Stroke
The diagnosis of stroke (apoplexy), and rehabilitation after it, have occupied medicine since ancient times. Early recognition and intervention were, and still are, crucial to reducing the direct consequences of a stroke, and the solution may be medication or an intervention on the blood vessels of the brain. Early signs such as difficulty speaking or loss of speech, not understanding what is said, difficulty swallowing, loss of strength, loss of or change in sensation, disorientation, visual disturbances, vomiting, nausea, severe headache, dizziness or loss of consciousness warn us that something is happening in the central nervous system. An excellent test that doctors use to recognise a stroke is the FAST test, but the general public should be familiar with it too. In stroke, the FAST test looks at:
- Face: ask the person to smile. Notice whether there is any marked asymmetry on the left or right side of the face!
- Arms: ask the person to raise both arms. Notice whether one arm lags behind the other!
- Speech: say a short random phrase and ask the person to repeat it. Notice whether their speech is slurred and/or strange.
- Time: write down the time when the symptoms started and call 112. Doctors need to know the time so that the intervention can be appropriate.
A stroke is a neurological dysfunction of relatively rapid onset caused by changes in the blood vessels. It manifests as a focal (regional), and sometimes global, disturbance of the central nervous system, with brain dysfunction lasting more than 24 hours. Sometimes the signs of a stroke are not so obvious but non-specific, and in some cases, such as when the small cerebral vessels are affected, they may be hidden and point to other diseases.
Rehabilitation after a stroke begins on the very first day with supportive measures, which include preventing pressure sores, thrombosis and embolism, pneumonia and a new cerebrovascular event. Early mobilisation, the use of aids, medication and adequate nutrition are important from the very beginning. Regular exercise will increase physical strength, endurance and aerobic capacity, and will reduce the potential risk of a heart attack or another stroke. Exercises during rehabilitation must be structured to reduce spasticity, increase range of motion and regain functional movement. Cooperation between the specialist in physical medicine and rehabilitation and the neurologist is crucial so that neurorehabilitation is carried out in a coordinated way. Various exercise concepts have been developed with this aim, but we must stress that all of them should be applied with due care and caution. Bobath therapy, Vojta therapy, DNS and rehabilitation robotics (neurorobotics), combined with occupational therapy and physical modalities as well as regular exercise, all contribute to recovery. Through regular evaluation during rehabilitation, the physiatrist will intervene either by modifying the physiotherapy or with medication. Our experienced, well-trained physiotherapists, who are skilled in therapeutic techniques such as CIMT, Bobath, Vojta, DNS, PNF and others, know how to recognise problems during rehabilitation, which is key to adapting the exercises to the individual and therefore to the recovery process. The use of rehabilitation robotics (neurorobotics) and mobility and self-help aids at Faktor Zdravlje Polyclinic is an integral part of rehabilitation.
