What is a stroke?

Stroke is a suddenly occurring disease of the brain. It is caused by a disturbance of blood flow or bleeding into the brain. Typical symptoms are e. g. acute paralysis or reduced sensibility in one side of the body, reduction of the visual fields (hemianopia), double vision (diplopia), gait disorders, disturbances of speech or swallowing. Stroke is the most important factor for long-term disability in Europe. For example in Germany approximately 200.000 persons get ill by stroke every year. One million persons in Germany are living with the sequels of stroke.

In stroke rehabilitation especially the following disturbances are of major concern:

• Hemiplegia = Plegia of one side of the body
• Hemiparesis = One-sided weakness
• Hemihypoaesthesia and -algesia = disturbances of sensation of one half of the body
• Disturbances of sense of position
• Hemianopia = Disturbances of visual fields
• Spasticity = pathological high tension of muscles
• Ataxia = Disturbance of body posture and balance
• Neglect = Diminished perception of one half of the body or the room
• Apraxia = Disturbance of planning a series of movements, e.g. with the intention to prepare a coffee machine
• Painful shoulder
• Disturbance of memory and concentration
• Disturbance of spatial orientation
• Edema of the paralytic arm or leg
• Disturbance of coping with the disease

After a stroke everything is changed!

This heading tells us everything about living with stroke. The whole life is changing according to the patient – and his family! But there is no need for resignation. There is much to do for the patient. But he can’t do that alone. He needs help by his family, and he needs a team of experienced therapists.

In the KLINIK HOHER MEISSNER an interdisciplinary team consistant of physicians, physiotherapeutists, occupational therapeutists, speech therapists, social workers and psychologists help the patient to reacquire independence in the activities of daily living and a reintegration into family and – if possible - profession.

Stroke rehabilitation starts in the hospital and dependent on the severity of the disability it has to be continued in the rehabilitation clinic afterwards.

Plasticity of the brain

Plasticity means the ability of the brain to adapt to new conditions. Studies gave evidence, that even the adult brain is able to plastic modulation. Intensive use of an arm or a leg leads to an enlargement of the representation area of this limb in the brain cortex and a better motor function. This is an important component of a successful rehabilitation as well. Physiotherapy induces an expansion of the representation area, even after vascular brain damage.

The Process of Stroke Rehabilitation

Rehabilitation helps stroke patients relearn skills that got lost. For example, these skills can include coordinating leg or arm movements. The ability to walk or carry out movements involved in any complex activity is intended. In case of disabilities after stroke, rehabilitation teaches patients to perform tasks by relearning or compensation. Patients may need to learn how to eat and dress using only one hand. They may learn how to communicate effectively when their ability to use language has been compromised.

Rehabilitation affords an interdisciplinary team of physicians, nurses, physiotherapists, occupational therapists, speech therapists, psychologists and social workers. The aim is to regain independence in the activities in daily living and an integration into family and profession.

Nursing Care and Occupational Therapy intend improvement of functional level regarding everyday tasks, such as bathing, dressing and eating. Occupational therapy may also test and recommend adaptive equipment. Physiotherapy addresses especially gross motor issues, such as walking and posture, as well as general strengthening and muscle retraining. Physical Therapy is added to lower level of spasticity or pain. Special forms of electrotherapy can support motor learning (EMG-triggered electrostimulation). Logopaedia addresses speech, language and swallowing. The aim of Psychological Therapy is to improve cognitive disturbances (e.g. disturbances of concentration and memory, neuropsychology) and coping with the disease. Social workers support planning and preparing life after rehabilitation. Dietician give information and train in healthy nutrition, e.g. in case of diabetes mellitus or adiposity.

There is a consensus among experts of neurological rehabilitation that the most important element in rehabilitation program is carefully directed, well-focused, repetitive practice. For example the gait-trainer helps us in repetive training of gait and walking.