Recovering from a stroke

IF you ever experience a stroke, the key thing you should remember is to act fast.

Get to the hospital as quickly as you can the minute you suspect you are having a stroke. These include:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause

Also, check the time so that you know when the first symptoms appeared. This is important for doctors to know how best to treat you.

And start seeing a physiotherapist as soon as possible after you are discharged from the hospital.

According to senior consultant physiotherapist Tarnjit Kaur Bains, those who start - and continue - physiotherapy immediately after their stroke are the ones who gain the most benefit out of it.

In fact, doctors will usually refer a physiotherapist to a stroke patient once he or she has been stabilised after admission to the hospital.

Bains, who has 25 years of experience under her belt, says that during the acute stage in the hospital, the physiotherapist does simple things like helping the patient to sit up and to breathe properly. But much of the most important work occurs after the patient is well enough to be discharged from the hospital.

According to the American Heart Association website (www.americanheart.org), brain injury from strokes can affect a patient's senses, motor skills (or movement), speech, behaviour, memory, and/or emotions.

Bains says that from a physical point of view, patients might recover completely, or at least, improve their affected motor skills over time. "However severe the stroke is, the sooner you start (physiotherapy), the likelier they are to get functional."

The extent of their recovery however, depends on the severity of their stroke and how soon they seek treatment. "What you want to achieve is to enable them to perform their daily activities, and even their jobs," she says.

Sharing the example of one of her patients - a middle-aged lady who needs to work to support herself, Bains says that although she is not able to drive herself, she can still do computer work, albeit with only one hand.

What physiotherapy can do

What physiotherapy can do

However, she says that the problem in Malaysia is the lack of importance attached to physiotherapy. "Patients really revere doctors at times, and when doctors don't tell them, or emphasise to them, that they need physiotherapy, they don't take it seriously enough and may skip their appointments."

Bains, who is currently the managing director of the BainsPhysio centre, adds that "most doctors, when they come to me for physiotherapy for their own problems, are amazed that we (physiotherapists) do so much".

Once a patient is discharged from the hospital, there is usually at least a month's period before they see the doctor, and then only do they get referred to the physiotherapist.

"The appointment with the physiotherapist might be three weeks to a month later, and even then, patients might miss the appointment."

This results in many patients only seeing a physiotherapist around four to six months after being discharged. By that time, they would already have bed sores and contractures, which the physiotherapist would then have to correct, before being able to start on the rehabilitative programme to restore their functional movements.

She says that a lot of family members also initially get very involved in the patient's care when they first come home.

"They do everything for the patient. But eventually, everybody goes back to their normal lives, and the patient is left without all the help he initially received," she says.

"That's why the physiotherapist's role is very important - to tell the family to assist, but only when necessary. The amount of support and assistance to give is very important. This is where the physiotherapist can come in and tell them how much independence the patient can achieve."

Bains opines that the role of family members is crucial in providing moral support, motivation, and positive thoughts to encourage the patient to get better.

They can also help in modifying the house to facilitate the patient's limited movements, as well as assist the patient in doing certain exercises that need to be repeated daily.

"Some families might think, we can do the exercises for them, what do we need the physiotherapist for? But as lay people, they don't know how to detect trick movements," says Bains.

She explains that "trick movements" are what the patient does to accomplish a task using muscles other than the ones that actually need to be exercised.

For example, the patient might swing his arm forward using his body, instead of actually lifting his arm. This only results in the weak muscles deteriorating and getting weaker, she adds.

According to Bains, within the first six months of receiving physiotherapy, stroke patients improve at an exponential rate. After that, they reach a plateau as they would have recovered the best physical function they can have.

However, this is the time when they and their physiotherapist work on fine-tuning their affected movements, so that they can perform more delicate tasks.

A lot of patience is needed during this period from both the patient and the physiotherapist, as the progress might be slower and more frustrating for the patient.

Improving fitness

Improving fitness

Prevention, as they say, is always better than a cure. So Bains is an advocate of those aged over 40 with low fitness levels seeking the help of a physiotherapist to help improve their fitness levels before anything unfortunate happens.

"Most stroke patients have four major problems - diabetes, high blood pressure, increased cholesterol levels, and obesity.

"So what happens is, we can start working to increase their fitness levels," she says.

Bains adds that most people already know they have health issues, and have seen the doctor, who advises them to exercise. This, to most people, means buying a pair of good shoes and starting to jog. But then, some go at it the wrong way, and end up spraining an ankle or overdoing it, thus triggering another round of visits to the doctor - usually the cardiologist.

A physiotherapist, she says, can design a graduated exercise regimen, so that the person's fitness level can be improved at a suitable pace. "A lot of people think that physiotherapists only do massage or exercise. And they think that you only see a physiotherapist after a major traumatic incident (like a stroke). They can't imagine seeing a physiotherapist before actually having a problem," says Bains.

"I want doctors in particular, to know that physiotherapists do much more than what they are aware of."

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