Stroke is No. 3 killer in Singapore after heart disease and cancer(1). A cerebrovascular accident (CVA), or stroke as it is more commonly called, may be defined as the sudden onset of neurologic signs and symptoms resulting from a disturbance of blood supply to the brain. The individual who sustains a CVA may have temporary or permanent loss of function as a result of injury to cerebral tissue.

Types of Stroke
The two major types of stroke are ischemic and haemorrhagic. Ischemic stroke is the most common type, affecting about 80% of individuals with stroke, and results when a clot or impairs blood flow, depriving the brain of essential oxygen and nutrients. Haemorrhagic stroke occurs when blood vessels rupture, causing leakage of blood in or around the brain.

Ischemic Stroke
Ischemia is a condition of decreased oxygenation to the brain tissue and results from poor blood supply. Ischemic stroke can be subdivided into two major categories; thrombosis and embolus.

Thrombosis refers to the formation or development of a blood clot within the cerebral arteries or their branches. While embolus is composed of bits of matter (blood clot, or plague) formed elsewhere and released into the bloodstream, traveling to the cerebral arteries where they lodge in a vessel, produce occlusion and infarction.

Haemorrhagic Stroke
Haemorrhagic stroke, with abnormal bleeding into the extravascular areas of the brain are the result of rupture of a cerebral vessel or trauma. Haemorrhage results in increased intracranial pressures with injury to brain tissues and restriction of distal blood flow.

Transient Ischemic Attacks (TIA)
A TIA, also called a mini stroke, resembles a stroke in many ways. When you experience a TIA, the blood supply to the brain is temporary interrupted. This will cause loss of motor, sensory, or speech function. These deficits, however, completely resolve within 24 hours. You do not experience any residual brain damage or neurologic dysfunction. But, the bad news is, 10% of those with TIA, will develop stroke within a year.

Risk Factors of Stroke
Cardiovascular diseases affecting the brain and heart share a number of common risk factors important to develop stroke. These risk factors include:

  • • Hypertension
  • • Transient Ischemic Attack
  • • Diabetes mellitus
  • • Age older than 65
  • • Heart diseases
  • • Obesity
  • • High cholesterol
  • • Cigarette smoking
  • • Heredity

Signs and Symptoms of Stroke

  • • Paralysis, weakness or numbness on one side of the body
  • • Trouble with walking – stumble or have sudden dizziness, loss of balance or loss of coordination
  • • Difficulty with speech or slurred speech
  • • Blurred vision
  • • Headache, stiff neck, facial pain, vomiting or altered consciousness, or by recognizing the signs of F.A.S.T. by The Stroke Association of UK

Rehab Program for Stroke Patients
For most stroke patients, rehabilitation mainly involves physiotherapy. The aim of physiotherapy is to let the stroke patient relearn normal movements such as walking, sitting, standing, lying down, and transfer safely. Hence they can move more normally with the use of both sides of the body rather than an overuse of 1 side.

To achieve this, training, exercises, and physical manipulation to restore movement, balance, and coordination to the body are some commonly used techniques. Otherwise, they would overuse the good side of the body and neglect the weak-side. After it becomes a habit of moving, it would be difficult to achieve a normal pattern of movement.

The special qualities of water (buoyancy and resistance) are used in rehabilitation to assist in maximising movement and restoring function. As a person immersed in water, he or she weighs less. The buoyancy of water supports the body and protects the weight bearing joints. The floating effect will reduce the impact of forces on the body and the spine, compared with land based exercises.

Occupational Therapy
Occupational therapists help patients to relearn activities of daily living. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and toileting. While speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication.
The ultimate goal of physical rehabilitation is for them to regain confidence to get back to move independently in the community.

1. Singapore Heart, Stroke & Cancer Centre
2. Martin and Kessler. Neurologic Interventions for Physical Therapy. (2007). USA. Elsevier.
3. O'Sullivan Susan B. Physical Rehabilitation. (2006). USA. F A Davis Co.

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