DEFINITION
Stroke is defined as
• “rapidly developing clinical signs of focal
(or global) disturbance of cerebral function,
• with symptoms lasting 24 hours or longer
• or leading to death,
• with no apparent cause other than of vascular
origin”
STROKE
ISCHEMIC
THROMBOTIC
EMBOLIC
HAEMORRHAGIC
SUB
ARACHNOID
INTRA
CEREBRAL
ISCHEMIC STROKE
 Ischemic stroke accounts for about 87 percent of all cases.
 Ischemic strokes occur as a result of an obstruction within a
blood vessel supplying blood to the brain
HEMORRHAGIC STROKE
 Hemorrhagic stroke accounts for about 13 percent of stroke
cases.
 It results from a weakened vessel that ruptures and bleeds into
the surrounding brain.
TIA (Transient Ischemic Attack)

Transient ischemic attack (TIA) is often labeled “Mini-stroke or
Warning stroke”.
 Most TIAs last less than five minutes; the average is about a minute.
 When a TIA is over, it usually causes no permanent injury to the brain.
ANTERIOR
CEREBRAL ARTERY
(ACA) STROKE
MIDDLE
CEREBRAL ARTERY
(MCA) STROKE
STROKE
INTERNAL
CAROTID ARTERY
(ICA) STROKE
POSTERIOR
CEREBRAL ARTERY
(PCA) STROKE
BASILAR ARTERY
STROKE
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Age
Hypertension
Diabetes
Cardiac disorders
Cigarette smoking
Previous episode of TIA
 Elevated Blood
cholestrol
 Physical inactivity
 Obesity
 Excessive alcohol
consumption
Clinical Features

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

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Motor deficits – Usually one side of the body is paralysed
(Hemiplegia)
Speech disturbances – Broca’s aphasia (Nonfluent) and
Wernike’s Aphasia (Fluent)
Cognitive dysfunctions
Bladder and bowel involvement
Seizures
HISTORY
1) Hemorrhagic Stroke
Onset – Sudden onset of severe head ache
followed by loss of consciousness (Rapid
Coma)
2) Embolic Stroke
Onset – Sudden, Frequently associated with
Cardiac diseases
3) Thrombotic Stroke
Onset – Variable or uneven onset
NEUROLOGICAL IMAGING
CT Scan & MRI
 It is used to rule out the brain lesions such as
tumors or abscess and to identify hemorrhagic
stroke
 Greater resolution of brain and its structural
details is obtained in MRI than with a CT scan
Physical therapy - Acute Stage
 Positioning – Supine, sidelying, sitting
 Prevention of Pressure sores – Skin inspection
on bony prominences, Frequent change in
positioning (Once in 2 hours) & use of pressure
relieving devices (Eg- Water bed)
 Maintainence of Range of motion – ROM
exercises
 Training functional activities -like rolling,
bridging (Useful for bed pan)
Bridging
 Respiratory management – Breathing
exercises
 Facial exercises
MANAGEMENT OF SPASTICITY
1) Slow icing
 Slow icing – Origin to
Insertion
2) Stretching
 Slow sustained stretching
 Maintained for 30 sec
3) Slow stroking
 Alternative strokes with flat
hands in the paraspinal areas
at 3 – 5 times per minute
4) Weight bearing
 Promotes stabilization and
reduction in Spasticity
MAT EXERCISES
Prone on Elbows
Quadrupod
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Rolling to Prone
Prone on Elbows
Quadrupod
Kneel sitting
Kneel standing
Half Kneeling
Standing
BALANCE TRAINING
 Sitting balance
 Sit to Stand transition
 In case of postural hypotension – Tilt table should be
used for vertical progression
 Standing balance
GAIT REHABILITATION
Emphasize on Knee flexion and heel Strike
Discourage Circumduction gait (Seen in Stroke patients)
Provide foot marks – Visual cues
ASSISTANCE
Ankle Foot Orthosis (AFO)
Quadrupod in the normal side
FUNCTIONAL ELECTRICAL STIMULATION
Electrical stimulation for performing a functional activity
In case of foot drop – prevents foot dragging in swing phase