In a stroke, certain areas of the brain become less well supplied by an occlusion of an artery or, in rare cases, by a cerebral hemorrhage. As a result, the cells in this area are destroyed and neurological deficits arise.
But not only are the sudden neurological failures distressing, but also scary. Some patients experience life-threatening situations during a stroke, which are a challenge to the body and psyche. However, when the acute event is over, the patient expects a long way from examinations, rehabilitation and medication. Here, the goal is to help people as much as possible, to regain all skills and to offer a good prophylaxis against a new stroke.
Especially important for a cure or a reduction of the symptoms is an early start of therapy (Time is Brain). In this way, the cells can be rescued before they die.
Also important is the affected vessel. In a so-called major stroke, important vessels supplying the brain are affected and patients suffer a severe deficit. In a minor stroke, however, only mild neurological deficits remain. Through various rehabilitation measures, the recovery can be positively influenced.
The healing process after a stroke goes through different phases. The sooner the treatment starts in the hospital, the better the chances of a speedy recovery.
The patient with a stroke first arrives at the emergency room where treatment is initiated as quickly as possible after the diagnosis has been made. It is, if there are no other diseases prohibit, a strong blood thinning (lysis) through the vein and if necessary with a catheter, the clogged vessel freed (thrombectomy). Even during therapy, the symptoms can improve significantly.
Ideally, the treatment should then be done in a stroke unit. Stroke units are facilities that specialize in the treatment of strokes.
In the acute phase, vital parameters such as heart rate, blood pressure and respiratory rate must first be stabilized. Equally important is a well-adjusted blood sugar and a temperature below 37.5 °. Thus, the development of brain edema can be prevented. Cerebral edema is a major complication that adversely affects the healing process.
If the acute phase is overcome, the patient should continue to be stabilized. In addition, the first rehabilitation measures should be initiated. These include physiotherapy and occupational therapy and speech therapy. The existing neurological functions should be protected in this way. Also, complications such as spasticity - cramping of the musculature - be prevented.
But what exactly happens in the brain during the healing process? New scientific findings have shown that it comes after a stroke to a reorganization in the brain. In medical jargon, this process is called neuronal plasticity. The rehabilitation therapy tries to promote this reorganization by different therapeutic concepts. Clinical progress depends on this. Furthermore, the coordination of motion sequences should be improved in this way.
Another important aspect of rehabilitation is the integration of the patient into everyday life and into professional life. The patient should learn to deal with his disability.
In addition to the entire rehabilitation measures and the prophylaxis is essential. It should be done 48 hours after the stroke with ASS® or Clopidogrel®. In the further healing process risk factors should be eliminated. These include nicotine abstinence, abstinence from excessive alcohol consumption and weight loss. Also, the blood pressure and blood sugar must be well adjusted and checked regularly.
No general statement can be made about the duration of the cure. The healing depends strongly on the start of therapy, the affected vessel and the location of the damaged area.
In a minor stroke (small stroke), only small vessels supplying the brain are affected. The neurological deficit is low. Accordingly, the patients recover quickly.
In a major stroke, however, one of the main vessels is affected. This is based on a variety of brain cells. As a result, patients experience a severe deficit, such as paralysis, speech disorders, visual disturbances or impaired consciousness. Through a plasticity of the brain cells from other brain areas can take over the partially lost functions. As a result, a clinical improvement occurs, but the symptoms do not completely disappear. Some patients stay in need of assistance or care for a lifetime. The greatest progress can be achieved within the first six months, as most of the reorganization of the brain takes place during this period.
Other important prognostic factors include the occurrence of complications such as cerebral edema, cardiac arrhythmias or pneumonia. The question of how far the brain was damaged before the stroke is also essential. If small microinfarcts have occurred, the healing process will be delayed. For this reason, younger patients also have a better prognosis and can recover relatively quickly from a stroke. They have a higher reserve capacity because their brain was not damaged.
After a stroke, the patients learn the functions through continuous training. For learning functions, a specific brain area, the hippocampus, plays a significant role. If it is intact, the chances of recovery are higher. In addition, the patient can compensate for his neurological deficits faster than patients with damaged hippocampus.
An improvement of the symptoms is possible by this high variability in the recovery already in the first hours. Over half of the patients admitted to a stroke unit can be discharged home at discharge.
The speed of recovery of the patient is strongly related to the side effects of these. The healthier the patient is, the faster and better he can perform the training. With mild symptoms, patients can recover within a few days.
However, over a quarter of patients are severely affected and require longer hospitalization and subsequent admission to a rehabilitation clinic. An interdisciplinary team also works there with physiotherapists, occupational therapists, speech therapists, medical staff and social workers. Together, the functions that are affected by the stroke are trained and promoted.
The chances of recovery are quite individual and dependent on the affected vessel and the damaged area. However, there are some criteria that significantly improve the prognosis.
Of particular importance is early treatment. The therapy can only be started in the first 4.5 hours, which is why an immediate medical presentation is crucial. If the onset was uncertain or more than 4.5 hours have passed, you should nevertheless present yourself immediately in a hospital. The inclusion on a stroke unit significantly improves the prognosis of patients and is important to find the cause of the stroke and to initiate prophylaxis and rehabilitation.
The treatment takes place here with a medicamentous lysis therapy or a mechanical Rekanalisation. In a lysis therapy, the blood clot, which clogged the vessel, dissolved by medication. In a recanalization, however, the whole thing is done intraoperatively and then a stent (a kind of metal spiral) is used, so that the vessel does not close again.
Also important is the treatment in a stroke unit. Stroke units are facilities that specialize in the treatment of strokes. There is an optimized therapy and monitoring of patients. In addition, early rehabilitation measures are initiated there.
In addition to these secured measures, there are other criteria that increase the chances of a cure. This includes the motivation to perform the exercises of the physiotherapist and the renunciation of risk factors, such as nicotine or excessive alcohol consumption. A healthy lifestyle and a sporting activity can also have a positive effect.
Of course, after a stroke, the avoidance and treatment of complications such as dysphagia, cardiac arrhythmia or infections is quite central. A quick start of rehabilitation measures prevents complications. Patients should get out of bed early if they are stable. Best within the first two days after the event. This can avoid thrombosis and pneumonia. In addition, early exercise is also crucial, as up to 80% of patients suffer from paralysis.
Since stroke is not only a physical burden but also a mental burden for those affected, the social support of relatives is particularly important. This makes it easier to get started in everyday life and working life.
If the language center is damaged, the chances of recovery are quite different. The odds are dependent on the type of disorder and the severity.
Every third stroke patient is affected by a speech disorder (aphasia). Basically, there are different speech disorders. The patient may have difficulty speaking, but understands what he is told.
But he can still have the ability to speak, but what he says makes no sense. In some cases, severely affected patients can neither understand nor speak (global aphasia). In general, however, one can say that early rehabilitation has a positive effect. Ideally, the rehab therapy should be done immediately after the acute treatment.
First, you should determine the type of disorder to be able to perform a targeted therapy. In the further course, speech therapists, speech therapists and linguists support the patient through individually adapted exercises.
These exercises improve the comprehension of speech and facilitate linguistic utterances. The goal of these exercises is the stimulation of nerve cells. This promotes reorganization and adjacent brain areas can take on lost functions in this way.
Two factors are particularly important for the recovery of speech functions: time and staged training. The staged training includes a logopedic therapy, if possible, of at least five hours per week. This significantly improves the chances of regaining the language. Here, however, the patient's own initiative also plays a major role, because independent practice can accelerate or maintain healing. Unfortunately, in about two-thirds of those affected, speech disorders do not completely decline.
In addition to the nature of the disorder, the level of the disorder is also important. If basic structures are damaged, they can not be well compensated. When complex structures are damaged, the simple, basic structures can work well together and take over these complex functions. The foundation must therefore still be intact.
Self-initiative also plays a crucial role in the healing process. The exercises should be performed regularly. The biggest progress will be made in the first 6 months. But years after the stroke can improve the symptoms. It definitely pays to continue the exercises persistently.
A stroke of the cerebellum manifests itself clinically with various symptoms, such as gait insecurity, dizziness, coordination and speech disorders. Therefore, it can be distinguished quite well from a stroke of the cerebrum.
Also balance disorders with dizziness and gait uncertainty are possible. In addition, the patient can see double images, which affects the balance even more. Finally, speech is also controlled by the cerebellum. In case of failure, a dysarthria may appear that sounds similar to increased alcohol consumption.
As with any stroke, the symptoms can disappear within a very short time or persist for weeks to months. Remaining residual symptoms are also possible.
The chance of recovery depends on the size of the infarct. In a small infarct, the chance of the neurological deficit regressing is relatively high. In larger infarcts, however, a larger area is damaged and many functions are impaired.
Decisive for the prognosis is also the time of treatment. The sooner the therapy starts, the more cells can be saved before they die. After the acute treatment should be started directly with a rehabilitation. This promotes early recovery and the prognosis can be improved. In addition, existing functions can be protected.
During the rehabilitation especially movement should be practiced. For speech disorders, special exercises should be performed by speech therapists and speech therapists. Self-initiative is crucial for prognosis - if the exercises are performed regularly, progress can be made faster.
The prognosis after paralysis after a stroke depends on different factors. Therapy time, the severity of the disorder and the reserve capacity of the brain play an important role.
A clinical improvement in symptoms can usually be seen after two months. However, it is a lengthy process that requires a lot of discipline. Because the more often the exercises of the physiotherapist are repeated, the higher the chances of a cure or at least a relief of the symptoms. Through the exercises, the reorganization of nerve cells is stimulated - adjacent areas can thus take over the function of the damaged area.
Particularly important is an early and intensive start of rehabilitation. Various studies have shown that the intensive early rehabilitation is crucial for the regression of the symptoms. In a paralysis motor functions can be learned again. However, one has to say that paralysis is a serious neurological disorder that rarely heals completely.
The patient must get off the wheelchair and wheelchair bed as soon as possible. As mentioned above, this is not only very positive for exercise training, it also prevents complications. The number of steps in each exercise unit seems to have a big effect.
Paralysis of the upper extremities is present in 80% of those affected. In the first two months, patients can relearn the movement of their fingers. If the function of the hand has not recovered after half a year, chances are much less that an improvement will occur. It is also very important to integrate and practice the hand in everyday activities. Important in patients with paralysis is a spasm (spasticity) to prevent.
Furthermore, the pre-existing conditions, such as diabetes mellitus or cardiac arrhythmia, are decisive for the prognosis. These increase the risk of complications and reduce the chances of recovery. For this reason, patients should be monitored regularly, especially during the acute phase. Blood sugar, blood pressure and body temperature should be kept stable. All this can have a positive effect on the recovery and thus increases the chances of recovery.