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Post-stroke recovery
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Publishing Date: May 17, 2020

The sequelae of a stroke depend on the part of the brain affected, the severity of the injury and the person’s own health when the stroke occurs.
Recovery may or may not be complete, but there are three truly essential disciplines, not only for rehabilitation but also for the prevention of secondary problems: physiotherapy, occupational therapy and speech therapy. Get to know the role of each one better.

 

 

1 – What are the main problems or sequels that result from a stroke and need therapeutic intervention?

“Although each case is unique, most people have motor, sensory, coordination problems and many still have changes in cognitive functions such as perception, attention, memory, language and executive functions. At the functional level, they have difficulties in carrying out related activities with your self-care (personal hygiene, dressing, eating), with your profession, as well as with leisure activities (physical activity, playing with your children, going out with your family, walking, shopping). All of these areas are worked on, trained and developed through specific techniques that we can use to enhance the results we intend to obtain. ”

Elisabete Roldão, Occupational Therapist

 

“Most strokes translate into motor and sensory changes that can mean paralysis or paresis of the limbs, changes in the perception of the body scheme and spatial orientation, changes in tone, hypoesthesia, hyperesthesia or paresthesias, as well as changes in understanding and expression. Physiotherapy will, in the first place, maintain the muscle properties and length, providing the proper alignment of all body segments, to then be able to stimulate muscle action and facilitate functional movement patterns, it will also seek to recover the sensitivity of the affected segments, subjecting -the various types of sensory stimulation.In cases where the paralysis is more severe or the individual is more debilitated, physiotherapy will act in the prevention of pressure ulcers and other situations related to immobility, namely changes in the respiratory forum. These conditions have a great impact on the functional independence of the individual, physiotherapy should stimulate your autonomy through the training of basic functional activities, for example, changes in position [position], transfers between seats, gait training and the use of stairs. ”

Vanessa Fonseca, Physiotherapist

 

“The main difficulties in which the speech therapist intervenes are language (aphasia), swallowing (dysphagia) and the level of motor deficits (dysarthria). Aphasia consists of the difficulty in understanding and expressing a message through language, dysphagia it is present when the movement of the bolus – from the oral cavity to the stomach – is compromised and when the mobility of the muscles involved in speech is altered, we are facing dysarthria. The greatest objective of the speech therapist in these cases is to soften the capacities lost, so that the person who suffered the stroke regains his autonomy and increases his functionality in daily activities. Despite the fact that usually speaking more about issues related to communication, dysphagia is a problem that can keep people away from moments of shares on a social level, mainly in a country like Portugal, where a lot of time is spent around the table. Just remember that when a person people often choke, don’t control their saliva or can’t taste the same delicacies as others, prefer to keep some distance and isolation from those moments. ” –

Catarina Olim and Ana Paiva, Speech and Language Therapists

 

 

2 – Can you leave examples of intervention techniques and exercises that help in solving some common problems?

“We can use various techniques such as Proprioceptive Neuromuscular Facilitation, Bobath or Margaret Johnston, however, Training in Activities of Daily Living is the specific technique and expertly mastered by occupational therapists. This technique forces us to know the activity in detail, the context and the person so that we can analyze, adapt and train the performance of a task or activity so that it is performed in a functional, effective and satisfactory way by our user, thus enabling him to perform it in his daily life The major objective of the occupational therapist is to rehabilitate or enable to make the user independent and functional in the activities that are important and meaningful to him, so that he can be integrated again into the community, returning to perform his previous roles of father / mother, husband / woman, worker (a), friend (a), child (a), athlete, or others that possibly has. The intervention of the occupational therapist in post situations -AVC should be started as soon as possible as soon as the situation is clinically stabilized and allows. ”

Elisabete Roldão, Occupational Therapist

 

“For patients who suffer, for example, from hemiplegia, in the context of a rehabilitation session, the exercises go through the training of movement patterns inserted in functional actions, such as the change of position in the bed or the reaching of objects in the sitting position. the individual has this capacity, the balance training in the standing position should be done, stimulating the transfer of weight on the affected limb, training it to receive a load. Each case has its specificities, so autonomous exercises should only be done done with the certainty that the individual will not accentuate pathological patterns or resort to compensations. It is recommended that the exercises be done in front of the mirror in order to correct postures and ensure that the exercise is performed correctly. it must be done in the presence of a family member, in order to facilitate corrections when the physiotherapist is not present. ”

Vanessa Fonseca, Physiotherapist

 

“In the case of aphasia, the most recurrent technique will be the naming of real objects and images. It consists of showing the patient objects – and it is very important that they fit into their daily lives to arouse interest and be useful – and to encourage the appointment of We can, for example, give a syllabic clue if we find it difficult for the patient to start the word (for a mirror, for example, say “Es …”). In the case of dysarthria, we can resort to using the mirror by placing the patient facing him so that he can see the therapist’s model and can repeat the facial exercise, while we help with the hands to make the movement happen or stimulate the muscles with “facial massages”. Finally, dysphagia is a situation more delicate in that the exercises must always be performed by professionals, as an error can lead to the patient’s choking or something even more serious, so to work on a case of dysphagia we must stimulate and train the responsible muscles swallowing and afterwards, when there is control over these muscles, we can train the swallowing of liquids using a thickener to prevent the liquid from “going down quickly” and the patient not controlling its course and eventually choking. Regardless of the techniques used, it is important not to avoid communicating with the person because he thinks he does not understand, or to speak shouting because he thinks he does not hear well. Care must be taken to reduce existing noise sources, speak directly to the person and promote communicative environments. ”

Catarina Olim and Ana Paiva, Speech Therapists

 

 

3 – What are the basic general care that the caregiver of someone who had a stroke should have at home?

“First of all, the discharge process must be worked out in advance, as there are several issues to take into account before sending the user home. On the other hand, and unfortunately, not everyone will have, at the time of discharge, skills, conditions and autonomy to be able to return to the home, with some who follow other paths, namely the National Continuing Care Network. In any case, at home, the family must be prepared and informed by health professionals of the different situations to be taken into account with regard to respect to medication, food care and continuity of the rehabilitation process.

With regard to the occupational therapist, he has a fundamental role here, emphasizing the adaptations that must be made at home in order to enhance the performance and independence of these users. Simple changes such as the reduction of carpets, the elimination of obstacles, the placement of support rods in the bathtub or shower, the placement of utensils for daily use that are within reach, can promote independence and security. There are, however, more complex cases for which major adaptations will be necessary, promoting the elimination of steps with ramps or stair lifts, the adaptation of the bathroom with a bath chair or board, or the use of some support products such as floorboards. transfer, wheelchairs, electric beds, among others. “-

Elisabete Roldão, Occupational Therapist

 

“The arrival of an individual at home after a stroke must be planned in order to adapt the space to their needs. The family must also be prepared for the difficulties that may arise, namely, when relational or communication skills are altered. At the communication level, the family must use simple language, with direct commands, giving the individual time to respond, and it may also be necessary to use alternative means, which are selected with the speech therapist.
In terms of home adaptations, it may be necessary to have an articulated bed, a toilet or bath chair, or even change the arrangement of the furniture in order to allow walking, for example, in a wheelchair. It may be necessary to apply handles on the toilet walls or a handrail on the stairs.
In addition, the family must be taught to move and mobilize the individual in an appropriate manner, to assist in changes in position and transfer between seats. They must also be taught to encourage correct movement patterns and to avoid pathological patterns.
It is essential that the family does not replace the individual, allowing him to recover his autonomy. ”

Vanessa Fonseca, Physiotherapist

 

4 – If possible, leave a short description of a case that you have followed and that has had a positive evolution throughout the work.

“I cannot forget a case of a 50-year-old military man with a stroke that resulted in his paralyzed right hemibody and still presenting an aphasia of appointment. The first time I saw him was in the infirmary, in a wheelchair, and I was barely able to put him in a standing position as he fell to the right side, unable to control his body or movements. It was an intervention process of about a year during which we worked on motor skills starting with mobilization, stimulation of movement, muscle strengthening and progressively continuing to train for hand coordination, grips and Daily Living Activities, I remember that after two weeks of starting the graphics training, he wrote a postcard for his wife on Valentine’s Day that was already readable. Activities such as dressing / undressing, eating with a knife and fork, personal hygiene, writing, answering the cell phone, controlling the TV remote and many others were initially very compromised. being completely dependent on third parties to execute them. Training in Activities of Daily Living was implemented and we were able to achieve full functionality in all these activities and others that were very important for this user. He was discharged and was considered fit to continue serving the armed forces. Currently he is already retired, dedicating himself to family and friends and is still developing a project related to the cultivation of aromatic herbs. It is a case of success, as we have managed to resume their roles at the family, community and professional level in an autonomous and independent way. Unfortunately, not everyone is like that because it does not depend only on the commitment of the user, family or professionals, it depends on the clinical situation and severity of the injury. ”

Elisabete Roldão, Occupational Therapist

 

Sources:
– Ana Paiva, Speech and Language Therapist at Arte & Fala
– Catarina Olim, Speech and Language Therapist at Arte & Fala, President of the Portuguese Speech and Language Therapists Association
– Elisabete Roldão, Occupational Therapist, President of the Portuguese Association of Occupational Therapists
– Vanessa Fonseca, Physiotherapist at Fisiolar

 

 

Fontes:
– Ana Paiva, terapeuta da fala na Arte & Fala
– Catarina Olim, terapeuta da fala na Arte & Fala, presidente da Associação Portuguesa de Terapeutas da Fala
– Elisabete Roldão, terapeuta ocupacional, presidente da APTO – Associação Portuguesa de Terapeutas Ocupacionais
– Vanessa Fonseca, fisioterapeuta na Fisiolar

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