Cerebrovascular accidents (CVA or stroke) can be life changing for you and your loved ones. A stroke is characterized by a change of blood flow in the brain. Different types of stroke can occur in different areas of the brain. As a result, symptoms vary based on type and location of stroke. Care and recovery following a stroke has to be individualized as each patient is unique in their recovery needs.
What is stroke and what are the two types?
There are two types of stroke: hemorrhagic and ischemic. The physiology differs but an area in the brain becomes deprived of oxygen in both cases.
A hemorrhagic stroke occurs when a blood vessel breaks and bleeds into the brain. As the blood is redirected, the area that the blood vessel was meant to supply is now deprived of oxygen. The blood also releases toxins as it clots which further damages brain cells. Of the two types, hemorrhagic strokes are rarer, typically more severe, and have higher mortality rates.
The second, more common type of stroke is ischemic. This occurs when a blood clot lodges in an artery. This occludes blood flow, effectively stopping the blood flow to the area in the brain meant to receive it.
Learn how to act F.A.S.T to recognize the signs of strokes as they are happening. Stroke Awareness: Signs to Know and How Physical Therapy Plays a Role
What physiological factors contribute to which symptoms are present after stroke?
The brain is divided in half into left and right hemispheres. Each hemisphere is vascularized by three main arteries: the anterior cerebral artery, the middle cerebral artery, and the posterior cerebral artery. These arteries can be thought of as being in the front, middle, and back of the brain respectively.
The affected area of the brain and the impairments following a stroke are determined by which artery the stroke occurred in. Each area of the brain controls different functions of the body, so symptoms following a stroke can generally be predicted. This is because the brain is organized into areas that control different functions. Additionally, strokes in the left hemisphere affect the right side of the body and vice versa.
Anterior Cerebral Artery (ACA) strokes place patients at risk for impairments in frontal lobe function. Due to damage in this lobe, they may show changes in emotional control, higher reasoning skills, organization, and judgement. ACA strokes are also typically characterized by hemiparesis, or a loss of strength on one side of the body, especially in the lower body or leg. Finally, ACA strokes are characterized by incontinence, especially of the bladder.
Middle Cerebral Artery (MCA) strokes place patients at risk for impairments in temporal and parietal lobe function. Due to damage in this lobe, they may show difficulty with speech. This can include both coordinating the muscles of the throat and mouth to speak clearly or with comprehension and planning of logical speech. It can also affect the ability of the patient to swallow food and drink safely. MCA strokes are also typically characterized by hemiparesis, especially in the upper body or arm.
Posterior Cerebral Artery (PCA) strokes place patients at risk for impairments in occipital lobe function. PCA strokes are typically characterized by a change in vision. Due to damage in this lobe, they may demonstrate double vision, blurred vision, or blind cuts in their field of vision.
What does physical therapy look like in the three phases of stroke?
Although strokes have some predictability based on what area of the brain was affected, EVERY stroke is different and an individualized approach to care is very important! Symptoms of stroke can vary widely in severity and variety. Sometimes patients have symptoms that completely resolve within a few weeks after starting care.
There are three phases of stroke recovery: acute, sub-acute, and chronic.
The acute stage is 3-7 days following the stroke. The patient is typically in the hospital during this time and may receive a PT evaluation that will determine recommendations for continuing rehabilitation care.
The sub-acute stage is three months following a stroke. The brain has the best capacity to heal and relearn movement in the first three months following a stroke, and intense therapy during this time is highly recommended.
The brain needs practice and loading for improvements to take place in this period. If the brain is not challenged in this time, the short window of optimal relearning will close with the patient likely making little to no progress. Therapy provides the opportunities for the brain to re-learn movement and its communication with the body by safely challenging strength, balance, dexterity, and endurance.
Many stroke patients will also receive gait training and functional training, like learning how to efficiently roll in bed or stand up from a chair with the least amount of assistance. The gains that are made in the first three months are typically permanent.
The chronic stage is the time greater than three months from the initial stroke. There can still be recovery from stroke impairments, however the rate of recovery will be slower. This period of care may be focused on progressing a patient to a more mobile assistive device (like a cane versus a walker), performing patient and family education, and recommending home modifications to help a patient become as independent as possible.
As years pass, symptoms become more permanent and care moves into a maintenance and compensatory stage, where treatment is no longer focused on large changes in status but maintaining or moderately improving the baseline strength, balance, and endurance of patients.
Compensatory treatment may also include prescription of adaptive devices to assist the patient in activities that they are unable to physically complete. When patients have permanent changes from their stroke, many will come to physical therapy for their annual allotment of physical therapy visits. These phases of care are often “tune-ups” where rehabilitation is focused on progressing patients back to their maximal potential after time spent away from clinic.
Occupational Therapy for Stroke Recovery
Physical therapy is not the only service that Spooner can offer to patients who have experienced a stroke. It is common for physical therapists to co-treat with occupational therapists, many of whom specialize in upper extremity/hand therapy. Through seeing an occupational therapist and a physical therapist simultaneously, goals can be achieved from a whole-person and whole-body perspective.
Read more about how Occupational Therapy can improve different areas of your life from Occupational Therapists: Empowering Everyday Living
May is Stroke Awareness Month. If you or a loved one has had a stroke, you are not alone on your journey. At Spooner, we want to help you achieve your goals following stroke. This could be getting back to your recreational hobbies, becoming independent, or improving overall vitality. We are here to support you.
Learn more about Neurological Rehab at Spooner and schedule an appointment today to have treatment unique to you following a stroke.