A Guide to Physical Therapy for Stroke

A stroke can be a devastating event. It is the leading cause of disability in the United States and affects over 795,000 people each year.¹

Many people who suffer a stroke require physical therapy as part of their rehabilitation process. In this guide, we will discuss what a stroke is, what causes it, how it is diagnosed, and how physical therapy can help.

At the appropriate time in recovery from stroke, when you are ready for evidence-based care in your home, at a clinic, or virtually, a CityPT clinician can be there for you.

Table of Contents

• What is a Stroke?
• Symptoms of Stroke
• Causes of Stroke (CVA)
• Diagnosing a Stroke: Current Evidence
• Diagnosing Functional Deficits Post-Stroke
• What to Expect: The Stages of Rehab Following Stroke
• Navigating Stroke Recovery with a Rehab Team

What is a Stroke?

A stroke, also known as a cerebrovascular accident (CVA), is a sudden event that causes neurological damage. It occurs when the blood supply to the brain is interrupted, depriving it of oxygen and nutrients.

There are two main types of strokes: ischemic and hemorrhagic. Ischemic strokes, which make up about 87% of all strokes,¹ occur when a blood clot blocks an artery that supplies blood to the brain. Hemorrhagic strokes happen when a blood vessel in the brain ruptures and bleeds into the surrounding tissue.

Symptoms of Stroke

Symptoms of a stroke can appear suddenly and may include:

• Numbness or weakness in the face, arm, or leg (especially on one side of the body)
• Confusion or difficulty speaking
• Difficulty seeing in one or both eyes
• Difficulty walking
• Dizziness
• Loss of balance
• Severe headache (with no known cause)

Time is of utmost importance when it comes to managing a stroke, thus the American Stroke Association offers the acronym F.A.S.T. as a way to quickly identify the signs:²

• Face drooping
• Arm weakness
• Speech difficulty
• Time to call 911

If you or a loved one experience any of these symptoms, it is important to seek medical attention immediately.

Causes of Stroke (CVA)

There are many factors that can increase your risk of having a stroke. These include:

• High blood pressure
• Heart disease
• Diabetes
• Smoking
• Obesity
• Sedentary lifestyle
• Excessive alcohol consumption
• Family history of stroke or heart attack
• Rare genetic conditions

Managing these risk factors is important in stroke prevention. Most importantly, managing modifiable risk factors can reduce the risk of a stroke.

In addition to these lifestyle factors, there are also some medical conditions that can increase your risk of stroke, such as:

• Atrial fibrillation (a type of irregular heartbeat)
• Carotid artery disease (narrowing of the arteries that supply blood to the head and neck)
• Sickle cell disease (an inherited blood disorder)
• Transient ischemic attacks (mini-strokes)

If you have any of these risk factors, it is important to talk to your doctor about ways to reduce your risk.

Diagnosing a Stroke: Current Evidence

The diagnosis of a stroke is made based on the patient's symptoms, medical history, imaging, and physical examination. The gold standard for diagnostics is magnetic resonance imaging (MRI). However, computed tomography (CT) is often used in the emergency setting because it is readily available and can be performed quickly.

It is of utmost importance to determine the type of stroke, or other underlying causes of neurological symptoms, as quickly as possible. This is because the majority of stroke cases can be treated with clot-busting drugs (TPA) within a specific time frame — typically 3 to 5 hours from symptoms onset. They can also help reduce long-term effects of a stroke. However, these drugs are only effective with ischemic strokes and can actually cause more harm if given to hemorrhagic stroke patients.

In reality, some hospitals are better equipped (and certified) to administer TPA within a shorter window time. If possible, keep this in mind when heading to a hospital.

Diagnosing Functional Deficits Post-Stroke

Once your medical state has stabilized following a stroke, it's time to assess the neurological damage done. The effects can vary significantly, ranging from minor deficits to complete debilitation. A rehab team will complete an in-depth assessment to gauge your current functional state and help set goals for a realistic recovery. However, only time will tell what recovery potential is possible.

A post-stroke rehab team consists of:

• Physical therapists
• Occupational therapists
• Speech and language pathologists
• Psychologists/counselors
• Social workers

What to Expect: The Stages of Rehab Following Stroke

The goal of physical therapy following a stroke is to help the patient regain as much function and independence as possible. Every patient is different, so the specific treatment plan will be tailored to the individual. Overall, it's been found that the first 2 to 3 months are most vital for regaining as much function as possible with an intensive rehab program.³

Where you begin your recovery process will depend on the severity of your ongoing symptoms and functional deficits. For moderate to severe cases, you can expect to follow a continuum of care similar to the following:

Acute Care/Inpatient Rehabilitation

Following a stroke, patients typically require at least a few days in the hospital for close medical monitoring and management. For patients with more severe deficits, they may be transferred to an inpatient rehabilitation facility (IRF) for daily intensive therapy services.

Post-hospital Rehabilitation

After being discharged from the hospital or IRF, patients continue their recovery through a variety of options. These include home therapy, outpatient therapy, or continued intensive care in a skilled nursing setting. The number of therapy sessions and frequency will be determined by the patient's progress and insurance coverage.

Community Reintegration and Long-term Management

The final stage of post-stroke rehabilitation doesn't have a defined beginning or end. Rather, it focuses on helping the patients return to their daily life and routines. This includes things like returning to work, getting back behind the wheel, or adjusting to any permanent changes in physical function. Patients will also need to continue monitoring their health long-term and managing any new risk factors to prevent another stroke.

This final stage is often neglected due to exhaustion of insurance funding or a lack of progress that an insurance company deems "significant" enough to continue. Yet, remember that even small gains in function can greatly improve your quality of life. It's important to set goals with your care team that are realistic and attainable to help you stay motivated throughout your recovery.

Navigating Stroke Recovery with a Rehab Team

Whether you or a loved one are recovering from a stroke acutely or you're dealing with chronic deficits, having a team of specialists to help guide you through the process is crucial.

Most importantly, if you reach the "final" stage of rehab and want continued support or feel you could continue making progress, you may consider continuing to work with a CityPT clinician. Our providers aren't limited by the rules of insurance companies and can offer more creative and individualized care plans to help you reach your goals.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.

References