Case Studies On Stroke

Strokes are known as the leading cause of acquired disability in adults where between 20-30% are left unable to walk, and leaving those who are able to walk, with a moderate to severe walking disability (Maguire et al., 2012). This disability results in a huge socioeconomic impact on the patients and their families lives. In order to improve their quality of life, an improvement in balance is the important first step in which is crucial to enable more independent movement, for example walking.

Physical activity can improve health and lower risk for heart disease, stroke, type 2 diabetes, depression, and some cancers, (CDC, 2014). Even though physical activity can reduce recurrent stroke, stroke survivors are not engaging in physical activity at optimal levels to protect against recurrent stroke. In their research, Boysen & Krarup, pg. 148, (2013) found that “following a stroke, sequelae such as hemiparesis and ataxia may limit the trainability of stroke patients and lead to decreasing levels of physical activity and physical performance.” Historically, motivation to exercise has also been cited in the literature as a deterrent and a facilitator to exercise among the stroke survivor population (Damush, Plue, Bakas, Schmid & Williams, 2007). According to a study conducted by researchers Mohan, Wolfe, Rudd, Heuschmann, Kolominsky-Rabas, & Grieve, (2011) patients who survive an initial stroke are at a significantly increased risk for future strokes compared with the general population; a systematic review and meta-analysis showed that the cumulative risk of stroke recurrence was 3.1% at 30 days, 11.1% at 1 year, 26.4% at 5 years and 39.2% at 10 years. Furthermore, recurrent strokes are more likely to be disabling or fatal compared with the first stroke (Mohan, Crichton, Grieve, Rudd , Wolfe, & Heuschmann,

(2013). The efficacy of SMART Arm training early after stroke for stroke survivors with severe upper limb disability: a protocol for a randomized controlled trial. BMC Neurol 2; 13:71.

Five participants with acute stroke and unilateral hemiparesis (Age 51 ± 17 years; Height 1.7 ± 0.1m; Weight 81.6 ± 3.6kg; LOS 36 ± 24.6 days; 3 males, 2 females; 2 with right hemiplegia) were recruited for RE gait training during inpatient rehabilitation in conjunction with traditional therapy. Participant inclusion requirements: have a medical clearance, upright standing tolerance (≥30 min), intact skin, physically fit into the device, have joint range of motion within normal functional limits for ambulation, have had stroke with its onset >1 week and 0.05). This may suggest that the RE was limited to rehabilitate muscles during the IDS and swing phases as seen in figures (6-8).

People often relate the loss of arm mobility to stroke patients because it is so noticeable when a person cannot use one of their arms properly. Statistics show, “motor deficits are common following stroke. Approximately 43% to 69% of people suffering from a stroke have upper-extremity impairment, 1, 2 and 4 years after a stroke, 67% still experience non-use of the affected arm as a major problem” (Siebers et al., 389). In these cases, CIMT can be more beneficial than less invasive therapies. CIMT looks to force movement and use of the affected side of the body after a stroke in order to promote rehabilitation while limiting the unaffected limb. However, this type of therapy does not come easily as CIMT is a very rigorous therapy. In the article, Stroke patients ' and therapists ' opinions of constraint-induced movement therapy, it was stated this therapy is intense because the unaffected arm is restrained while the patient participates in about 6 hours

According to American Stroke Association (ASA), stroke is a disease that affects the arteries that lead to the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. As a result, part of the brain cannot get the blood and oxygen it needs which causes brain cells to die (American Stroke Association, n.d.). Depending on where the stroke occurs in the brain, the level/type of impairment differs with the individual. For example, if a stroke occurs in the back of the brain, it is likely that some disability involving vision will result. Overall, the effects of a stroke depend primarily on the location of the obstruction and the extent of brain tissue affected (American Stroke Association, n.d.).

The subjects of the study were ten people who had recently had a stroke, two were women and eight were men. Additionally, these people had only one leg affected and were able to safely use all the testing equipment. Each person was first subject to four tests for a clinical assessment to better understand the subjects. These tests were the Modified Ashworth Scale, Timed Up and Go Test, manual muscle testing, and a test to determine the person’s range of motion.

A stroke occurs when there is a sudden decrease in blood flow to a localized area in the brain (Trakalo, 2015, p.1234). This can occur in different ways such as a thrombus, an embolus, a stenosis, or a hemorrhage - all of which can cause devastating neurological effects depending on the extent of ischemia and necrosis resulting from the decreased oxygen carried by the blood.

The initiation of the therapy can vary in how quickly it begins for each individual. For some patients it begins within two days post stroke and continues after being discharged. Since there is such a wide range of the severity of strokes, rehabilitation options can be different from client to client. For some individuals, rehabilitation can take place in an inpatient therapy at a hospital, for others they may return home and attend outpatient therapy at a clinic. There are other options including subacute care units and long term care facilities that also provide important therapy “Rehabilitation Therapy after a Stroke,” 2015). Regardless of the environment, these therapies aim to achieve the same goal of improving the function and independence of the stroke

Constraint Induced Movement Therapy (CI) is one of the many treatments that are used to increase brain plasticity in stroke patients (Taub, 2004). Stroke survivors undergoing CI treatment will focus on training the affected area for several hours a day throughout the week (Taub, 2004). This treatment is used in combination with other treatments and it increases the use of the affected extremities. This treatment is used specifically to overcome nonuse of the affected extremities. This study showed that use depended brain recognition in monkeys are the same in humans, showing that using effected extremities after stroke can have similar affects (Taub, 2004). Training the affected area will help to gain mobility in the extremity, nonuse of the extremity will not foster mobility (Taub,

“Stroke is the third leading cause of death, after coronary heart disease and cancer. Each year there are about 600,000 strokes in the united states and strokes kill over 150,000 americans each year. Over 15% of people who have had a stroke die within 30 days, and 15-30% of people of people who survive a stroke are permanently disabled” ("Your). “A stroke happens when a blood vessel to the brain is blocked by a clot or burst. When a blood vessels burst or breaks, it is known as a hemorrhagic stroke. This causes your brain to not get the oxygen from the blood it needs, killing brain cells. Someone in the world has a stroke every 40 seconds. More women than men have had strokes each year, in part because women live longer.”("About). According

The first clinicians to study hemiplegic shoulder positioning were Dean et al.’s (2000) who recruited 23 chronic stroke patients and allocated them to an intervention group of 10 patients and a control group of 13 patients. Both groups’ arm received training on active tasks but the intervention group additionally received prolonged positioning of the hemiplegic arm thrice per day for 20 minutes, during 6 weeks (Dean et al. 2000). Three different positions were implemented: first, the patient laid supine with shoulder in maximum painless abduction, external rotation and flexion of the elbow; second, the patient laid supine with shoulder in 90ο abduction, maximum painless external rotation along with elbow flexion, and; third, the seated patient

What are the impacts of the wrist and hand splints on the recovery of individuals who have undergone strokes?

A cerebrovascular accident more commonly known as a stroke or brain attack is the term used to describe the sudden death of brain cells in a localized area due to inadequate blood flow. In order to woke the brain needs a constant supply of oxygen and nutrients. This supply is carried to the brain

“About 120 individuals were consecutively and randomly allocated to one of three groups: (T1) rhythm and music-based therapy program; (T2) therapeutic riding; or (T3) control group receiving the T1 training program a year later.”(Käll, 2012). The search criterion was limited to individuals who suffered from stroke 1 to 5 years prior to the study. By searching through hospital files, they selected people who were potentially eligible for the trial. Those who met the criteria were those who were aged 50-75 years, being in the late phase of stroke, having their own house, subarachnoid haemorrhage with initial presence of hemispheric impact/symptoms, and having an additional stroke within the past year. “The therapy program, designed to help people with injuries and diseases of the central nervous system is called Ronnie Gardiner Rhythm and Music method (RGRM™) and has since 1993 been implemented in healthcare and rehabilitation in Sweden.” (Käll, 2012).The method is based on the principle of neuroplasticity which allows the nerve cells in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment (Medcinenet.com) , and uses rhythm, music, colour, the voice, text, shapes and movement to stimulate coordination, balance, endurance, attention, memory, body image and social interactions. (Käll, 2012). With hippotherapy, the rhythmic and repetitive walking motion of a horse resembles that of a human walking, and the many textures, sounds and sights provide an enriched environment. The concept of hippotherapy and all these different things that can be incorporated with it, such as rhythm and music, gives people that have suffered from a stoke