Post-stroke care management on physiotherapy. 

Stroke may damage parts of the brain that control body movement and coordination. Physiotherapy helps you to regain as much strength, coordination and flexibility as possible. Your physiotherapists will assess you and recommend a care plan, based on your medical history and current problems, to give you every chance of achieving a good recovery. 

How does stroke affect my movement?

You may experience weakness or complete paralysis on one side of your body. This can make it difficult for you to use those limbs in your daily activities. You may experience sensory disturbances in the limbs on the affected side. The affected limb can feel numb or have a heavy sensation due to the weakness. This can affect your ability to coordinate movements. Occasionally, some people may experience a “burning sensation” or that of “pins and needles” which can be uncomfortable or painful. You may have problems with your balance and maintaining an upright posture. Joints over affected side may be prone to injury. For instance, a strain on the ligaments or inflammation along the tendons can occur in the shoulder, knee or ankle joints on the weaker side. The muscles over your affected side also may become stiff which can limit your movement. Some people may develop muscle spasms or spasticity.

What is physiotherapy?

After a stroke, the brain cannot grow new cells to replace the damaged ones. Physiotherapy can help to promote neuroplasticity. In essence, neuroplasticity refers to the brain's ability to reorganise itself by forming new connections between its nerve cells. Various techniques such as exercises, skills training, manual therapy, or the use of electrical / other physical treatments to facilitate recovery. Where applicable, a robotics guided therapy approach may also be used.

How can physiotherapy help?

In the early stages after a stroke, your physiotherapist will focus on:

1) Restoring your ability to move safely.

Depending on your needs, physiotherapists will:

• Offer therapy to help strengthen and coordinate the movements in your limbs.
• Advise you on how to position yourself when lying down or sitting.
• They can work with your carers or nurses to teach techniques on how to transfer yourself from your bed to a chair and vice versa.
• Help you to relearn walking tasks and motivate you to participate actively in your rehabilitation journey.
• Decide if any assistive aids, such as walking sticks will improve your walking.
• Improve your endurance and higher balance skills that are needed especially for community mobility.
• Work together with the stroke care team, your carer, family and friends to support your recovery.

2) Preventing secondary complications such as 

• Muscle and joint stiffness
• Chest infections

For some people who have suffered a severe stroke, a full recovery may be less likely. In such instances, your physiotherapist would use assistive devices to teach you and your carers different ways of doing things to help you achieve your optimal level of independence in your activities of daily living.

Where will I have therapy?

	The location of your therapy will depend on the stroke severity. It is important to talk to your stroke care team to find out which location would be most appropriate for your condition.
Inpatient Physiotherapy starts as soon as you are admitted into a hospital. It involves exercises at the bedside, moving around in the ward or in a specialized gym area. When medically stable, you may be transferred to a rehabilitation unit (in the hospital or community hospital) to continue your treatment. Outpatient Upon discharge from the hospital, there are day rehabilitation centres or outpatient therapy gyms services in hospitals which offer a variety of programmes to work on specific goals.
Home based therapy There are specialised community rehabilitation teams that are able to provide home based therapy. This might be suitable for people who have difficulty in mobilising out of their house or have certain functional goals that would benefit from training in a more contextualized environment like their home.

How can my carer or family help?

	If possible, your carer or family members should attend the rehabilitation sessions with you. They can learn to assist you with the exercises and apply the rehabilitation techniques with you at home.
If you are confined to the bed, Your physiotherapist will teach your carers how to position yourself in different ways so as to maintain flexibility in your joints and to improve your posture and balance. The nurses will teach your carer and help to reposition you every 2 to 3 hours to prevent bed sores during the hospital stay.

Tips for recovery

It is important to be as active as possible soon after a stroke. Exercise on a routine basis at a regular time each day or as prescribed by the physiotherapist. Practice the exercises suggested by the physiotherapist. Remember to exercise every day or at least 3 times per week to promote better recovery. To involve and move your affected side as much as possible. Be patient and aim for long term rather than immediate results. Try new activities that will help in your recovery. If you suffer from post stroke fatigue, exercise can help but it should be built up progressively in a gradual manner as tolerated. Use a notebook to record down the progress. You may join therapy groups in Singapore National Stroke Association (SNSA) or Stroke Support Station (S3).

How can I move about safely and reduce my risk of falling?

If you need to use a walking aid to assist with your walking tasks, then it is useful to take note of this safety advice.

• You should aim to improve or maintain strength in both legs.
  • Repetitions of sit to stand exercise is a simple and effective way to maintain strength.
  • Other methods for legs strengthening can be designed by your physiotherapist for your specific needs.
• You should maintain a good sense of your balance during standing.
  •  Regular practicing of suitable balancing exercises which were taught by your physiotherapist can help to fine tune your balance.
• If you have just woken up from a sleep, do sit up for a few minutes and then perform a few sit-to-stand movements at the bedside before walking away from your bed.
• If you are not feeling well or have just woken up from a sleep and need to start walking immediately, do ensure that someone walks with you.
• Installation of grab bars inside bathrooms and at entrances with kerbs or steps will promote safety.
• When walking outdoors: If the condition in your environment has become risky or has become different from your routine encounters. (example: wet floor, dim lights, surge in pedestrian crowd, walking into a crowded area)
  • Move at a slower pace and take shorter steps.
  • If possible, have someone stand close to you as you proceed to walk. 
  • Use of appropriate walking aids as suggested by the physiotherapist. 

Article available in Chinese, Malay and Tamil. 

StrokeHub Video: 

Physiotherapy (Extended Version) https://youtu.be/m-DITheYw5A

Physiotherapy https://youtu.be/mlkrEoe5-Lg