MEER | STROKE
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STROKE

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Stroke Neurological Rehabilitation Program

‘A stroke occurs when the blood flow to part of the brain is cut off it is a ‘brain attack’ (in the same way that a heart attack happens when the blood supply to the heart muscle is cut off). Without a blood supply, brain cells can be damaged or destroyed because they may not receive enough oxygen.’ (NICE clinical guideline, 3). A stroke patient will go through a long journey of treatment starting from the ICU and ending after months and maybe years in the clinic or his house.

The treatment and care of someone who has had a stroke or TIA should take into account their personal needs and preferences where possible. They, and their family and careers, have the right to be fully informed, and decisions should be made in partnership with the healthcare team (NICE clinical guideline).

40% percent of stroke patients are left with moderate functional impairments and 15% to 30% with severe disability. Effective rehabilitation interventions initiated early after stroke can enhance the recovery process and minimize functional disability. Therefore our aim in Meer PT is to maximize the recovery of the stroke patients in Erbil and Iraq by introducing the first Neurological rehabilitation center in the country.

Our Message:

To develop a complete and professional rehabilitation program initially after stroke to enhance the recovery process and minimize functional disability.

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Our Target:

The program will target stroke patients in the Erbil hospitals who are still in the early stages or the ICU units.
The program will also include out patients who are still in the acute or sub-acute stages.
The program welcomes stroke patient from Erbil and other cities.

Evidences:

Every year a significant number of stroke survivors are left with residual disabilities varying from mild to severe form which can be reduced by proper rehabilitation. A number of controlled and uncontrolled randomized studies have suggested that rehabilitation program lead to an improvement in functional status that cannot be attributed merely to spontaneous recovery.

In a retrospective study of 30 patients in an acute care hospital, there was a statistically significant difference in length of stay and ambulatory status for the group receiving rehabilitation treatment within the first 72 hours after admission. There was no significant difference between the two groups with regard to age, sex, site of lesion, or previous cardiovascular disease. The present study indicates that early intervention shortens hospital stay and improves outcome (Hayes and Caroll 1986).

The Agency for Healthcare Policy and Research Guideline for Post-Stroke Rehabilitation (AHCPR, 1995) has concluded that better clinical outcomes are achieved when patients with acute stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Skilled staff, better organization of services, and earlier implementation of rehabilitation interventions appear to be important components.

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Physical therapist helping wheelchair bound senior Hispanic man (60s), exercising upper extremities.

Our Plan:

Based on the aim of the program and the unit, the program will start immediately the second day post admission where a physiotherapist will be sent to the ICU unit to assess the patient.

When the patient is stable, the rehabilitation will start in the ICU unit to reach a specific goals such as improve/ maintain a normal oxygenation, prevent any complications, maintain level of functional status.

The second stage of the program (if the patient is not able to reach the center) will be the home visits; a physiotherapist will be sent to the patient at least once/day depending on the patient’s need.

The third stage of the program will be in the center where an intensive rehabilitation sessions start from 3-6 hours / day (6 days/week) will be giving to the patient including; physiotherapy, occupational therapy and Speech therapy if needed.

Limitations:

1. Difficulties in patient’s transfer to the center.
2. Difficulties in reaching the patient and starting with him/her as soon as possible (the second day post admission).
3. To accommodate with each patient’s ability and tolerance.

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Plans to overcome the limitations:

1. A full equipped van will be used in the future to transfer the patient from his place of accommodation to the center.
2. Arrangements with the best neurological physicians will be made.
3. Each patient will be given a program which will be planned and studied by a multi-disciplinary team to insure its suitability to the patient.

Conclusion:

Early initiation of rehabilitation procedures can enable greater return of neurological function and improves long term outcome and quality of life.

According to the guideline for stroke rehabilitation, rehabilitation procedures should be started as soon as the diagnosis is established and life threatening problems are managed and this is the aim of this program.

Doctor Talking with Senior Patient
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Introduction to Stroke

A stroke is caused by a disruption of blood flow to the brain as a result of a blockage or leakage in a blood vessel. The effects of a stroke vary depending on the severity of the blockage or leakage. Common symptoms of a stroke are arm and leg weakness, facial weakness and speech problems. Symptoms can cause decreased mobility, balance problems and difficulty performing everyday tasks. Physiotherapy treatment is very important following a stroke. It should commence as soon as possible and continue until an individual has reached their maximum potential. Physiotherapy can improve an individual’s quality of life by increasing their independence, mobility and ability to perform everyday tasks. Meer PT understand that a stroke can cause a huge change in lifestyle for an individual and their family. We also understand that everyone wants the maximum recovery for their loved ones. Our physiotherapists can work with an individual and their family / carers to achieve their potential.

What is a Stroke?

A stroke occurs if an area of brain tissue is deprived of its blood supply causing brain cells to lose their supply of oxygen. This is usually caused by a blockage or burst blood vessel. Without oxygen, brain cells can become irreversibly damaged within minutes. Unlike other cells in the body, if brain cells are irreversibly damaged then they are unable to heal themselves. The brain, however, is very adaptable and areas of the brain are capable of learning new tasks to compensate for the areas that have been damaged. Physiotherapy encourages this learning and to help the body re-learn normal movement patterns.

There are two types of stroke:

* Ischemic (90%)
* Hemorrhagic (10%)

Ischemic strokes These are caused by a blockage within an artery. This blockage restricts the blood flow to an area of the brain, and therefore, brain cells in this area are damaged due to a lack of oxygen. Hemorrhagic strokes (also known as brain hemorrhages) These are caused when a blood vessel in the brain ruptures causing bleeding into an area of the brain. This causes a buildup of pressure and damages the delicate brain tissue. Blood flow to neighboring brain cells is restricted and these cells can also become damaged due to a lack of oxygen.

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Disabled senior man does stretching exercise with the help of his physical therapist.

Effects of a Stroke

There are many common effects of strokes. These effects depend on the type of stroke suffered, its severity, the area of the brain affected and the extent of damage to the brain tissue. The effects of stroke can be described as:

* Physical effects
* Non-physical effects

Common physical effects

* Reduced mobility
* Weakness or paralysis (usually on one side of the body)
* Reduced sensation
* Neglect to one side of the body
* Swallowing difficulties
* Speech and/or language difficulties
* Incontinence
* Fatigue
* Post stroke pain
* Foot drop

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Common non-physical effects

* Mood changes
* Cognitive difficulties
* Behavioral changes

Stroke Physiotherapy Treatment

Around half of stroke survivors are left with significant disability. The brain is, however, very adaptable and, with physiotherapy, recovery can take place over a period of years. Patients often have a rapid period of recovery in the first few months after a stroke followed by a slower recovery over the following years. To gain the maximum recovery, physiotherapy treatment should be continued once you leave hospital.

.. You will be discharged from hospital when you are medically stable. Being discharged from hospital does not mean that you will not improve further. Your rehabilitation should continue as soon as you leave hospital. With the correct physiotherapy input and advice you still have lots of potential to improve over the coming years.

During your initial assessment you will discuss your short and long term rehabilitation goals. These goals will then be at the center of your rehabilitation. Physiotherapy will assist you in regaining as much movement and function as possible. Treatment often focuses on sitting balance, standing balance, walking, using your affected arm / hand and managing any changes in muscle tone, pain or stiffness.

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physiotherapy can help:

* improve balance and walking
* increase ability to roll / move in bed / sit / stand
* reduce muscle spasms, pain and stiffness
* increase strength
* retrain normal patterns of movement
* increase affected arm and leg function
* increase energy levels
* increase independence and quality of life
* reduce the risk of falls

After a stroke may people experience difficulties performing tasks that were previously simple. This can make everyday life a struggle for both you and those close to you. Meer PT will advise you on the use of walking aids, splints, supports and home equipment to make your life easier. During treatment sessions our physiotherapists will lead you through a graduated programme of functional exercises to increase your mobility and muscle control. The

Physiotherapists at Meer PT will usually teach you (and your family members / carers if appropriate) exercises to be continued between appointments.

Having a stroke is a life changing event. Many individuals feel low in mood and have reduced confidence following a stroke. At Meer PT we aim to make our treatment sessions effective and enjoyable. Many patients develop close relationships with our physiotherapists. This, combined with increased function and independence, allows our patients to lead as fulfilling lives as possible.

Why Meer PT?

* Motivated, caring staff
* Unique treatment programmes tailored to suit each individual
* No waiting lists
* Be seen in our center, at your home or in your care home
* Patients can be seen by more than one physiotherapist at once, if required
* Dedicated, patient centred approach
* Specialist falls prevention programme available
* Case management
* Proven track record

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