HEMIPLEGIA AND REHABILITATION (Cerebrovascular accident-CVA, brain attack, brain crisis); is a completely clinical definition and is defined as clinical neurological symptoms of vascular origin, focal disorder of cerebral function that develop rapidly and last longer than 24 hours, according to WHO. Hemiplegia is the name given to the clinical appearance of these neurological symptoms.
Risk factors for cerebrovascular events:
- Age and spouse
- Positive family history
- Race
- Diabetes mellitus
- Passed SVO
- Asymptomatic carotid rupture
- Hypertension
- Cardiac comorbidity
- Transient ischemic attacks
- High hematocrit
- Common cellular anemia
- High cholesterol/lipids
- Smoke
- Drinking alcohol
- Oral contraceptive
- Physical inactivity
- Obesity
Transient Ischemic Attacks : These are temporary focal ischemic episodes involving the brain and/or brainstem. 50% of these attacks recover within one hour and 90% within four hours.
Cerebral Infarction : A decrease in blood flow below the critical level required for cell survival, resulting in ischemia and necrosis in an area of the brain.
Cerebral Infarction – Etiology :
- Ischemic
- Thrombosis
- Embolism
- Hemorrhagic
- Subarachnoid hemorrhages
- Arteritis, collagen vascular diseases
- Infectious causes
- Toxic causes
- Tumor
- Trauma
Syndromes that develop due to stroke:
- Disorders of consciousness
- Motor coordination and balance
- Tone
- Sensation, proprioception, visual field
- Language and communication
- Apraxia
- Denial
- Cognitive function
- Emotional lability
- Engine control and power
Medical treatment:
- Ventilation and oxygenation
- Oral feeding is not done for 24 hours
- Pneumonia control (10%)
- Fluid and electrolyte balance
- Evaluation of cardiac status after 48 hours
- Frequent monitoring of blood pressure
- Deep vein thrombosis (33-75%)
- Secondary fatal pulmonary embolism
- Epileptic attacks (7.7-42.8%)
Care:
- Positioning the patient in bed
- Supporting the patient extremity with a pillow
- Elevation of the head in the supine position
- Applying elastic stockings or pneumatic compression
- Turning the patient every two hours
- Passive and active ROM exercises
- Be careful of the sick shoulder
- Encouraging the patient to get out of bed
- Limited sitting for 5-10 minutes, multiple times during the day
Rehabilitation:
- Sensorimotor and functional study
- Traditional therapeutic exercise programs
- Neuromuscular facilitation exercises
- EMG biofeedback
- FEZ
- Maintenance training
- Equipment (AFO, splints, etc.)
- Speech and language disorders
- Psychosocial assessment
Rehabilitation in the Acute Phase:
- Most of the clinical problems in hemiplegia depend on immobilization and deconditioning of the patients.
- The rehabilitation program should be started as soon as possible after CVA.
- On the 1st and 2nd days following a cerebrovascular attack, the patient should be given an appropriate position and precautions should be taken against possible deformities and contractures.
- Hemiplegia rehabilitation starts from the first day.
Benefits of Early Rehabilitation:
- There is an increase in ambulatory capacity.
- The length of hospital stay is shortened.
- Early treatment is both preventive and therapeutic.
- The patient’s level of independence in self-care activities increases.
Rehabilitation Activities in the Acute Phase-1
- Evaluation and management of medical problems
- Monitoring and compliance with medications
- Providing hydration and nutrition
- Facilitating rest and sleep
- Venous thromboembolism prophylaxis
- Proper bed and chair positioning
- Frequent rotation and position changes
- ROM exercises
- Deep breathing and coughing exercises
- Frequent observation of the skin
- Regulation of swallowing
- Safety precautions
- Removal of the catheter, planned, timed toilet program if possible
- Bowel regulation regimen
Rehabilitation Activities in the Acute Phase-2
- Sitting on a chair
- Bedside exercises with supervision
- Self-attempting daily living activities
- Try to stand and walk whenever possible
- Educational programs on stroke, recovery and self-care
- Evaluation and study of communication
- Psychological support to the patient
- Family education and support
- Assessment of social support and resources
- Evaluation of ongoing rehabilitation
Exercises:
- Passive ROM exercises several times a day
- If the patient is conscious, the healthy side is strengthened with resistive exercises.
- Exercises are performed to prevent contractures and adhesions, increase joint range of motion, increase proprioceptive sense, stimulate flexion-extension reflexes, increase muscle strength, and eliminate muscle imbalances.
- Over time, turning in bed and sitting up with a rope are shown.
- Flexibility, strengthening
- Endurance and balance exercises are given.
Positioning:
Transfers:
Mobilization:
Upper extremity orthosis – shoulder strap:
