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Rehabilitation after stroke

The goal of rehabilitation is to maximally eliminate stroke complications and to prevent the development of disability, so that the patient is fully adapted to everyday life.

During recovery period particular attention is given to treatment of such stroke complications:

  • Motor disorders, dysfunction of internal organs. . Hemiparesis - paralysis of half of the body. Edema of paralyzed hands and feet. One-sided decrease of sensitivity. Spasticity is a pathological muscle tension. Apraxia is a damage to targeted movements.
  • Speech and swallowing disorder.. Aphasia is a speech disorder, loss of ability to express one's thoughts. Dysarthria is a disorder of speech articulation (slurred speech).
  • Neuropsychological and psychological disorders. . Impairment of memory, concentration and cognitive functions. Anxiety disorders.

Comprehensive recovery

Success of treatment of motor disorders, such as paralysis and spasticity, depends not only on physiotherapy, medical gymnastics and other methods aimed to directly correct motor functions, but also on the progress of therapy of communication, cognitive and psychological disorders. Vice versa is true as well.

Recovery after stroke requires an integrated approach that can not be achieved by doing exercises on one`s own. Without the supervision of an interdisciplinary team of specialists, the efforts of the patient and relatives will be futile or ineffective. As a result, patient can be completely unmotivated to participate in further rehabilitation.

The following areas of treatment can be distinguished::

It should be noted that dozens of concepts have been developed for individual areas of treatment. For example, Vojta-therapy, PNF, Hydrotherapy, EMG-triggered electrical stimulation, Stochastic resonance therapy, compulsory therapy, various types of massages and complexes of gymnastic exercises are used for the therapy of motor disorders. To overcome depression, stress and significantly improve the CNS function various stimulation techniques are applied, including Transcranial magnetic stimulation, Mesodiencephalic modulation, and Audiovisual stimulation.

None of these concepts has a clear advantage over others, therefore it is not recommended administration of only one technique. When a patient is recovering from a stroke, it is recommended to combine the most applicable exercises from various techniques.

Clinics that are part of the rehabilitation center have all the necessary resources, specialists and experience for successful treatment and rehabilitation of patients froma stroke of any complexity.

If you have questions about recovering from a stroke in Germany
please call: +49 228 972 723 35 or fill in
the request form.

Transcranial magnetic stimulation

Currently, transcranial magnetic stimulation presents significant interest to clinicians and researchers all over the world. The physical basis that stimulates nerve tissue by using alternating magnetic field is based on fundamental discoveries in the field of physics and medicine. In the beginning of 20th century studies showing the influence of alternating magnetic field on the human brain were already reported (in 1896, d'Arsonval described the process of phosphenesis - a patient's subjective perception of flashes of light in the eyes that occur when the patient's head is placed in a coil that generates an alternating magnetic field). Half a century later, Barlow (1947) and Colin (1959) showed that phosphenesis is associated with the stimulation of not only the retina of the eye but also the visual cortex of the brain by the magnetic fields. Positive results had also been obtained by stimulation of the peripheral nerves through the alternating magnetic field.

Hippotherapy for Stroke Patients

Hippotherapy is a physiotherapeutic treatment based on using rhythmic movements of the horse. This technique has been used since 1960s for treatment of cerebral palsy. It has also been used as part of rehabilitation of patients with cerebrovascular disorders. Horseback riding helps patients to improve balance, control their movements and restore muscle tone. Hippotherapy improves the patient's vestibular system by providing proprioceptive and psychosomatic effects.

Restoration of motor function

Stroke rehabilitation includes a well-known Bobat technique, which aims to reduce spasticity (excessive muscle tension) . This method is based on stretching the extensor muscles. The flexor muscles are particularly well stretched in the arms, whereas extensor muscles - in the legs. Stretching exercises are conducted as part of medical gymnastics. Other therapeutic methods are also used. There are also methods of proprioceptive neuromuscular simplification (PNF), and Vojta-therapy.

Restoration of coordination and gait

One of the complex tasks in stroke rehabilitation is restoration of a stable body position and gait. In severe cases the first measures of mobilization aim to improve the balance in the sitting position and the ability to stand while holding to some object. Patients with unilateral paralysis can stand up thanks to even distribution of the force load on the body muscles. Patients with severe injuries use a walking training machine. Belts provide security. Legs are fixed   on two platforms, which correspond with their movement when the patient is walking. Special mechanisms help to conduct vertical and lateral movements with the body. Later on, other physiotherapeutic methods are used for restoration of walking.   If the corpus of the patient is not stabilized, second doctor is needed to fixate the pelvis of the patient while first controls the knee of the paralyzed leg at the same time.

Ergotherapy

Ergotherapy is part of a recovery after a stroke. It is especially important in treating sensorimotor disorders of the upper limbs. Training of movements, coordination and motor skills, in some cases, prevention of use of a healthy hand  are the main methods of ergotherapy. The Perfetti method is used along with Bobat`s method and a number of other therapeutic techniques. The Perfetti method is primarily used for training of fine motor movements. For example, in this method a person sweeps the hand over various surfaces or objects or performs movements by a separate joint. Patient should then describe his feelings. The goal of such exercises is to improve sensory perception and to achieve patient's independence while performing such movements.

Recovery of resistance after stroke

Studies show that almost 40% of stroke survivors experience at least 1 major fall in the first year after the stroke. More often, it happens during dressing or taking off clothes, and mostly (in 7 times more often) this occurs among women.

Recovery of everyday skills

In rehabilitation, the restoration of everyday skills, such as personal hygiene, dressing, eating, and moving, are important.  In addition to the basic functions, complex functions should be restored,  such as cooking, housekeeping, writing by hand or printing.

Restoring communication functions

Damage of speech (aphasia) and speech apparatus (dysarthria or dysarthrophonia) is the specialty of speech therapists, but even in such cases a differentiated examination is necessary in order to correctly assign the appropriate treatment. When speech is distorted, patient knows what he wants to say, but he/she can not express the thought in words, the words and sentences can be distorted as well. Sometimes there can be a loss of ability to comprehend. With dysarthria, it is difficult for a patient to pronounce words, they sound blurry, in severe cases the words may not be understood by another person.

Restoration of swallowing after a stroke

Treatment of swallowing disorders after a stroke is a specialty of speech therapist. The goal of such therapy is partial or complete restoration or compensation of  lost functions. Treatment uses  stimulating and restraining techniques that involve stretching, manual influence with pressure elements, tapping, etc.  Such therapy  may use neurophysiological techniques, for example, Bobat´s technique. Treatment also includes diet, control of the eating processes, changing the position of the head and the whole body and using special swallowing techniques. Mendelssohn's syndrome damage to the glottic area deserve to be mentioned here.

Treatment of neuropsychological disorders

Treatment of cognitive impairment is based on an accurate analysis of the symptoms. Such factors as carefulness, perception, memory, planning and solving the problem are carefully checked. Also doctors check if there are violations of visual-spatial perception,  or space construction functions and if there are disorders of object perception. Doctors determine if there is change in consciousness. Impulsiveness and stress resistance levels are determined.

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