An increasing number of people are suffering from strokes such as cerebral infarction, a disorder generated by the obstruction of blood vessels in the brain, due to a narrowing of the arteries or a blockage by a clot.

To prevent this, it is essential to lead a healthy life and avoid risk factors such as smoking or obesity. And above all, it is very important to stop this type of stroke in time and to start, as soon as possible, a rehabilitation at all levels, so that the person recovers his functional autonomy and returns to his daily life.

In this article we explain how rehabilitation is carried out after a stroke and what activities are performed in this process.

What is a stroke?

A cerebral infarction, also called ischemic stroke, occurs when there is a sudden reduction in the blood supply to the brain , usually caused by an obstruction or a hemorrhage. This type of stroke occurs when a blood vessel ruptures or narrows (thrombosis), or when it becomes blocked by a clot (embolism), for example. The result is that certain areas of the brain do not receive the oxygen and glucose they need.

Usually, strokes occur suddenly and develop rapidly , worsening over hours if not addressed quickly. Strokes are more common in people over 55 years old, and are the most common cause of death among women, and the second most common cause of death in men. Bad habits such as smoking, sedentary life or obesity also have a negative influence, increasing the risk of suffering a stroke.

People with a family history of stroke, diabetes, and sleep apnea syndromes are also at increased risk for such a stroke. Every year, it affects some 130,000 people , and a third of them suffer from sequelae ranging from motor difficulties to cognitive impairment and loss of functional autonomy.

However, there are two key elements when dealing with a phenomenon such as this, and they are: on the one hand, prevention, which involves raising awareness of the benefits of simple habits such as exercising or leading a healthy life; and on the other hand, early detection and rehabilitation. Next, we will talk about this second part, which is fundamental for the recovery of the patient after a cerebral infarction.

Rehabilitation after stroke

When a person is suffering a stroke, a series of characteristic symptoms occur : numbness or weakness on one side of the body, sudden confusion, difficulty walking and lack of coordination, and headache. When this occurs, the emergency services must be quickly activated and the person taken to the nearest hospital. You will then be referred to the Stroke Unit, which specializes in these disorders.

Once the necessary medical tests have been carried out and the relevant diagnosis has been received, the patient will remain in hospital until he or she is clinically stable. The first few hours are very important, as signs of more or less extensive injury may become evident, which will serve later to plan an appropriate rehabilitation. Although the brain tries to recover the damaged functions spontaneously (restructuring healthy tissue), many times it is only possible to a certain degree, and this is not always achieved.

After receiving medical discharge, the patient who has suffered the stroke will begin the rehabilitation plan, which includes a multidisciplinary therapeutic approach that will vary depending on the needs of each person. This must be initiated early and coordinated between the different healthcare professionals who will be part of the patient’s life throughout the recovery process.

1. Physical rehabilitation

The physical rehabilitation of the patient will be considered based on the parts of the body and physical abilities that have been affected after the stroke. The main objective is to recover, totally or partially, the functional autonomy and the basic skills such as: walking, having a stable body, maintaining balance, etc.

The physical rehabilitation plan also includes physical activities that may include: mobility training (use of canes, ankle braces, and general mobility aids), fine and gross motor exercises (to improve coordination and muscle strength), restriction-induced therapy (restricting the unaffected area while practicing movement with the injured limb), and range-of-motion therapy (for patients with spasticity problems).

Today, thanks to technology, new practices have been incorporated to address physical rehabilitation after stroke, such as: functional electrical stimulation, robotic technology, virtual reality or wireless technology. All these technology-assisted physical activities are used to improve weakened muscles and to re-educate certain movement patterns that have been affected by stroke.

2. Cognitive rehabilitation

After a stroke, cognitive problems and alterations in language, memory, attention and concentration, among others, can occur. The aim of cognitive rehabilitation is to slow down and reduce the negative impact of these alterations, by stimulating the different cognitive functions that have been damaged by the stroke, taking advantage of the neuronal plasticity of the brain that allows the neurons to regenerate functionally and anatomically to form new connections.

In most strokes where there is cognitive impairment, the patient experiences difficulties in temporal and spatial orientation. In this sense, therapies focused on orientation will facilitate that, in the first moments of the rehabilitation, the person has a better personal and spatial-temporal location.

Cognitive stimulation tasks in patients with cerebral infarction can be performed on paper or assisted by technology (generally a computer or a tablet), depending on the preserved capacities of each person.

The neuropsychologist in charge of the rehabilitation has to pay attention not only to the progress in the cognitive level, but also to the rest of the contextual variables that have to do with the family, social and/or work environment of the person who has suffered the stroke. In the end, the ultimate goal of this rehabilitation process is for the person to obtain the greatest possible functional autonomy, and to be able to carry out daily life tasks correctly.

3. Speech therapy rehabilitation

The alterations in language after a cerebral infarction are a great impediment for the patient, especially if they imply clinical manifestations such as aphasia, which implies an inability to emit or understand language; or dysarthria, which implies difficulties in articulating sounds and words.

The speech therapist is the professional in charge of getting the patient to recover the language functions and their communication skills . Generally, exercises in reading, writing, expression and comprehension of language are carried out, with methods ranging from the verbalisation of sentences at a certain rhythm, the naming of images or the discrimination of phonemes.

In any case, the aim of speech therapy rehabilitation is for the patient to recover the linguistic ability that he or she had before the stroke; or, at least, to recover a certain functional autonomy that will allow the patient to communicate with others and interact with his or her environment in the best possible way.

4. Occupational therapy

Occupational therapy is part of the stroke rehabilitation process and its objective is to achieve that the patient recovers the ability to perform basic and advanced activities of daily living , so that he/she can adequately reintegrate into society after having suffered the stroke.

During the occupational therapy process, health professionals assess the possible adaptations of the environment and the incorporation of support elements for the patient. Sometimes, people who suffer a stroke need to modify some elements of the home so that they do not have difficulties in their return: for example, by installing a staircase in its doorway, modifying the furniture or replacing the bathtub with a shower tray.

Stem cells: the ultimate in rehabilitation

In recent years, a new therapy based on the implantation of neural stem cells has been studied to recover lost functions in patients who have suffered cerebral infarctions. In the studies carried out, mice with stroke have been used to which stem cells of mesenchymal origin have been implanted, encapsulated in a harmless and biocompatible material, such as fibroin from the silkworm, a very fibrous type of protein.

In the experiments carried out, it has been observed that the animals that were implemented with this therapy with stem cells significantly improved the motor and sensory abilities that had been affected after suffering the cerebral infarction. Furthermore, it has been shown that encapsulation increases the survival rate of the implanted stem cells, thus positively influencing the repair of damaged brain tissue and preventing its extension after the stroke.

In short, researchers are working on the future development of drugs that are capable of stimulating these types of stem cells in the brain, so that they can multiply, move to the affected brain areas and begin the process of cell repair.

Bibliographic references:

  • Brott, T., & Bogousslavsky, J. (2000). Treatment of acute ischemic stroke. New England Journal of Medicine, 343(10), 710-722.
  • Patel, M., Coshall, C., Rudd, A. G., & Wolfe, C. D. (2003). Natural history of cognitive impairment after stroke and factors associated with its recovery. Clinical rehabilitation, 17(2), 158-166.
  • Rodríguez García, P. L. (2014). Ischemic stroke: advances and projections. Cuban Journal of Neurology and Neurosurgery, 4(1), 71-88.