A stroke occurs once every 3 minutes and 27 seconds in the UK and is the largest cause of disability. This totals approximately 152,000 strokes occurring in the UK every year. At present there are 1.2 million stroke survivors in the UK. 
Types of stroke: 
 
There are 2 types of strokes, ischaemic (blood clot) or haemorrhagic (bleed). 
 
An ischaemic stroke occurs when a blood vessel within the brain becomes blocked by a blood clot causing a blocking and cutting off the blood supply to that area of the brain. Ischaemic strokes account for 85% of all strokes. Often these types of stroke are caused by narrowing in the arteries of the head or neck commonly due to atherosclerosis (a build-up of fatty deposits). This causes blood to collect and the chance of clots forming increases. Another cause is atrial fibrillation, blood clots can form in the heart and when they escape they can become lodged in the blood vessels of the brain. 
A haemorrhagic stroke is when a blood vessel bursts causing blood to leak into the surrounding tissues, these account for 15% of strokes. This type of stroke is most commonly caused by high blood pressure causing arteries to become weakened making them more likely to rupture. Or there may be aneurysms of badly formed vessels within the brain. 
Stroke classification (Bamford/OCSP): 
This classification is based on the extent of the symptoms and can predict the extent of the stroke and the area of the brain affected:- 
 
Total Anterior Circulation Stroke: all 3 of the following symptoms will be present: motor and sensory deficits, hemianopia and higher level deficits (swallowing difficulties, visuospatial disturbances, reduced consciousness). 
 
Partial Anterior Circulation Stroke: 2 of the three above symptoms will be present 
Posterior Circulation Stroke: sensory or motor deficit affecting either 1 side or both sides of the body, visual deficits and cerebellar dysfunction. 
 
Lacunar stroke: sensory or motor deficit involving 2 of the face/arm/leg only. 
A stroke can affect someone in many different ways depending on where it occurred in the brain, no one stroke is the same. 
 
Below is a list of ways someone may be affected: 
 
Arm weakness (77% of stroke survivors report arm weakness) 
Leg weakness (72% of stroke survivors report leg weakness) 
Visual problems 
Facial weakness 
Slurred speech 
Impaired bladder and bowel control 
Swallowing difficulties (dysphagia) 
Communication difficulties (aphasia) 
Depression or emotionalism 
Sensory impairment 
Tonal changes 
Balance difficulties 
Cognitive deficit 
Fatigue 
 
Stroke risk factors: 
High blood pressure 
Diabetes 
Atrial fibrillation (irregular heart beat) 
Patent foramen ovale (hole in the heart) 
High cholesterol 
Sickle cell disease 
Smoking 
Increased alcohol intake 
Drug use 
 
Recovery after a stroke: Neuroplasticity 
Initially after a stroke there will be a central area where there has been poor blood supply, this is the area where there will be some cell death. Directly surrounding this area is the ‘penumbra’, this is where cells may have had a reduced blood supply but were still getting some input from collateral vessels. Depending on the roles of the central cells depends on what symptoms you may have, for example arm weakness. 
Neuroplasticity is the term used to describe how a brain has the potential to rewire or reorganise neural pathways after an injury. Studies have shown the most effective way of enhancing this rewiring and reorganizing is through repetitive task-specific training. So this means that there may be potential to rewire/reorganise the neural pathways in the brain so that you can regain use of the weak arm. 
 
Physiotherapy and other rehabilitation services hope to enhance the neuroplasticity of the brain to improve a stroke survivors functional recovery and abilities. 
 
How can Physiotherapy help? 
Recovery from a stroke can occur in the initial weeks, or even months later. For those whose stroke may be chronic may go through periods of time when their physical abilities deteriorate through illness or general deconditioning. Physiotherapists can offer expert advice and specialist treatment strategies to enhance neuroplasticity and functional recovery following a stroke. Research studies have shown positive effects of physiotherapy on improving outcome and quality of life after stroke. Below are some of the treatment approaches which can be used: 
 
Graded strengthening programs 
Balance rehabilitation 
Gait re-education 
Postural advice 
Massage 
Taping 
Constraint induced movement therapy 
Stretches 
Core stability exercises 
Activity analysis and rehabilitation 
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