KNOW THE SIGNS OF A STROKE

FACE:

Is your or someone else's face drooping? Are they drooling out of the corner of their mouth? Is one of their eyes more or less open than the other?

ARMS:

Can you or the other person hold both of your arms out in front of you, and keep them at the same height? Are there tremors? Is there pain, sluggishness, or does one arm keep dropping?

SPEECH:

Is your or another person's speech slurred, slowed, or incoherent? Do you feel like you can coordinate your mouth to make the words? Do you feel like you can form a sentence, and another person can understand it?

TIME:

Every minute counts. Stroke patients who receive treatment in the first hour have the best chance for surviving, and the best outcomes after their stroke.

CALL YOUR EMERGENCY NUMBER IF YOU BELIEVE YOU OR SOMEONE IS HAVING A STROKE

A stroke is a medical event in which the tissues of the brain are damaged, either through a bleed in the brain or through stoppage or interruption of the bloodflow to an area of the brain. The brain is responsible for controlling conscious and unconscious elements of normal human function. It is the seat of control of the central and peripheral nervous systems, is responsible for maintaining normal bodily function as well as interacting with the world in a controlled and coordinated manner, and is the source of our perception of the world, our personalities, and our selves. It is the single most energy-hungry part of the body, consuming glucose, oxygen, and other fuel materials from the blood, and is therefore served by a robust and well-reinforced network of arteries, nerves, and small vessels whose function is tightly regulated. Given its importance, the brain is separated from the main circulatory system by the blood brain barrier, which finely controls bloodflow to the brain, filters the blood passing through and around the brain, as well as preventing infection of the brain itself by outside pathogens. Because of its importance and centrality to normal human life, damage to or changes in the brain have the potential to have immediate, significant, and permanent consequences that require ongoing management.

In a stroke, bloodflow to the brain is disrupted in one of two ways. One form of stroke occurs when there is a sudden or sustained disruption to the bloodflow to a part of the brain, starving that part of the brain of blood, oxygen, and nutrients. This is called an ischaemic stroke, and can occur over time or very quickly. An ischaemic stroke that occurs as a result of change over time is usually accompanied by signs of age or lifestyle-related factors like narrowing of blood vessels due to the buildup of plaque inside the vessels, narrowing of vessels due to chronic blood pressure changes, and other changes that may occur in cases of uncontrolled chronic conditions like diabetes, other cardiovascular disease, or some other illness. An ischaemic stroke that occurs very quickly is commonly caused by blockage of a blood vessel by a solid mass like a clot, a globule of fat, a bubble of air, or some other obstruction to normal blood flow. This obstruction is called an embolus, and an embolus can travel within the blood vessels until it flows down a vessel too small for it to fit, eventually causing a blockage. When this blockage occurs in the heart, it is called a heart attack, when this blockage occurs in the brain, it is called a stroke.

The second type of stroke occurs when a blood vessel in the brain bursts, resulting in a bleed into the brain that isn't filtered by the blood brain barrier, and which floods the area. This is called a haemorrhagic stroke, and can be caused by factors that build up slowly or which occur quickly. Slow-building factors that contribute to haemorrhagic strokes include old age, with strokes occurring in the elderly, as well as gender, with these strokes more likely to occur in men. Another longterm risk factor in the development of a haemorrhagic stroke is elevated blood pressure, which strains the tissues of the small blood vessels of the brain to the point where they rupture. These blood vessels themselves may be at risk if there are deformities in their constitution. Deformities in the blood vessels of the brain are called Arterio-Venous Malformations, and the presence of these malformations has the potential to cause bleeds in the brain. Haemorrhagic strokes can also occur with short notice, most commonly due to a spike in blood pressure which places sufficient strain on the small vessels that causes them to burst, resulting in a bleed. An example of this is an increase in blood pressure that occurs when exerting oneself when lifting, or an increase in blood pressure due to stress. 

Regardless of the cause, strokes cause damage to and changes in the brain. These changes may be fast-resolving if a person who is experiencing a stroke is admitted to hospital, diagnosed, triaged, and managed with utmost expedience. If there is a delay in diagnosis, if the damage is catastrophic, or for any other reason, there may be ongoing consequences of the stroke. The consequences of a stroke may be difficult to predict accurately - a stroke is a medical event that doesn't just affect the area of the injury, but which has the potential to affect other parts of the brain with time as the brain changes to compensate and as the after effects of the injury evolve. Strokes can affect peoples' personality, their perception of the world, their fundamental senses, their cognition and mental function, and their movement and balance. Because of the potential of a single medical event to have such profound and long-lasting consequences, strokes are never managed in isolation by one person or profession, but always within a team of disciplines that address all potentially changed domains of function, including physiotherapists, speech pathologists, occupational therapists, social workers, home support workers, and of course the medical team which may include a consultant or a surgeon. Management of a stroke may go further than the hospital admission, with a person being eligible for support at home that includes carers, at-home medical support and management, or even modification of the home to support safe movement and engagement with a familiar environment. 

Physiotherapy management of strokes is a deeply involved and studied domain of practice. The most common treatment provided is physical rehabilitation with a neurological aspect, designed to promote appropriate and sustainable posture, increase the ease of movement and decrease the risk of falls, to restore and maintain the strength of the body, and to conduct these interventions in coordination with other disciplines to ensure the best possible outcome for the person under care. This management can be undertaken in hospital, in a private clinic, or in the home, depending on the progression of the condition, propriety of the patient to engage with therapy, and practicality of the service delivery plan, as well as any additional considerations that may arise. The problems presented by strokes are too numerous and nuanced, and the scope of physiotherapy to support the wellbeing of a stroke patient is too broad to be accurately described in one article, but rest assured that if there is a problem presented by a stroke or other brain-related neurological event, there is a physiotherapy discipline and a physiotherapist who can help.

Management of your discomfort depends on its causative factors, how it feels and changes during the day, what makes it better and worse, and the length of time you have been experiencing that pain. All of these factors will be addressed in your initial assessment, which is the first step toward managing and minimising any pain or discomfort. The treatment you receive will be tailored to address the specific cause of your discomfort, and will focus on minimising pain, maximising your ability to move pain-free, and developing a plan to minimise the risk of a flare-up in the future.

At Atlas Physio, we will provide you with education, structured management, and ongoing monitoring of your pain both in-clinic and out. Contact us to arrange an assessment, and to take the first step on a course of corrective care today.