After a Stroke – What Next? - GUIDE - the acute phase, immediately after a stroke - Part 1
NORMAN Neurological Rehabilitation Centre
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A stroke can be a sudden and devastating event whose consequences can completely change the life not only of the person directly affected, but also of their whole family.
A serious stroke, with many widespread deficits, can leave the patient’s loved ones deeply unsure of how to care for the person affected. The information available is often contradictory and hard to find. It can also happen that different specialists hold differing views on the best approach to rehabilitation. This is why it is so important to understand which recovery activities are possible and needed at each stage of rehabilitation.
How will this guide help?
This guide aims to advise families and carers of stroke patients, as simply and clearly as possible, on what can be done as part of stroke rehabilitation. It is also intended to make it easier to make decisions when planning therapy at times when little information is available. The text of this guide is for information only and does not replace the work of specialists.
The main phases of post-stroke care
The acute phase
The condition a patient is in immediately after a stroke is called the acute phase. The degree of neurological deficit, as well as the patient’s overall condition, often varies greatly. A patient in the acute phase after a stroke may face relatively minor problems, or may even be in a coma requiring respiratory support and intensive nursing care. They may also be in a state in which they cannot assess their own situation – disoriented and frightened, or unable to make contact with those around them.
Therapy can begin as early as this phase. It involves stimulating the plasticity of the central nervous system in the right direction, as far as possible, and keeping the development of pathology to a minimum. Good, professional interdisciplinary collaboration during this phase is a decisive factor in the smooth progress of the whole rehabilitation process. When to start stroke rehabilitation and how to do it is hugely important, because a patient who reaches a stable, non-critical state of health more quickly will be able to begin more intensive recovery work sooner.
The goals of therapy in the acute phase
The main goal of recovery work in the acute phase, depending on the needs and condition of the person after a stroke, is to facilitate vital functions, which mainly include:
- respiratory stimulation and/or breathing exercises, which play an important role in preventing pneumonia, together with work on inhalation, exhalation and rhythm,
- stimulating the cough reflex,
- stimulating swallowing.
Facilitating these vital functions is part of oro-facial therapy, in which neuro-speech therapists and physiotherapists mainly specialise, while difficulties with swallowing and articulation are addressed by speech rehabilitation after stroke. This type of therapy also includes:
- stimulating normal facial expression,
- chewing,
- swallowing,
- integrating oro-facial reflexes.
Coming soon in the next part of the guide
References
- Benedikt Bömer, "PNF w Neurologii", Kraków 2013.
- Anna Kiss Feherne, "NDT Bobath dla dorosłych", Warszawa 2011.
- "Usprawnianie po udarze mózgu", Elipsa-Jaim s.c., Kraków 2004.
- "Metoda NDT-Bobath w neurorehabilitacji osób dorosłych", PZWL, Warszawa 2012.
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The next step
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