Stroke or CVA
Definition / Symptoms
There are more than 150,000 strokes or cerebrovascular accidents (CVA) reported in the UK every year. They happen when the blood supply to an area of brain is interrupted and the brain cells in that region are damaged, or even die. Ischaemic strokes are the most common form of stroke.
Common problems encountered after a stroke include difficulties with speech, cognitive, emotional and visual issues, as well as more physical and balance related difficulties.
Although some people will have a complete recovery, two thirds of people who suffer a stroke will have some form of long term problem (lasting more than one year) and this can often involve a person’s ability to walk. When a stroke has an impact on mobility, it will tend to affect only one side of the body, as usually only one side of the area of brain is damaged. Often, a person will be left with a weakness and or spasticity in their affected side. They can also have problems with coordinating their movement.
Ischaemic stokes occur when a blood clot blocks the flow of blood and oxygen to the brain. The clots form where the arteries have been blocked, or narrowed, by fatty deposits. As one gets older, the arteries can narrow, but lifestyle factors can accelerate the process. The culprits are smoking, high blood pressure, obesity, and diabetes, high cholesterol levels and an excessive alcohol intake.
Complications and related diseases
The amount a stroke effects someone is determined by the size and position of the original brain injury. If there is significant weakness and spasticity, mobility and gait will be severely affected. The loss of balance due to poor proprioception and the inability to feel where their feet are, will cause increased problems with standing, walking and, sometimes, even sitting. If left untreated the rehabilitation process is harder to manage and it is more difficult to achieve improvements.
One of the main problems associated with long-term stroke rehabilitation is the contracture of muscles due to the spasticity. This can lead to painful deformities of both the lower and upper limbs. For example, they can prevent people from being able to stand or open their hand. Another concern is the patterns of movements that people adopt to manage their condition. Bad habits can form and these are then difficult to unlearn.
Tests and Diagnosis
Assessing an individual following a stroke requires a neurological examination. This includes: analysing joint ranges of movement; joint stability; muscle strength; spasticity; standing posture/alignment; and a gait/walking assessment.
A wide variety of upper and lower limb orthotic devices are used successfully by people encountering the physical effects of stroke. These can be used during rehabilitation in the year or more, following the stroke in conjunction with physiotherapy in the post-rehabilitation period. The orthotics are used to help support one part of the lower limb while strength and movement is returning to the muscles near them. These must be adapted and matched to the exact needs of the user, since muscle control can change rapidly and complications such as swelling can also quickly change. Secondly, spasticity or muscle imbalance can result in poor joint positioning and a shortening of one or more muscles. Typically, part of the calf muscle becomes shorter, forcing the toes downward and making the ankle give way to the outside. This shortening effect can be prevented by using a properly-formed resting splint. Shortening that has already occurred may sometimes be improved through the use of a dynamic contracture orthosis, which acts like a spring to apply a constant stretch on the effected muscles.
Ultimately our goal is to optimise the patient’s gait so that it looks as normal as possible. More and more we are using a particular orthosis to do this, it is called the Neuro Swing. It is designed with an ankle joint that allows the patient some freedom of movement and it can be fine-tuned incredibly accurately in our gait lab. More traditional AFOs have the drawback of blocking good movement along with the bad.
At LOC, we only fit bespoke ankle foot orthoses. These are designed and manufactured based specifically on the individual’s requirements from a plaster cast of their leg.
Further information / Reading / Links
There are a large number of therapists who can have a role to play in rehabilitation following a stroke. We work with physiotherapists, occupational and speech therapists who we are confident to recommend.
Milestones Neurorehabilitation Clinic