Move Forward Guide
Physical Therapist's Guide to
Stroke is the third leading cause of death in the United States and is a leading cause of serious, long-term disability in adults. Stroke can happen to anyone at any time—regardless of race, sex, or even age—but more women than men have a stroke each year, and African Americans have almost twice the risk of first-ever stroke than whites do.
If you have one or more of the following symptoms, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent for you:
- Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
- Sudden confusion or trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
If You Think Someone Might Be Having a Stroke
Act F.A.S.T.! Emergency treatment with a clot-buster drug called t-PA can help reduce or even eliminate problems from stroke, but it must be given within 3 hours of when you start having symptoms. Recognizing the symptoms can be easy if you remember to think F.A.S.T.
F=Face. Ask the person to smile. Does one side of the face droop?
A=Arms. Ask the person to raise both arms. Does one arm drift downward?
S=Speech. Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?
T=Time. If you observe any of these signs, call 911.
Research shows that people with stroke who arrive at the hospital by ambulance receive quicker treatment than those who arrive by their own means.
What Is Stroke?
Stroke is sometimes called a "brain attack." With a heart attack, blood supply to the heart is reduced or stopped. With a stroke, blood supply to part of the brain is reduced or stopped. This means that part of the brain does not receive enough oxygen. Millions of brain cells die every minute during a stroke, increasing the risk of permanent brain damage, disability, or death.
One common cause of blockage that leads to stroke is a blood clot or a build-up of fatty deposits (arteriosclerosis) in blood vessels that supply the brain. The reduction in blood flow results in an ischemic stroke. Most strokes are ischemic.
Another common cause of stroke is a leaking vessel in the brain. This is called a hemorrhagic stroke.
Signs and Symptoms
If you are having a stroke, you might:
- Feel a sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
- Be confused about where you are or what you're doing
- Have trouble speaking or understanding what others are saying
- Have trouble seeing in one or both of your eyes
- Have trouble walking, be dizzy, or lose your balance
- Have a sudden, severe headache that seems to come out of nowhere
A transient ischemic attack (TIA) is a kind of "warning stroke" or "mini-stroke" that produces stroke-like symptoms but no permanent damage.
Recognizing and treating TIAs can reduce your risk of a major stroke.
Stroke can cause a range of long-term problems, such as:
- Inability to move on one side of the body("hemiparesis")
- Severely limited movement
- Balance problems
- Weakness in the leg or arm on one side
- Off-and-on numbness
- Unusual physical sensations
- Sensitivity to cold temperatures
- Memory loss
- Slowed or slurred speech
- Difficulty remembering words
How Can a Physical Therapist Help?
How well you recover from stroke - and how long it takes to recover—depend on the size and location of the stroke, how quickly you receive care, and, in some cases, other health conditions you might already have.
Rehabilitation begins very soon after your stroke, and your physical therapist is an important member of your health care team. The therapist's main goal is to help you return to your roles in the home, in the community, and at work.
After examining you and evaluating your condition, your physical therapist will develop an individualized plan to help you achieve the best quality of life you can. The plan will focus on your ability to move, any pain you might have, and ways to prevent problems that can occur after a stroke.
One of the first things your physical therapist will do is show you how to move safely from the bed to a chair. Later, the therapist will:
- Help you relearn how to walk
- Fit you with a wheelchair, if needed
- Provide training to your family and caregivers
- Train you in how to use devices that can help you keep mobile when a stroke has affected your ability to move, walk, or keep your balance: orthoses, prostheses, canes, walkers, wheelchairs—perhaps even robotics.
Depending on the results of the physical therapist's evaluation, and depending on how long it's been since you had your stroke, treatment will vary.
Relearning How to Use Your Upper Body, How to Walk, and How to Do Your Daily Activities
Your physical therapist will design a training program based on tasks that you need to do every day, selecting from well-established as well as cutting-edge treatments. Physical therapist researchers are at the forefront of innovating many of these techniques:
- Constraint-induced movement therapy – used to strengthen your weaker arm (the arm on the side of your stroke); your physical therapist will apply a mitten or a sling on your strong arm to keep you from fully using it. This "forces" you to use your weaker arm or hand to do daily tasks, which helps build your strength and control.
- Functional electrical stimulation (FES) - used to help move your muscles and make them more usable. For instance, your therapist might use FES to treat "hemiplegic shoulder"; where the shoulder is painful, stiff, and even "out of joint" and doesn't work as it should.
- Motor imagery and mental practice - used to strengthen the arms, hands, feet and legs; working with your therapist, you "rehearse" a movement without actually doing it, which stimulates the part of your brain that controls the movement.
- Positioning - used from the very beginning after a stroke, positioning also is important throughout rehabilitation, particularly if you're using a wheelchair or if you have shoulder problems. Positioning helps to reduce the muscle pain, spasms, slowness, and stiffness that can result from stroke. Your therapist will teach you how to safely move ("transfer") from a sitting to a standing position and how to support yourself when sitting or lying down, using foam wedges, slings, and other aids.
- Virtual reality and interactive video games - a computer-generated environment that provides experiences similar to real life. Using a keyboard and mouse, a special wired glove, or sensors on your body, you can practice daily tasks as your therapist helps you "re-wire" your brain and nerve connections.
- Partial body weight support (BWS) - combined with treadmill training to help people walk better; the physical therapist gradually decreases the amount of support as your posture, strength, balance, and coordination begin to improve.
- Biofeedback - used to make you aware of how your muscles work and how you might be able to better control them; your therapist attaches electrodes to your skin to provide measurements of muscle activity that are displayed on a monitor. The therapist will work with you to help you understand and change those readings.
Your needs will change over time. Even after rehabilitation is completed, your physical therapist will assess your progress, update your exercise program, help you prevent further problems, and promote the healthiest possible lifestyle.
Can this Injury or Condition be Prevented?
Some risk factors for stroke can't be changed—such as family history, age, gender, race (stroke death rates are higher for African Americans even at younger ages) and previous heart attack or stroke. But there are many other stroke risks that you can change:
- High blood pressure
- Cigarette smoking
- High cholesterol
- Carotid artery disease
- Physical inactivity
All of these risks can be reduced through lifestyle changes, such as regular exercise. As experts in designing exercise programs tailored for people with health problems, physical therapists can help you reduce your risks for stroke.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with problems related to stroke. Some physical therapists have a practice with a neurologic focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurologic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with stroke.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
Acknowledgments: Judith Deutsch, PT, PhD, and APTA's Section on Neurology