How allied health clinicians help stroke survivors live more independently
A stroke occurs when there is a reduction in blood flow and oxygen to part of the brain. It can be haemorrhagic (due to a bleed) or ischemic (due to a clot), which is the most common type of stroke.
Stroke affects everyone differently and how a person is affected depends on the part of their brain that was damaged by the stroke and the extent of the damage.
Stroke survivors can experience physical, cognitive and emotional changes, including changes in their ability to move and walk, talk and understand language, swallow, think, focus and remember. Stroke can also affect their vision and sense of touch, taste and smell, affect their personality, cause pain, stiffness, fatigue, anxiety and depression.
It’s these changes that can reduce a stroke survivor’s ability to live independently, move about and perform everyday activities, from dressing, preparing meals, and taking the stairs at home to shopping, driving and participating in leisure activities and work.
How allied health clinicians help stroke survivors recover and rehabilitate
Post-stroke rehabilitation can help the brain adapt to the damage caused by the stroke through relearning skills or learning new ways to do things. This involves the brain making new neural pathways or connections in its healthy or undamaged parts, an ability called neuroplasticity.
We now know that the brain makes new connections throughout our lives in response to experiences, including stroke and rehabilitation activities. Practice and repetition of rehabilitation activities can enhance the creation of new connections, helping recovery of skills or competency in new ones.
Allied health clinicians provide rehabilitation to stroke survivors and their focus is largely on helping them regain as much function and independence as possible through activities, strategies, and the introduction of assistive equipment and home modifications.
Two or more clinicians will often form a multidisciplinary team (MDT) to support stroke survivors. This is because the multidisciplinary approach has been found to be very effective in improving stroke survivors’ mental and physical function and their quality of life – and is recommended by Australia’s Stroke Foundation. For example, with an MDT, an occupational therapist will focus on helping a stroke survivor regain or master new ways to perform everyday activities, a speech pathologist will provide ways to overcome their speech and language difficulties while a physiotherapist works on improving their strength, coordination and balance and an exercise physiologist creates programs to improve health and fitness.
As you can see, this multidisciplinary approach creates comprehensive programs that address multiple challenges at the same time and provide a unified approach to helping stroke survivors achieve their short and long-term goals.
The many benefits of post-stroke allied health therapy
In addition to helping stroke survivors regain motor function, which is needed for performing activities like walking, sitting, and making meals, and learn new ways of doing things, allied health therapy can
- Provide essential after-hospital continuation of support and rehabilitation. Allied health clinicians ‘take over’ from your hospital medical team to continue your recovery and rehabilitation which can take weeks, months or years – far longer than the usual post-stroke hospital stay.
- Reduce the risk of another stroke by lowering a person’s high blood pressure and LDL cholesterol and helping them maintain a healthy lifestyle and weight. Physical inactivity is a risk factor for stroke, especially concerning for stroke survivors as they spend significantly more time being sedentary as a result of the damage caused by their stroke.
- Give stroke survivors the much-needed support, motivation and confidence needed for regaining skills, learn and use new ones, master assistive technology, and continue to push through challenges to achieve their goals.
- Reduce the occurrence and severity of secondary complications such as falls, shoulder pain and subluxation (partial dislocation) in the weakened arm, spasticity or stiff and rigid muscles, and contractures, which are the stiffening or tightening of the muscles, joints and tendons usually in the hands, hips, knees, elbows and ankles, and swelling in the hands and feet.
- Improve safety and function by reducing spatial neglect, a condition in which stroke survivors ‘neglect’ their affected side by not noticing or responding to stimuli.
When to start allied health therapy following a stroke
While post-stroke rehabilitation and recovery is different for each person, when to start allied health therapy should be determined by your doctor. And as for the amount of therapy, the Australian Stroke Foundation recommends rehabilitation include as much scheduled occupational therapy and/or physiotherapy as possible.
There are many theories as to why starting a recovery and rehabilitation program early can be beneficial for stroke survivors, including the reduction of pressure sores, infections and deep vein thrombosis and that the first weeks and months following a stroke the brain is most primed for making new pathways to replace the ones damaged by the stroke (called neuroplasticity). In fact, the first three months following a stroke have been found to have the greatest rate of recovery and is when survivors experience the most improvement, although improvement can take years.
Australia’s Stroke Foundation recommends stroke survivors seek support from health professionals like speech pathologists, physiotherapists and occupational therapists, as soon as possible after their stroke, with approval from their doctor. and occupational therapists, as soon as possible after their stroke, with approval from their doctor.
A therapy program just for you
As everyone’s experience of stroke is different, personalised therapy programs are recommended for achieving the best results.
The effects of a stroke vary from person to person and are largely determined by the type of stroke, its location, and the extent and severity of the damage caused to the brain when a blood vessel ruptured, narrowed or became blocked by a clot.
The most common symptoms or signs of stroke are
- Impaired speech: muscle weakness and difficulty coordinating the speech muscles causes slurred or garbled speech;
- Weakness and/or numbness in the arm, leg and face, particularly on one side of the body;
- Reduced and restricted physical abilities, such as walking, loss of balance or coordination due to compromised control of the body’s voluntary muscles (you may have heard the term motor function which involves making specific movements of muscles to perform tasks and actions like walking).
Other symptoms of stroke include:
- Difficulty understanding speech/language
- Compromised cognitive ability such as thinking, memory, judgement and reasoning
- Difficulties chewing and swallowing food, drink and saliva
- Changes in personality, behaviour and temperament and emotional control
- Loss of bowel and bladder control
- Vision changes such as blurring and loss of periphery vision in one or both eyes
- Changes in smell, touch, taste, and hearing
- Fatigue and difficulty sleeping
- Sexual dysfunction
How each allied health clinician contributes to a rehabilitation and recovery program
Allied health clinicians use proven evidence-based strategies and person-centred approaches to help stroke survivors enjoy more independent, socially connected and healthier lives.
Each allied health clinician has a defined role in post-stroke therapy, however as they often work together in multidisciplinary teams, they will contribute and share their expertise to create personalised and targeted programs for each stroke survivor. More specifically:
Speech pathologists can help stroke survivors regain speech and language skills, including addressing difficulties with cognitive abilities, such as memory, attention and problem-solving, that affect communication. Speech pathologists also help stroke survivors overcome swallowing difficulties (called dysphagia) so they can eat safely, benefit from optimal nutrition, and avoid lung infections from food entering their lungs.
Physiotherapists can help stroke survivors regain movement in their arms and legs and learn ways to move around proficiently and safely. They help survivors with weakness in their arm and leg acquire the techniques, strength, balance and coordination to walk, sit, go up and down stairs, and provide strategies and therapies for reducing secondary complications like shoulder dislocation and spasticity.
Occupational therapists or OTs can help stroke survivors regain skills or learn new skills and ways for performing everyday activities and tasks and participating in life, such as bathing, dressing, preparing meals, using a keyboard, and driving. OTs also help people with swallow difficulty, recommend home modifications to create safer environments that enhance movement, and provide strategies to compensate for cognitive impairment, such as difficulties with thinking and memory.
While OTs use therapy techniques repetitive practice and task-specific training to help stroke survivors regain their functional skills, both OTs and physiotherapists both use a type of therapy called Constraint Induced Movement Therapy (CIMT) to help survivors with weakness in one arm. By constraining the unaffected arm and focusing therapy sessions on the weakened arm, including repetitive practice of functional tasks, the muscles are strengthened and the brain stimulated to make new neural connections to perform movements. In addition to CMIT, OTs and physios may also recommend strategies to remind the stroke survivor to use their affected limb as much as possible to continue to build strength and ability in that arm and help them avoid learned non-use, a phenomenon associated with stroke.
Exercise physiologists can create tailored exercise programs that can help stroke survivors improve their fitness and strength. Aerobic exercise can enhance the recovery of movement and acquisition of new movements, help reduce depression following a stroke, and help prevent another stroke.
Other allied health clinicians who can help stroke survivors recover and rehabilitate include psychologists who focus on improving mental and emotional challenges, and dietitians who create a healthy eating and lifestyle program to boost health and help reduce the risk of another stroke.
Striking the right balance with compensatory strategies
For stroke survivors who have weakness or paralysis in an arm, performing even the simplest tasks, like getting dressed and making a cup of tea, are a challenge, and for many, frustrating. Not surprisingly, many find new or alternative ways, called compensatory strategies, to do things with their affected arm or solely using their unaffected arm.
And while compensatory strategies enable stroke survivors to perform activities and can promote recovery, as muscles are strengthened and new neural connections in the brain created, allied health clinicians are mindful that compensatory strategies can both assist and impede recovery. This is because compensatory strategies can enable stroke survivors to ‘favour’ their unaffected arm, which can reduce recovery of function in the affected arm. Compensatory strategies can also be mistaken for recovery and mask a stroke survivor’s actual progress.
Clinicians therefore create post-stroke therapy programs that aim to strike the right balance of using compensatory strategies to facilitate but not affect the stroke survivor’s rehabilitation progress.
How our clinicians work together with you and your family
Our clinicians will assess how your stroke has affected you and discuss the challenges you would like to overcome and the activities you want to perform. They may also seek advice from your doctor and talk to you about your longer-term goals, perhaps to return to driving, leisure activities or work. Our clinicians will also talk to your family and carers to share your goals and therapy strategies so they can best support you between sessions. Every action taken is in effort to implement a person-centred approach to therapy.
Your needs and how the stroke has affected you largely determines the types of therapies or interventions in your program. For example, if you are experiencing weakness in your arm, your post-stroke therapy team is likely to include an occupational therapist and physiotherapist who will create a tailored program together to help you regain movement, strength, balance, and coordination. OTs often use task-specific training in post-stroke rehabilitation, which is basically learning by doing.
If you or a loved one have experienced a stroke, don’t hesitate to reach out for support. The road to recovery is challenging, but with the right guidance and teamwork, significant improvements are possible. We encourage you to talk to your healthcare provider about starting allied health therapy.
