroke is characterized by signs of failure in the affected brain regions. The following symptoms are possible:

  • Paralysis in various forms
  • Hemiplegia
  • speech disorders
  • blurred vision
  • dysphagia
  • dizziness
  • feeling failures
  • Disturbances of consciousness
  • strong headache
  • nausea
  • Vomit

Stroke: exams & diagnosis

Even the suspicion of an apoplex is an emergency and justifies the notification of an emergency doctor. After a first physical examination, the doctor will arrange admission to a neurological clinic. There, preferably neurologists in a special stroke unit take care of further diagnostics.

Imaging procedures

  • CT: Usually the first examination in the hospital is a computed tomography of the head. The technology provides images of the brain and its blood vessels and makes it possible to distinguish between cerebral hemorrhage and impaired blood circulation.
  • MRI: Magnetic resonance imaging provides even more vivid images of the brain than CT, but takes longer. It is often used for monitoring the progress and exact damage assessment as part of forecasting.
  • Angiography: With the help of contrast media and X-rays, doctors gain a precise overview of the course and condition of the blood vessels in the brain.
  • Sonography: The doctor can use ultrasound to quickly and easily examine the large blood vessels on the neck that supply the brain with blood. The diagnosis of arterial calcification can be made here. The possible detachment site of a blood clot can also be shown.

laboratory tests

The blood of the stroke patient is examined for inflammation and blood clotting disorders in the laboratory. The electrolytes, liver values, kidney values ​​and blood sugar are also of interest.

Stroke: treatment & rehab

Acute treatment of stroke in the clinic

If a person has a stroke, the time to treatment is the decisive factor for the prognosis. The patient is best cared for in a clinic with a so-called “stroke unit”, a special stroke department. If it is an apoplexy caused by a blood clot that clogs a blood vessel in the brain, the doctors dissolve the thrombus with medication as quickly as possible (lysis therapy). Hemorrhage must be excluded beforehand. In addition, doctors can often remove the clot mechanically from the blood vessel using a fine catheter under X-ray control (thrombectomy). If stroke is the cause of the stroke, the patient may need surgery to stop the bleeding and reduce pressure on the brain.

Rehabilitation after stroke in the rehabilitation clinic

A stroke has a profound impact on the personal life and especially the professional life of those affected. In each case, it is checked whether neurological rehab is necessary after the acute hospital stay. Even patients with only minor restrictions benefit from this special time with specialized therapies. For older stroke patients, the focus of rehab is on independence in everyday life. A seamless transition from the first treating hospital to a neurological rehabilitation clinic is very important. The earlier the combination treatment begins, the better the prognosis for the patient.

Your way to the rehabilitation clinic

Doctors and social workers in your acute clinic can apply for a stay in a specialized rehabilitation facility for you. As a rule, the process is started in the first few days. An early neurological rehabilitation may also make sense for you. Your health insurance or pension insurance, the Federal Employment Agency or the social welfare office is responsible for the various treatments. Let the social service advise you on your personal situation.

Your time in the rehabilitation clinic

Your rehabilitation after a stroke takes place in a specialized neurological facility. How long a stay in rehab will take for you depends entirely on the severity of your stroke, your age and your general health situation. First, expect weeks to a few months. An extension is possible individually, if it is considered useful by the treating physicians. It is possible to use further therapy sessions on an outpatient basis after discharge.

Physiotherapy after a stroke

After a stroke, many sufferers struggle with loss of control over one side of the body, a severely restricted body feeling and balance problems. Patients often compensate for this with the healthy side of the body and the imbalance shifts even further in the wrong direction. The diseased side can also develop increased muscle tension (spasticity). The first step here is physiotherapy (physiotherapy). Therapists will develop a personal treatment plan for you. Its goal is to maintain, improve and regain your mobility. The physiotherapists strive for maximum independence in all areas of life for you. Special exercises can inhibit the increased muscle tension, train the function of the disturbed limbs again and train the sense of balance. Together they strive to improve the perception of the diseased side of the body. If possible, physiotherapy also includes training of relatives. For example, your family will be taught storage techniques.

Occupational therapy after a stroke

Occupational therapy is another important building block on the way back to everyday life. Work and occupational therapy is a more understandable term for the treatment. It addresses physical and mental skills. Depending on your needs, you can practice eating, dressing, washing and doing household chores with an occupational therapist. Coping with everyday life is your goal. You learn to consciously perceive and execute your movements. Even a trip together on public transport can be part of the training program. The therapist also looks at your house or apartment and discusses any necessary renovation measures with you and your family. You will learn everything about tools that you are entitled to and how to use them.

Speech therapy after stroke

Speech therapy, called speech therapy by doctors, deals with two different areas that can occur in the context of a stroke. In aphasia, the patient’s ability to communicate is impaired, and in dysarthria, speech ability itself is impaired. The stroke here has damaged various parts of the speech center in the brain. Some patients also suffer from both forms at the same time. The speech therapist works with you to restore your communication skills. Understanding fellow human beings and expressing themselves verbally are trained as well as reading and writing. For example, they perform breathing exercises, voice training and articulation exercises. Independent speech is also a topic in speech therapy.

Neuropsychological therapy after stroke

A stroke not only affects physical functions. Areas of the brain such as memory, intelligence, social behavior and the emotional world can also be changed. Many apoplexy patients have trouble concentrating and staying alert longer. The neurologist uses standardized psychological test procedures to make an accurate diagnosis for each neuropsychological area. Training programs on the computer help you to restore various mental abilities. Coping with mental illness for you and your relatives also falls within this therapeutic area.

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