Role of Physiotherapy in Stroke

What is a Stroke?

A stroke occurs if an area of brain tissue is deprived of its blood supply causing brain cells to lose their supply of oxygen. This is usually caused by a blockage or burst blood vessel. Without oxygen, brain cells can become irreversibly damaged within minutes.

Unlike other cells in the body, if brain cells are irreversibly damaged then they are unable to heal themselves. The brain, however, is very adaptable and areas of the brain are capable of learning new tasks to compensate for the areas that have been damaged. Physiotherapy encourages this learning and to help the body re-learn normal movement patterns.

There are two types of stroke:

       * Ischaemic (90%)
       * Haemorrhagic (10%)
Ischaemic strokes

These are caused by a blockage within an artery. This blockage restricts the blood flow to an area of the brain, and therefore, brain cells in this area are damaged due to a lack of oxygen.

Haemorrhagic strokes (also known as brain haemorrhages)

These are caused when a blood vessel in the brain ruptures causing bleeding into an area of the brain. This causes a build up of pressure and damages the delicate brain tissue. Blood flow to neighbouring brain cells is restricted and these cells can also become damaged due to a lack of oxygen.

Is there any treatment?

Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics.

Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years.

How Neuro physiotherapy helps

Improve balance and walking and reduce the risk of falls, increase ability to roll / move in bed / sit / stand, reduce muscle spasms, pain and stiffness, increase strength and function of affected arm and leg, retrain normal patterns of movement, increase energy levels, increase independence and quality of life

Manual Therapy

Manual Therapy encompasses the treatment of muscular ailments of various etiologies through 'hands-on', physical intervention. This form of physical treatment usually refers to hands-on techniques and includes:

Soft tissue mobilization, Myofascial release, Craniosacral techniques, Movement with Mobilization, Movement with Mobilization, Joint manipulation, Mobilization of neural tissue, Visceral mobilization Strain and counter strain, Integrative Manual Therapy.

Neuro Development treatment- Bobath technique

Neuro development treatment aims to inhibit spasticity and synergies using inhibitory postures and movements and to facilitate normal autonomic responses that are involved in voluntary movement. The treatment process includes the gradual withdrawal of the direct input of the practitioner leading to increased independence.

Alexander Technique

The Alexander Technique is a method that works to change (movement) habits in our everyday activities. It is a simple and practical method for improving ease and freedom of movement balance support and coordination. The technique teaches the use of the appropriate amount of effort for a particular activity giving you more energy for all your activities.


Rolfing involves the manipultion of the soft tissues or myofacial system to allow for proper alignment and organization of the whole body in gravity. It helps loosen up spastic muscles and smoothes out gait patterns and helps keep the spine alignment.

Vojta Therapy

Vojta therapy (reflex locomotion) is a highly specialized type of physical therapy that is designed to primarily enhance the motor development of a child. The treatment has added benefits of improvements in cognition fine motor breathing and digestion. The method which is developed by Dr. Vaclav Vojta a pediatric neurologist is still being improved upon.

Muscle Re-education Approach

Ultimate goal of this approach is the development of co-ordinated movement patterns training begin with learning the control of individual muscles on a cognitive level.

Knott and Voss' PNF Approach

Relies on quick stretch and manual resistance of muscle activation of the limbs in functional directions which are often spiral or diagonal.

Roods Sensorimotor Approach

Involves superficial cutaneous stimulation using stroking brushing icing or muscle stimulation with vibration to evoke voluntary activation.

TENS (transcutaneous electrical nerve stimulation) - a small extractable device that delivers electric impulses to nerve endings to stop pain.

Bioelectric treatment- a precise dose of bioelectric currents (electroceuticals), is administered through electrodes placed on the skin to cause a biological change and interrupt pain signals. It can treat chronic and acute pain conditions including complex regional pain syndrome, back pain, muscle pain and headaches.