Stroke
Characteristics and Causes
Stroke is defined as the sudden onset of a non transient focal neurological deficit. It can be induced by ischemia or cerebral hemorrhage. In the former the brain has been damaged by a sudden lack of blood, in the later from the leakage of blood into the brain tissue. Ischemic stroke is the most frequent, 80 percent of stroke cases are of this types. Hemorrhage type stroke is more rare and differs in intraparenchymal and subarachnoid characteristics.
Risk Factors and Effects on the Person
The principal risk factor for cerebral ischemia is age. Other important risk factors are high blood pressure, heart disease, diabetes, carotid artery stenosis, smoking, dyslipidemia and physical inactivity. Stroke can cause loss of strength in the limbs (hemiparesis/hemiplegia), language disorders, lack of sensitivity, visual field disturbances, swallowing disorders, spasticity, incontinence, seizures, depression, and cognitive deficits. The resulting disabilities can be significant.
Importance of Early Rehabilitation
The recovery of functions lost as a result of the brain damage is facilitated by a timely stimulation of the brain and its plasticity, i.e. the ability of our brain to reorganize the activities that control movement and cognitive activity. The immobilization caused by stroke may also precipitate other physical symptoms intensifying the patient's condition. Hypo-kinetic syndrome, characterized by little or no autonomy in movement, can have muscle, joint, skeletal, circulatory, respiratory, skin and urological consequences. Therefore, the person affected by stroke should be exposed to early mobilization and rehabilitation exercises for the control of the head and trunk, and the use of both upper and lower limbs.
Post-Stroke Rehabilitation
Rehabilitation treatment is designed to reduce the disability caused by stroke, with a goal to make the patient as independent as possible and thus improve life quality. When the clinical situation is sufficiently stabilized, the patient can be transferred from acute care (stroke unit or the like) to the departments of intensive rehabilitation, which assess and treat all disabilities presented by the patient. The rehabilitation project of the Santa Lucia Foundation employs a multidisciplinary team of doctors specializing in cerebrovascular diseases (neurologists, physiatrists, cardiologists, speech therapist, geriatricians, pulmonologists, urologists), nurses, physical therapists, speech therapists, psychologists, nutritionists and social workers. The plan of rehabilitation may also provide for the use of brain-computer interfaces (BCI) for the rehabilitation of the upper limbs and other advanced technologies for cognitive rehabilitation.
Cognitive-Behavioral Deficit
Stroke patients are routinely assessed thorough neuropsychological examination, to determine the presence of emotional or cognitive-behavioral deficits, such as aphasia, apraxia or neglect. If the neuropsychological evaluation reveals the presence of one or more disorders, patients are followed with the rehabilitation interventions of specialized speech therapists.
Swallowing problems
The stroke patient may have swallowing problems (dysphagia), a complication that exposes him to an increased risk of pneumonia. Patients are examined by a speech pathologist and may be specifically treated for this issue by specialized speech therapists. The treatment is accompanied by the prescription of a personalized diet, which takes into account any specific swallowing problems of the patient. In particular, it may be necessary to administer a progressive diet, starting from liquids, milk shakes, chopped, soft, up to food of normal consistency. In case of complete dysphagia, artificial nutrition through nasogastric or percutaneous gastrostomy can be prescribed.
Technologies to Support Rehabilitation
The complexity of the neuromotor rehabilitation and the multiplicity of recovery objectives typically require a multidisciplinary rehabilitation program. New technologies offer valuable assistance and complement the conventional rehabilitation techniques increasing their effectiveness. In particular, the use of technology allows an increase in the intensity, precocity, participation and motivation during rehabilitative exercise. The Santa Lucia Hospital is equipped why with a TechnoRoom, which is home to multiple advanced solutions for rehabilitation. High-tech equipment is also available at all of the physiotherapy gyms.
Occupational Therapy
A central theme of the rehabilitation of the patient concerns social and occupational reintegration. The goal of occupational therapy is to return the patient to the highest degree of autonomy in normal life. Programmed training is provided to recover or compensate for the basic functions of autonomy in daily activities such as bathing, eating, dressing and cooking. The Occupational Therapy Unit also has a Ausilioteca (Assistive Devices Facility) for adaptation to patient needs tools useful in everyday life and for learning the use of augmentative and alternative communication technologies.
Patient Discharge Plan
The rehabilitation team, in collaboration with the Social Services Unit of the Hospital, agrees with the patient and family regarding the discharge plan. Patient, family and caregivers are provided with information on the continuity of care and home care as well as the change of physical domestic features, if necessary.