Physiotherapy plays an important role in physical rehabilitation following a brain stroke. The goals are to help patients regain functional independence by restoring mobility through improving sitting balance, gait, upper limb function, and other physical abilities. Key aspects of stroke rehabilitation include early mobilization, prevention of complications like shoulder pain, and an interdisciplinary team approach with continued care across settings to optimize recovery and reintegration. Successful rehabilitation requires thorough assessment, early intervention, coordinated team-based care, and engagement of patients and families in pursuing functional goals.

1. BRAIN STROKE AND PHYSICAL
REHABILITATION
BY- JITENDRA KUMAR
GROUP- 407
GUIDED BY – PROF. Bobrik Yu.V.

3. BRAIN STROKE-
• A stroke occurs when the blood supply to your brain is interrupted or
reduced. This deprives your brain of oxygen and nutrients, which can
cause your brain cells to die. A stroke may be caused by a blocked
artery (ischemic stroke) or the leaking or bursting of a blood vessel
(hemorrhagicstroke).

4. Disabilities – Caused by brain stroke:-
• Hemiparesis (48%) “
• Inability to Walk (22%) “
• Need for Help in daily activities. (24-53%) "
• Clinical Depression (32%) “
• Cognitive Impairment (33%)

5. Recovery:-
Dependent Upon –
" Type “
1) Cerebral Ischemia.
2) " Cerebral Hemorrhage.
" Extent “
1) Level of Recovery in Rehab
2) Remaining Disability
3) Pre-existing Comorbidities.

6. Brain stroke and role of physiotherapy:-
• To understand the role of physiotherapy following stroke.
• To be aware of causes of hemiplegic shoulder pain and methods of
prevention.
• To recognize the importance of positioning and know how to
position an patient with acute stroke.
• To understand the term Early mobilization.

7. What is Physiotherapy?
• Physiotherapy is concerned with helping to restore well-being to
people following injury, pain or disability through mainly physical
means. ! Following stroke, the overall aim is to help people regain
functional independence in everyday tasks such as standing, walking
and eating etc.

8. Initial stages:-
• Assessment !
• Advice on positioning !
• Advice on prevention of shoulder pain !
• Respiratory management. !
• Sitting out/ mobilizing

9. Core areas in stroke physiotherapy :-
• Sitting balance !
• Transfer training !
• Gait reducation !
• Upper limb functional rehab !
• Strength, co-ordination, balance, tone etc. !
• Assessment of falls risk !
• Stair practice!

10. Hemiplegic shoulder pain:-
• Incidence somewhere between 5% and 80% !
• Severe, persistent shoulder pain in 5% !
• Secondary, muscular-skeletal disorder.

11. P eeehabilitation
ELEMENTS OF THE STROKE REHABILITATION:-
• Prevention
• Treatment
• Compensation
• Maintenance
• Reintegration

12. Goals of physical rehabilitation:
• Restore patient to maximum mobilization
• Help patient regain functional independence and confidence
• Provide measures to prevent falls and
ensure safety
• Educate patient and family about secondary prevention
• Facilitate psychosocial adjustment

13. Rehabilitation team members
• psychologists
• OTs
• recreational therapists
• PTs
• speech pathologists
• medical social services personnel

14. Patient assessment:
• repeated clinical examinations
• full & consistent documentation
throughout
Assessment target-
• neurologic impairments
• medical problems
• disabilities
• living conditions and community reintegration

15. Continuity of care and family involvement:
• Multiple care settings during
recovery
• Patient and family must:
• be fully informed &
participate in decisions
• participate actively in
rehabilitation

16. Mobilization;
• Within 12-24 hours, if possible
• Daily active/passive ROM exercises
• Progressively increased activity
• Changes of position in bed
• pullsheet method
• limb positioning & support
• Encouragement to resume self-care & socialization

17. Measures to prevent recurrent strokes:
• Carotid endarterectomy in patients who have 70%-99% carotid artery
obstruction.
• Anticoagulants in patients with atrial fibrillation and other
nonvalvular cause of embolic stroke.
• Antiplatelet agents in patients who have had transient ischemic attack
(TIA).

18. Preventing deep venous thrombosis:
• Heparin
• low molecular weight (LMWH), or
• low-dose unfractionated (LDUH)
• Other effective measures
• intermittent pneumatic compression
• elastic stockings

19. Management of dysphagia:
• Goals
• prevent dehydration and malnutrition
• prevent aspiration and pneumonia
• restore ability to chew and swallow safely

20. Indicators of poor rehabilitation:
• Severe functional/motor/cognitive deficits
• Persistent urinary/fecal incontinence
• Severe visual/spatial deficits
• Sitting imbalance
• Severe aphasia
• Altered level of consciousness
• Major depression
• Severe comorbidities
• Disability before stroke
• Older age

21. Threshold criteria for admission in
rehabilitation:
• Medically/moderately stable
• One or more persistent disabilities
• Able to learn
• Physical endurance sufficient to:
• sit at least 1 hour per day
• participate in rehabilitation

22. Management plan for rehabilitation:
The management plan should identify
• significant impairments and disabilities
• measures to prevent recurrence
• treatments for comorbidities
• rehabilitation interventions
• plans for periodic monitoring

23. Measure of successful rehabilitation;
• Normalized health patterns
• Freedom from physical pain/emotional distress/impairments
• Retention of cognitive/communicative abilities
• Mobility and independence in ADL
• IMPROVED QUALITY OF LIFE

24. Summery; requirement of successful physical
rehabilitation:
• In-depth assessment at all phases
• Appropriate patient selection
• Early introduction to rehabilitation
• Teamwork approach in multidisciplinary setting
• Shared goals and management plan
• Detailed, shared record keeping

25. Thank You!!!!!!!!!!!!!!!!!!!!!!!