Rehabilitation after a cerebral infarction: what it is and how it is done

More and more people are suffering from strokes such as cerebral infarction, a disorder caused by blockage of blood vessels in the brain, due to narrowing of the arteries or blockage by a clot.

To prevent it, it is essential to lead a healthy life and avoid risk factors such as smoking or obesity. And above all, it is very important to stop this type of stroke in time and begin, as soon as possible, a rehabilitation at all levels, so that the person recovers their functional autonomy and rejoins life daily.

In this article we explain How rehabilitation is carried out after suffering a cerebral infarction and what activities are carried out in this process.

• Related article: "Types of stroke (definition, symptoms, causes and severity)"

What is a cerebral infarction?

A cerebral infarction, also called ischemic stroke, It occurs when there is a sudden reduction in blood flow to the brain, usually caused by an obstruction or bleeding. This type of stroke occurs when a blood vessel breaks or narrows (thrombosis), or when it becomes blocked by a clot (embolism), for example; and the consequence is that certain areas of the brain do not receive the oxygen and glucose they need.

Normally, cerebral infarctions occur suddenly and have a rapid development, getting worse as the hours go by if not addressed quickly. Strokes are more common in people over 55 years of age, and are the most common cause of mortality among women, and the second cause in men. Bad habits such as smoking, a sedentary lifestyle or obesity also have a negative influence, increasing the risk of suffering a stroke.

People with a family history of stroke, diabetes, and sleep apnea syndromes also have a higher risk of suffering from such a stroke. Each year, it affects about 130,000 people., and a third of them suffer from sequelae ranging from motor difficulties to cognitive deterioration and loss of functional autonomy.

However, there are two elements that are key when addressing a phenomenon like this, and they are: on the one hand, prevention, which involves becoming aware of the benefits of habits as simple as exercising or living a healthy lifestyle. healthy; and on the other hand, early detection and rehabilitation. Next, we will talk about this second part, which is essential for the patient's recovery after a cerebral infarction.

Rehabilitation after a cerebral infarction

When a person is suffering a stroke, a series of characteristic symptoms occur: numbness or weakness on one side of the body, sudden confusion, difficulty walking and incoordination, and headache. When this happens, emergency services must be activated quickly and the person taken to the nearest hospital. You will then be referred to the Stroke Unit, specialized in these disorders.

Once the necessary medical tests have been carried out and after receiving the relevant diagnosis, the patient will remain hospitalized until they are clinically stable. The first hours are very important, since signs may be evident that indicate more or less extensive injuries that will later be used to plan adequate rehabilitation. Although the brain tries to recover damaged functions spontaneously (restructuring healthy tissue), is often only possible to a certain degree, and is not always achieved.

After receiving medical discharge, the patient who has suffered a cerebral infarction will begin the recovery plan. rehabilitation, which includes a multidisciplinary therapeutic approach that will vary depending on the needs from each person. This must be started early, and must be coordinated between the different health professionals who will be part of the patient's life throughout the recovery process.

1. Physical rehabilitation

The patient's physical rehabilitation will be planned based on the parts of the body and physical abilities that have been affected after the cerebral infarction. The main objective is to recover, totally or partially, functional autonomy and basic skills such as: walking, having a stable body, maintaining balance, etc.

The physical rehabilitation plan also includes physical activities that may include: mobility training (use of canes, ankle braces and aids). for general mobility), fine and gross motor exercises (to improve coordination and muscle strength), restraint-induced therapy (to improve restricts the unaffected area while practicing movement with the injured extremity) and range of motion therapy (for patients with spasticity).

Nowadays, thanks to technology, new practices have been incorporated to address physical rehabilitation after cerebral infarction, such as: functional electrical stimulation, robotic technology, virtual reality or technology wireless. All these technology-assisted physical activities are used to improve weakened muscles and to reeducate certain movement patterns that have been affected by the stroke.

• You may be interested: "Neuropsychological rehabilitation: this is how it is used in patients"

2. Cognitive rehabilitation

After a cerebral infarction, cognitive problems and alterations in language, memory, attention and concentration, among others, may appear. The objective of cognitive rehabilitation is to stop and reduce the negative impact of these alterations, by stimulating the different cognitive functions that have been damaged for the stroke, taking advantage of the neuronal plasticity of the brain that allows neurons to regenerate functionally and anatomically to form new connections.

In the majority of strokes in which there is cognitive impairment, the patient experiences difficulties in orienting himself temporally and spatially. In this sense, therapies focused on orientation will facilitate that, in the first moments of rehabilitation, the person has a better personal and spatiotemporal location.

Cognitive stimulation tasks In patients with cerebral infarction, they can be performed on paper or assisted by technology (generally, a computer or tablet), depending on the preserved abilities of each person.

The neuropsychologist in charge of rehabilitation must attend not only to the progress at the cognitive level, but also to the rest of the contextual variables that have to do with the family, social and/or work environment of the person who has suffered the ictus. Ultimately, the ultimate goal of this rehabilitative process is for the person to obtain the greatest possible functional autonomy, and is able to correctly carry out the tasks of life daily.

3. Speech therapy rehabilitation

Language alterations after a cerebral infarction represent a great impediment for the patient, especially if they involve clinical manifestations such as aphasia, which involves an inability to emit or understand the language; or dysarthria, which involves difficulties articulating sounds and words.

The speech therapist is the professional in charge of that the patient recovers language functions and communication skills. Generally, reading, writing, expression and language comprehension exercises are usually carried out, with methods ranging from the verbalization of phrases at a certain pace, the naming of images or the discrimination of phonemes.

In any case, the objective of speech therapy rehabilitation is for the patient to recover the linguistic capacity they had before the cerebral infarction; or, at least, recover some functional autonomy that allows you to communicate with others and interact with your environment in the best possible way.

4. occupational therapy

Occupational therapy is part of the cerebral infarction rehabilitation process and its objective is to achieve that the patient regains the ability to perform basic and advanced activities of daily living, so that you can properly reintegrate into society after having suffered the stroke.

During the occupational therapy process, health professionals assess possible adaptations to the environment and the incorporation of support elements for the patient. Sometimes, people who suffer a stroke need to modify some elements of the home so that they do not have difficulties reintegrating: for example, by installing a stair lift in your doorway, modifying the furniture or replacing the bathtub with a tray of shower.

Stem cells: the latest in rehabilitation

In recent years, a new therapy based on the implantation of neural stem cells has been studied to recover lost functions in patients who have suffered cerebral infarctions. In the studies carried out, mice with stroke have been used in which stem cells of mesenchymal origin have been implanted., encapsulated in a harmless and biocompatible material, such as silkworm fibroin, a type of very fibrous protein.

In the experiments carried out it has been observed that The animals that received this stem cell therapy significantly improved their motor and sensory abilities. who had been affected after suffering the cerebral infarction. And furthermore, it has been shown that encapsulation increases the survival rate of implanted stem cells, thus positively influencing the repair of damaged brain tissue and preventing its extension after the infarction cerebral.

In short, researchers are working on the future development of drugs that are capable of stimulating this type of stem cells that are found in the brain, so that they can multiply, move to the affected brain areas and begin the repair process cell phone.

Bibliographic references:

• Brott, T., & Bogousslavsky, J. (2000). Treatment of acute ischemic stroke. New England Journal of Medicine, 343(10), 710-722.
• Patel, M., Coshall, C., Rudd, A. G., & Wolfe, C. d. (2003). Natural history of cognitive impairment after stroke and factors associated with its recovery. Clinical rehabilitation, 17(2), 158-166.
• Rodríguez García, P. L. (2014). Ischemic stroke: progress and projections. Cuban Journal of Neurology and Neurosurgery, 4(1), 71-88.