Higher function stroke rehab.

Physios are heavily involved in the acute and functionally impaired stroke rehab. Oviously the end stage functional ability will depend on the extent of the stroke and how much a person recovers, all maximised by PT (i.e not all stroke patients will return to high level function) depends on the patient. There is however a number of patients which do return to high levels of function, usually fairly young, previously fit and healthy people. This begs the questions; What is available out there to help them maintain their fitness and function, as well as being social and having the fun that is associated with being physically active? There are no gyms or sporting clubs out there that cater to a higher level stroke patient.

On my neuro placement I encountered a new and still small program which catered for these kinds of higher function stroke patients. Patients were pushed to do higher level and resisted strength training, sometimes on gym equipment, plyometeric training and running retraining (indoors and outdoors). Research was being conducted on the efficicacy of this programme, with great results.

This experience made me realise firstly, how many young people are actually affected by stroke, and secondly how little there is out there for these kind of patients in terms of increasing their quality of life and preventing future CV events (these people are obviously at risk of having another CV event, with this risk increasing if they remain inactive and unfit and regular exercise is one of the best ways to lower this risk and stay fit and healthy).

It also made me think about how much to push a patient. Some of these patients initially thought that they would never be able to run or exercise again but with peristance, modifications and supervision acheived amazing results. These patients will need to continue this for the rest of their lives, as they will always have their impairments and increased risk of CV event.

I also applied this to other PT subjects, for example musculo. When we have acheived pain free function a patient is discharged. A lot of the time though, the patient comes back (especially neck and back pain patients). To me these patients have a permanent impairment(This is not really based on evidence, just my own observations, that 0nce you hurt yourself that structure/joint is never quite the same and one time or another will casue you a problem). Hence emphasis on long term specific/therapeutic exercise is needed i.e Shoulder rehab group, chronic neck pain group ect. classes run by PT's. Just like running fitness groups for higher function stroke patients, or COPD patients can reduce the cost and strain on the health care system, so to can running classes for recurrent musculo conditions reduce surgeries, medication use, disability pensions, and reduce the likleyhood of a PT developing OA of their hands.