When Should Physical Therapy and Rehabilitation Begin After Stroke?

A frequently asked question is when is the best time for physical therapy and rehabilitation after stroke. Stroke is the condition in which some of the brain cells lose their function or die due to the deterioration of the blood supply to the brain. As a result, it causes weakness in the face and part of the body, namely paralysis, speech disorder and many other symptoms.

Stages of the brain after stroke

After stroke-related injury, the brain activates many of its healing properties. The first hours are acute, requiring immediate medical treatment; In this period, circulatory and metabolic changes and immune system responses are seen in the brain. The second period is the recovery period, it starts from the first days and usually lasts for a few weeks. The properties of neural circuits change, some connections are deleted, new connections are formed, the representation of the body in the brain changes shape. This process is called brain plasticity and is responsible for spontaneous recovery after stroke. The third period is weeks or months after the stroke; spontaneous recovery reaches a plateau. However, this does not mean that the recovery is over.

The coordination of internal mechanisms and physical therapy provides the highest efficiency.

Exactly by which mechanism and through which stages the plasticity of the brain occurs, and when and in which aspects the rehabilitation and physical therapy application is most effective are still areas of intense research. In order to obtain the highest efficiency from post-stroke rehabilitation, the reorganization of the brain and treatment practices should overlap and reinforce each other (1).

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Spontaneous recovery after a stroke depends on factors such as which area of ​​the brain is affected by the stroke, and the health status of the person before the stroke. Most of the spontaneous recovery takes place in the first 3 months, this period is shorter in milder strokes and longer in more severe strokes. In addition, the recovery rate of many symptoms resulting from stroke is not the same (2).

Plasticity mechanisms

In minor strokes, areas immediately adjacent to dead tissue may reorganize for lost function. In larger strokes, neighboring tissues may be insufficient for this task, and more distant brain areas may show reorganization. For example, after a damage to the part of the brain called the motor cortex, which provides movement orders to our body, the premotor cortex, which is accepted as the planner of the movement, can take over the lost functions over time, or the right brain half can take on these tasks to compensate for the damage in the left brain. These activities of the brain can be monitored with functional neuroimaging methods, but the whole process has not been adequately understood yet (3).

There are things to do from day one

In animal experiments regarding the timing of post-stroke rehabilitation, it has been observed that intensive rehabilitation, which is started very early, can increase cellular damage in the brain, while the positive effect of late intensive rehabilitation decreases. It is difficult to draw conclusions from these findings for humans (4). From the first day after stroke, there are things that need to be done in terms of physical therapy and rehabilitation. Appropriate positioning of the body, changing positions to prevent bedsores, joint range of motion exercises are some of these. After the life-threatening situation is over, more intensive rehabilitation applications such as compulsory use treatment, non-invasive brain stimulation and robotic rehabilitation can be started in combination. Even in the late period, functional gains can be achieved with rehabilitation.

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Physical therapy and rehabilitation should begin within the first 2 weeks after stroke.

We know that our brain learns through training and repetition. Implementation of rehabilitation in the period when the brain is most open to learning ensures the highest efficiency. This usually corresponds to the early life-threatening period after a stroke. It is appropriate to start physical therapy within the first 2 weeks. But the learning capacity of the brain is not lost, and sometimes the rehabilitation process can continue for a lifetime.

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