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A global cause of death and adult disability known to be third place in most parts of the world is Stroke. Stroke is a brain attack characterized by loss of blood supply to the brain or bleeding into the brain which results in neurological deficits. It is treated as a medical emergency with an evolved level of management which curtails the mortality rates and extent of neurological deficits, length of stay and improved door to needle time in developed countries. This evolution in the quality of care and management of stroke associated with the establishment of organized stroke services in specialized stroke units has improved the survival rate of stroke, leaving the majority of survivors with mild to severe disabilities.
The National Stroke Association1 reports that 15% of stroke results in death, 10% of survivors recuperate almost fully, whereas 75% remain with mild to severe impairments which require special care in the long run. A percentage as high as this reflects a large population (about 4 million in America) of survivors who may or may not attain optimal recovery or return to their pre-stroke economic, social and financial status. Therefore, this poses a vital question of what extent of recovery is obtainable after a stroke and what percentage of survivors actually obtain optimal recovery.
Questions about Recovery
A few questions a stroke survivor is likely to consider is what recovery would be like, if they would recover or how one recovers after a stroke. Given that no two strokes are the same and may likely manifest differently in individuals regardless of whether similar areas of the brain is affected or not, it is likely that the recovery process would be relative to the individual that is affected.
According to the National Institute of Neurological Disorders and Stroke1, the extent of recovery is dependent on the type of stroke, the severity of the brain damage, age and how quickly rehabilitation commences.
A typical stroke recovery process begins as soon as the survivor is stabilized in an inpatient setting. An array of rehabilitation approaches could be selected depending on the needs of the survivor whilst being attended to by a team of multidisciplinary professionals. It is not uncommon for survivors to be unaware of the quality of service they ought to be receiving; this is why the role of stroke support groups should not and cannot be overlooked. Survivors in support groups are able to interact with each other, receive valuable and helpful information and become better equipped to cope with life after stroke. Some of the recovery observed in the first few weeks to months after a stroke are attributed to spontaneous plasticity which sometimes makes it difficult to specifically measure the outcomes of rehabilitative interventions or approaches. However, the role of the multidisciplinary team in fostering recovery is not to be underrated. The recovery process is long-term and continues several years after the stroke2, provided the survivor is motivated to carry on with intensive and repetitive task practice which aids neuroplasticity.
A working definition for optimal recovery would certainly enhance the assessment of this state in stroke survivors. Optimal, in oxford dictionary means the best or most favorable. In reference to stroke, clinicians strive to enable stroke survivors attain the highest possible level of independence and productivity. Whereas, this is the goal for clinicians, are all survivors able to persevere no matter what to attain this? In most cases, survivors may be able to ambulate with obvious compensatory patterns and deficits or may resign and accept whatever level of independence they have attained, be it suboptimal or not. Is it of any benefit to motivate survivors to keep at it even well into the chronic phase of recovery with the hope of attaining optimal function without obvious compensations and deficits? It is true that recovery and stroke rehabilitation is complex and must consider the age of the survivor, the severity of the stroke, emotional factors, time of start of rehabilitation, and their social support system, however, can survivors in chronic stage with hemiplegic gait, wrist and hand deformity, subluxation and muscle wasting attain optimal recovery if they persevere with the rehabilitation program? What would be the ideal frequency of practice and regimen to attain this?
Figure 1 Hemiplegic gait
In spite of the array of rehabilitative methods (focused intensive practice, brain stimulation approaches and assistive technology) to prescribe to stroke survivors, can a clinician successfully guarantee stroke survivors the attainment of optimal recovery in the sense where there is no visible deficit particularly in those with more severe strokes? Are there any clinicians who have succeeded in rehabilitating survivors with severe strokes to the point where no obvious neurologic deficit can be observed? Or is this a myth that they can achieve optimal recovery when in reality it is just a theoretical speculation?
For further reading, check Stroke Clinicians Handbook
Opinions expressed by physiogramworld contributors are their own.
- Stroke Rehabilitation Information [Internet]. National Institute of Neurological Disorders and Stroke. 2016 [cited 14 April 2016]. Available from: http://www.ninds.nih.gov/disorders/stroke/stroke_rehabilitation.htm
- Stroke rehabilitation: What to expect as you recover from stroke – Mayo Clinic [Internet]. Mayoclinic.org. 2016 [cited 14 April 2016]. Available from: http://www.mayoclinic.org/stroke-rehabilitation/art-20045172?pg=2