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Grasping the Golden Period of Rehabilitation: Helping Stroke Patients Regain Normal Life
This article will discuss stroke rehabilitation and post-care. Moreover, understanding the causes of stroke and implementing targeted prevention strategies to avoid recurrence are also critical topics.
Rehabilitation of Neural Functions in the Brain
Generally speaking, the first three days post-stroke are crucial as they mark a turning point in the patient's condition, either for the better or worse. The first three weeks determine whether the patient will survive or succumb to the condition. The initial three to six months following a stroke is the golden period for rehabilitation, which is pivotal in determining whether the patient will be left with permanent disabilities.
Complications arising from a stroke, especially cerebral oedema and elevated intracranial pressure, typically subside within three to four weeks post-stroke. If the patient can endure this period, the risk of fatality significantly decreases. However, while survival is achievable, the patient's future—whether they will return to normalcy with mild stroke symptoms, suffer from moderate to severe disabilities, or become permanently bedridden in a vegetative state—depends on the extent of permanent damage inflicted upon the brain by the stroke and its complications.
Regardless of whether it is an ischemic or haemorrhagic stroke, neurosurgeons strive to manage the resultant complications through emergency interventions, medications, or surgery. Their goal is to minimise permanent damage to the brain, preserving essential functions to sustain life, thereby providing the injured brain with the necessary space and time to recover. This approach increases the chances of reversing impaired neurological functions during the critical three to six months of the rehabilitation period.
It is important to note that for stroke patients to benefit from traditional rehabilitation therapies such as acupuncture, physiotherapy, speech therapy, and occupational therapy, their brain must retain basic neurological functions. In other words, if the brain damage is severe enough to result in significant disability or a vegetative state, then these traditional supportive therapies would be ineffective.
In recent years, advancements in medical technology have enabled the use of specialised medications and physical methods, such as Transcranial Magnetic Stimulation (TMS) or Transcranial Direct Current Stimulation (tDCS), to facilitate the repair of damaged neural tissue. These approaches have proven to be highly effective.
Real-life Case Studies
The following stroke recovery stories illustrate the importance of seizing the golden rehabilitation period:
Case Study 1
Three years ago, Mrs Leung, aged 46, experienced persistent headaches for three to four weeks. After consulting her family doctor and an emergency physician, her symptoms subsided with medication. Subsequent brain scans performed at a public hospital revealed no abnormalities, leading Mrs Leung and her family to believe that the situation was under control. However, two weeks later, she suddenly experienced severe headaches at home and quickly lost consciousness. After emergency treatment at the hospital, brain scans and angiography showed that a ruptured aneurysm in her cerebellum had caused a severe haemorrhagic stroke. The resulting blood clot was compressing her brainstem, causing hydrocephalus and elevated intracranial pressure, along with dilated pupils. Neurosurgeons had to perform an emergency craniotomy to clip the ruptured aneurysm, remove the cerebellar blood clot, and drain the ventricles to relieve pressure on the brainstem and reduce intracranial pressure.
Despite three months of intensive care and rehabilitation, Mrs Leung remained in a deep coma. Doctors informed her family that she would likely become severely disabled or, in layman's terms, a "vegetative state" survivor. They advised the family to transfer her to a long-term care hospital and plan for future private nursing home arrangements.
During her stay at the rehabilitation hospital, Mrs Leung's condition did not improve but worsened, with several complications arising from prolonged immobility. In a desperate bid for recovery, her family transferred her to a private hospital for further stroke rehabilitation, despite slim hopes. Remarkably, after six weeks of intensive treatment, including specialised medications, physiotherapy, acupuncture, and transcranial direct current stimulation, Mrs Leung regained consciousness. Her speech, eating, and walking abilities gradually improved. After discharge, she continued with medication, physiotherapy, and TMS therapy, showing significant improvement in swallowing, hand-foot coordination, and walking. Three years on, Mrs Leung has not become the initially diagnosed vegetative patient but is instead a mildly to moderately disabled stroke survivor. She and her family have since relocated to the UK to enjoy their lives.
Case Study 2
Mrs Lee, a 69-year-old homemaker, had a long-standing history of diabetes, high cholesterol, and hypertension, regularly visiting public hospitals for follow-ups and medications. Two years ago, her children noticed difficulty in speech and weakness in her right limbs upon waking one morning. They immediately called an ambulance and rushed her to the emergency room. After a CT scan, the diagnosis was left cerebral ischemic stroke. During her two-week hospital stay, her children observed that her condition was not improving but worsening, gradually leading to an inability to speak and a complete loss of movement in her right limbs. Concerned, they transferred her to a private hospital for further treatment. Detailed MRI scans revealed that the blood vessels from her neck to the middle cerebral artery were completely occluded, leading to extensive brain tissue necrosis in the left hemisphere due to ischemia, which progressively worsened her speech and motor abilities.
After three months of inpatient stroke rehabilitation, including specialised medications, physiotherapy, acupuncture, transcranial direct current stimulation, and TMS therapy, Mrs Lee's right leg strength significantly improved, progressing from complete immobility to the ability to walk with the aid of support devices. Her speech abilities also recovered, enabling fluent communication with her children. Post-discharge, Mrs Lee continued with medication, TMS therapy, and physiotherapy, and her walking and speech abilities continued to improve. Since her stroke was primarily caused by poorly managed long-term high cholesterol, she now requires lifelong high-dose cholesterol and antiplatelet medications to prevent further cerebrovascular degeneration and recurrent strokes.
Today, two years later, Mrs Lee is moderately disabled, able to walk independently with assistive devices, and can live at home with the help of a caregiver. She does not require long-term care in a facility for severely disabled individuals, significantly reducing the financial burden on her children for her long-term medical and living expenses.
CT Angiography Shows:
Mrs. Leung suffered a severe haemorrhagic stroke due to the rupture of a cerebellar aneurysm.
Post-operative CT Scan Shows:
The cerebellar blood clot has been cleared, and the ventricular drainage has been completed, relieving pressure on the brainstem and intracranial regions.
CT Scan Image Shows:
A cerebellar blood clot is compressing the brainstem, causing hydrocephalus and elevated intracranial pressure.
Mrs. Lee's Left Cerebral Artery is Completely Occluded,
resulting in extensive ischemic stroke and progressive necrosis in the left hemisphere.
