physiotherapeutic management of stroke :: essays research papers

Introduction Cerebrovascular disease or the term stroke is used to describe the effects of an interruption of the blood supply to a localised area of the brain. It is characterized by rapid focal or global impairment of cerebral function lasting more than 24 hours or leading to death (Hatano, 1976). As such it is a clinically defined syndrome and should not be regarded as a single disease. Stroke affects 174-216 people per 10,000 population in the UK per year and accounts for 11% of all deaths in England and Wales (Mant et al, 2004). The risk of recurrent stroke within 5 years is between 30-43%. One problem is that the incidence of stroke rises steeply with age and the number of elderly people in the UK is on the increase. To date people who experience a stroke occupy around 20 per cent of all acute hospital beds and 25 per cent of long term beds (Stroke Association, 2004). The British Government now identifies stroke as a major economic burden on the National Health Service (DoH, 2002). Fifty percent of stroke survivors will experience some residual impairment (physical and cognitive), which is devastating to the individual and their families (Rudd et al, 2002). It is therefore vital for patients and resources that maximum functional recovery is achieved as fast as possible. The physiotherapist has a key role to play in the management of stroke patients, through assessment, prevention strategies, acute management and recovery. This essay aims to critically discuss physiotherapeutic management and examine how it has and may be influenced by a number of factors (e.g. type of organized system for the delivery of post stroke care, setting of therapy, evidence based practice from which National Guidelines are produced etc). The first stage is to outline stroke pathology, of which forms the basis of appropriate management. Pathology There are two major stroke sub groups, those resulting from infarction (ischemic stroke) and those resulting from haemorrhage (intracerebral and subarachnoid). Each of the types can produce clinical symptoms that fulfil the definition of stroke. The types often differ with respect to survival and long-term disability, from recovery in a day to incomplete recovery, severe disability and death (Warlow et al, 2001). Ischemic stroke is the most common type of stroke, which accounts for approximately 85% of all cases (Rudd et al, 2002). It affects 35 people per 100,000 of the population per year (Coull et al, 2004).