UncategorizedNeuroplasticity and Physical Rehabilitation……. The need to Start Early After Stroke!

March 13, 20150

“Riches, mediocrity and poverty begin in the mind.”
– Remez Sasson

Neuroplasticity

In the last two decades, neuroscientists have overthrown the dogma that the adult brain cannot change. Changes in neuroplasticity has led to promising treatment in every aspect of life from treatment of stroke and injury victims, dyslexia to prevention of cancer.
Now we know that Neuroplasticity is the brain’s ability to form new neural connections throughout life, influenced by intrinsic or extrinsic stimuli. The capacity of neurons and neural networks in the brain to change their connections and behavior in response to new information, sensory stimulation, development, damage, or dysfunction has always been the bedrock of patient’s physical rehabilitation design goals at Ageless Physiotherapy Clinic.
At Ageless Physiotherapy Clinic we achieve brain plasticity by recruiting the ability of the nervous system to modify its structural and functional organization to our advantage using our highly specialized physical rehabilitation programs.
The 2 most plausible forms of plasticity are collateral sprouting of new synaptic connections and unmasking of previously latent functional pathways. Other mechanisms of plasticity include assumption of function by undamaged, redundant neural pathways, reversibility from diaschisis, denervation super sensitivity, and regenerative proximal sprouting of transected neuronal axons.
A key aspect of neuroplasticity that has important implications for rehabilitation is the fact that the modifications in neuronal networks are use-dependent. Animal experimental studies and clinical trials in humans have shown that forced use and functional training contribute to improved function. On the other hand, techniques that promote nonuse may inhibit recovery.
In the past, the conventional wisdom was that benefits from rehabilitation were achieved primarily through training patients in new techniques that compensate for impairments (for example, using the uninvolved hand to achieve self-care independence). This approach avoided intense therapy on the weak upper limb.
Currently, it is recognized that repeated participation by patients in active physical therapeutic programs probably provides direct influence on the process of functional reorganization in the brain and enhances neurologic recovery.
These highly specialized physical rehabilitation programs consists of a family of treatments that teach the brain to “rewire” itself following an injury to the brain, the groundwork of which is based upon neuroplasticity.
Clinical evidence clearly demonstrates that physical therapeutic measures begun as soon as possible after a stroke, often within 24 to 48 hours, greatly increase functional movement, rate of recovery of lost limb functions and quality of life engendering the functional capacity of neuroplasticity.
Stroke rehabilitation must begin during the acute hospitalization, as soon as the diagnosis of stroke is established and life-threatening problems are under control. The highest priorities during this early phase are to prevent a recurrent stroke and complications, ensure proper management of general health functions, mobilize the patient, encourage resumption of self-care activities, and provide emotional support to the patient and family.
After the “acute” phase of stroke care, the focus of care turns to assessment and recovery of any residual physical and cognitive deficits, as well as compensation for residual impairment.
Organization and delivery of stroke care and rehabilitation in Nigeria is not always smooth. The healthcare systems built into the society is not still smooth enough to allow patients access smooth and reliable continuum of stroke care starting from when the patient arrives at emergency, through acute in patient care and when discharged for further rehabilitation in an organized rehabilitation center.
Over the years, the organization and delivery of stroke care have taken many forms. With the growth of physical medicine, occupational therapy, and physical therapy, varying therapeutics and treatment settings have evolved. Assessment of the effect of stroke care organization and settings is difficult because of the extreme variability of organizational settings. For example, on the one extreme, rehabilitation services can be provided in an outpatient setting, 1 hour per day, 3 days per week, by 1 therapist. At the other end of the structural continuum, rehabilitation services can be provided in a rehabilitation hospital setting, 5 hours per day, 7 days per week, by a team made up of several clinicians.
A considerable body of evidence, mainly from countries in Western Europe, indicates that better clinical outcomes are achieved when patients with acute stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Skilled staff, better organization of services, and earlier implementation of rehabilitation interventions appear to be important components.”
Critical points to consider if you have to seek early rehabilitation:
• The primary goals of rehabilitation are to prevent complications, minimize impairments, and maximize function.
• Secondary prevention is fundamental to preventing stroke recurrence, as well as coronary vascular events and coronary heart disease–mediated death.
• Early assessment and intervention are critical to optimize rehabilitation.
• Standardized evaluations and valid assessment tools are essential to development of a comprehensive treatment plan.
• Evidence-based interventions should be based on functional goals.
• Every patient should have access to an experienced multidisciplinary rehabilitation team to ensure optimal outcome.
• The patient and the patient’s family members and/or caregivers are essential members of the rehabilitation team.
• Patient and family education improves informed decision-making, social adjustment, and maintenance of rehabilitation gains.
• The multidisciplinary team should utilize community resources for community reintegration.
• Ongoing medical management of risk factors and co-morbidities is essential to ensure survival.
Benefits of early start to physical rehabilitation after Stroke
At Ageless Physiotherapy Clinic, our early major priorities are how to make you return to work and the lifestyles you are familiar with, how to make you return to driving and how to make you return to your sexual life. Our highly specialized physical rehabilitation programs are geared towards making you achieve all these right from when you start your physical rehabilitation on your hospital bed through when you are discharged to our rehabilitation center.
Let’s look at the perspectives around all these:
Return to Work
A stroke can have a major impact on every aspect of a person’s life, including his or her job. New research shows that only about half of stroke survivors are able to return to work, and continuing disability and depression are major causes.
Though people often associate strokes with old age — in other words, retirees — about 20% of strokes actually occur in people of working age, the study authors say. Because of the general aging of the population and an increase in stroke survival rates, the condition can have a noticeable impact on the workforce.
The weakness, speech, and movement problems that often occur after a stroke can lead to a lengthy disability period for many patients. Often stroke survivors also develop depression and other psychiatric problems. All of these factors can contribute to the decision not to return to work.
After you have a stroke, the road back to work can be challenging. Nearly one third of all strokes occur in people under the age of 65. Of those, nearly 1 in 2 survivors will return to a full- or part-time job. Depending on the severity of your stroke, you might need weeks or months away from work but because it’s one of our priority, we will help you make this transition smoothly by putting together a synergy that will involve your workplace, your hospital, your family and our rehabilitation team.
Questions to Consider When Thinking About Re-entering the Workforce:

• Physical disability
• Memory and cognitive problems
• Aphasia
• Fatigue
• Employer attitudes, supportiveness and understanding of stroke
• Physical work environment
• Transportation
• Stigma associated with stroke
• Depression

Return to Driving
The question of if or when a person can resume driving after a stroke can be difficult to answer. The family and medical staff will need to balance the patient’s desire for independence with safety concerns. Safe operation of a vehicle requires multilevel functions (e.g., physical, cognitive, psychomotor, perceptual motor, and behavioral). Legal requirements have to be considered also.
Our Physical Rehabilitation Team will:
1. Recommend that all patients be given a clinical assessment of their physical, cognitive, and behavioral functions to determine their readiness to resume driving. In individual cases, where concerns are identified by the family or medical staff, the patient should be required to pass the state road test as administered by the licensing department.
2. Recommend that patients with residual deficits are referred to adaptive driving instruction programs to minimize the deficits, eliminate safety concerns, and ensure that patients will be able to pass the state’s driving test.
Return to Sexual Function
Sexual issues relate both to sexual function and to changes in body image as a result of the stroke. Sexual activity usually diminishes and sometimes ceases after stroke, but sex remains an important issue to the majority of post-stroke patients. Sexual issues are often not adequately addressed, despite evidence that patients and their partners welcome frank discussions. If sex was important to you before your stroke there is no reason why you cannot have a sex life after your stroke, whether this is initiating a new relationship or resuming an old one.
However, keeping an open mind, addressing any physical and emotional issues and giving yourself time to adjust is often the solution to getting your sex life back on track.
Interventions that stress the importance of effective communication, sharing of concerns, and development of adaptive strategies to avoid fatigue (such as positioning, foreplay, and timing) are often helpful.

Recovering from a stroke can be one of the greatest challenges a person will ever face. However, research shows that early and specialized stroke rehabilitation can help to optimize an individual’s physical and cognitive recovery and enhance quality of life using the power of neuroplasticity.
When you start your physical rehabilitation early in our center, we help you to regain lost functions early, prioritizing your deficits and functional aims by allowing you have access to our highly specialized physical rehabilitation programs.
Why don’t you make that important call today and begin the important journey to freedom and return to normal life.

Is your brain able to re-wire itself……why dont you come and find out?
Our hotline is still 08138491652/08055463055.

#Image Credit: Dr Faisal Mamsa

TO BOOK AN APPOINTMENT, CALL 0813 949 1652 / 0805 546 3055

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