Stroke

A stroke is caused when the blood supply to part of the brain is cut off. It can be a life-threatening condition in some cases and treatment needs to be accessed asap. 

There are two main types of stroke:

 - ischaemic stroke - caused by a blockage cutting off the blood supply to the brain. This is the more common type of stroke,

 - haemorrhagic stroke - this is caused by bleeding in or around the brain (see below for SDH & SAH).  This type of stroke is less common but can cause extensive damage in some patients. 

You may also have heard of, or may even have had, a TIA - a transient ischaemic attack - commonly known as a mini-stroke. This can give you the symptoms of a stroke but they normally disappear within about 24 hours. The blockage in the brain which causes the symptoms is only temporary (hence the symptoms resolving) but it is common for people that have had a TIA to go on to have a full blown stroke, so you must seek medical advice if you think you are having/have had a mini-stroke. 

The brain is made up of millions of nerve cells that are constantly sending messages to neighbouring nerve cells. They need oxygen and nutrients to survive. The brain has a blood circulation system the same as the rest of the body to deliver these vital things. If that supply is cut off for more than a few minutes brain damage occurs.  Some of that damage could be permanent. We currently do not have a way to bring dead brain cells back to life. Many years ago, it was believed that the human brain was not capable of recovery after damage. We now know that the brain can establish new pathways of communication between nerve cells - a process known as neuroplasticity. Visit our Treatment page and scroll down to read more about neuroplasticity and how we use this to retrain movement after stroke. 

If you attended hospital after your stroke, it is likely you would have had scans to make an accurate diagnosis. The scan would have shown which areas of your brain were damaged and whether your stroke was due to a blood clot or bleed. Some people have a treatment called thrombolysis (clot busting drugs) but this is not suitable for everyone, and has to be delivered within a specific amount of time.  Some people have surgery. Others are managed medically and looked after until they are 'medically stable' and then transferred to a rehab unit/ward (or stroke unit - depending on your local facilities). Some people go straight home from acute hospital with community services whereas others will be in hospital for some time before going home with community support. 

We can work around your NHS treatment, providing input to 'get you started' whilst waiting for other services, work with/alongside them if you would like extra sessions, and/or provide more ongoing therapy once your NHS treatment has stopped. You may be eligible for a discount on your initial assessment if you have been discharged from the NHS in the last 3 months or are waiting for other services to start - see our Cost/Price page for details. 

Sometimes 'Stroke' can be used as a global term but you may have been told you have had a specific type of bleed. 

This may include a subarachnoid haemorrhage (SAH) which is bleeding between the brain tissue and one of the linings that surround the brain. 

Or you may have had a subdural haematoma (SDH) - a collection of blood between two of the linings surrounding the brain. 

A Traumatic Brain Injury (TBI) is caused by trauma to the head (e.g. hitting your head when falling from a height or during a car crash). 

An Acquired Brain Injury (ABI - can also be known as anoxic or hypoxic brain injuries) is not normally caused by trauma but usually by some other cause that stops the brain getting the oxygen it needs for too long (e.g. cardiac arrest).

We believe that everyone has the potential for (some) recovery after stroke, your chances of recovery are influenced by many things. This is why no two people will have the same recovery. 

The following things need to be considered:

 -  how big your stroke was - the bigger the area of damage, the harder it will be to see significant recovery

 - how severe your impairments are - e.g. an arm that had some movement straight after the stroke has a higher chance of good recovery compared to one that has no movement at all

 - pain - if you have any pain in your body, whether from the stroke or another condition, this can make progress harder, so pain needs to be addressed with your GP

 - any change in your cognitive function - if your thinking skills (e.g. memory, planning) were affected during your stroke it can make it harder to take on new information

 - changes in your communication - if you suffered a change in your ability to process language this can make it harder to follow instructions and make sense of things

 - visual and/or perceptual deficits - if you suffered a change in your vision or suffer with something referred to as 'neglect', your brain may not recognise one side of your body

 - changes in sensation - if a part of your body feels numb or not normal it can be harder to feel movement and get the feedback the brain needs

 - your age - a younger brain has more potential for change than an older one (but having said that, we are ALL capable of learning new skills)

 - any pre-existing medical conditions - other health problems can make things more challenging  e.g. you may need more frequent breaks during your sessions if you have problems with your breathing

 - your mood and psychological wellbeing - if you are suffering with low mood or depression or anxiety, these may need addressing by your GP to allow you to make the most of your therapy; a positive mindset is a MUST for a consistent recovery 

 - your motivation - how motivated you are to continue your therapy, especially when left to do your programmes in between your sessions will have a massive impact on your ability to achieve your goals; how important your end goal is to you is VITAL

 - your support network - if you have family/friends/carers that can support you; having people around you to support you with your practise and keep you focused on your goals always helps.

All the above factors will have an impact on your 'potential' for recovery and how long that recovery might take. Someone who has had a more minor stroke (only a small area of the brain affected with minimal impairment) has a higher chance of a good recovery and in a shorter space of time (weeks to months), than someone who had a larger stroke, with a much higher level of impairment.  A larger stroke might mean less chance of regaining full movement back and it might take a lot longer (months to years). Having said that, there are plenty of survivors out there who were told in hospital they would never walk again but proved everyone wrong!

Time-wise, you may see the bulk of your spontaneous recovery within the first 3-6 months after your stroke. Some survivors are told that they won't see any further changes after 2 years. Whilst it is true that most people will 'plateau' (stop seeing further change) after a time (and this time differs for everyone), there are certainly survivors who have seen more improvements a number of years down the line. 

The recovery journey can be long and hard work and is not always going to be consistent. Some days you might feel like you're going forwards two steps and back one all the time. This is quite normal. Try to focus on your overall improvement and keep striving forwards. 

There are so many simple everyday tasks, activities and movements that we take for granted - until we can't do them.  For some survivors having a stroke doesn't just mean losing movement in an arm or leg.  It can mean the loss of a job, a hobby, a role in a family and often a loss of independence and even identity.  Being suddenly dependent on your family, or needing carers, for your every need is a massive change. 

Physiotherapists are key to regaining movement after stroke.  Physiotherapists use a number of movement based techniques to retrain lost movement using a neuroplasticity - visit our Treatment page and scroll down the page to find out more about neuroplasticity, like what it is and how you can influence it. 

You are likely to have met physiotherapists when you were first admitted to hospital, if you went onto a rehab unit or if you have had therapy at home. Some survivors feel they still have more to achieve but may have been discharged from NHS services, or are currently waiting for the next service to pick them up but are keen to start the next stage of their recovery asap. This is where we come in. 

Visit our Treatment page to find out more about our assessment process, goal and treatment planning and types of treatment we can offer. 

Neuroplasticity is the brain's ability to form new connections and pathways. It is often discussed in relation to brain injury but in fact we all have this ability. Each time we learn a new skill, or have a new experience, it changes the connections in our brains. After a stroke, when certain parts of the brain become damaged, we can form new neural connections and pathways - in essence, creating new pathways for the messages to travel down to control things such as movement, by-passing the damaged area. This is where physiotherapy comes in. 

Here is a short video explaining neuroplasticity:

https://www.youtube.com/embed/ELpfYCZa87g

Neuroplasticity Video

The best way to utilise your brain's ability to change and adapt is to move. Some people experience a certain amount of 'spontaneous recovery' after a stroke (normally within the first few months) when swelling reduces and the brain settles down. During this time, you may have noticed that some of your movement came back on its own. It used to be said that the brain was only 'plastic' within the first 6 months after a stroke. For some patients, this is the time when the brain may be at its most plastic but recovery and re-training of movement may still be achievable further down the line. 

There is now a debate within medicine about when patients 'plateau' - do they stop improving because their brain has reached its physical potential to adapt OR are we seeing plateau's because we are not challenging the brain enough to see change.  A lack of resources e.g. access to timely therapy at the correct frequency/intensity, could influence your potential for recovery. 

Physiotherapy is a science-based profession which uses exercise, movement re-education, education and advice to help establish new pathways in the brain. This in turn improves movement by improving the connection between the brain and the muscles that move your limbs, and in time, making those connections quicker and more efficient. Whilst also training the brain, your physiotherapy programme is also strengthening your muscles, improving their endurance and control and helping you to relearn skills like walking. 

The key to establishing new pathways in your brain is repetition. 

Repetition is the absolute key to regaining movement. It takes our brains tens of thousands of repetitions to learn a new skill. A new skill could be something as small as learning to move your thumb, to something more complicated like walking. The brain learns what it practises most often, so your physiotherapy programme will be designed to promote 'normal movement' where possible. We will also be (constantly!) stressing to you the importance of repetition. Your programme won't include 10 reps (repetitions) of your exercises - it's likely to include 100! Obviously everyone is different so how this will be achieved will discussed during your treatment planning. 

But think of it this way - if someone wanted to learn to be a concert pianist, having never touched a piano in their life, how many hours PER DAY would they need to put in to achieve their goal in a set time frame? How many hours a day do Olympic athletes put in to stay at the top of their game? And yes, whilst they are not dealing with a brain that has had a stroke, the concept is still the same. Recovery from a stroke was once described to be like a full-time job - if you're serious about regaining movement, you need to be willing to devote a number of hours per day to your therapy. 

We understand that not everyone is able to do this, so your treatment plan will reflect what you are able to do. We can still support you to achieve your goals, but we will be honest with you about your rehab potential and recovery timescales. 

Any therapy programme will include an element of self practise - you practising the programmes prescribed for you in between your therapy sessions - your physio 'homework'. It is vital you complete these as prescribed if you wish to progress. The time in between your sessions could potentially be more important to your long term recovery than the time you spend with your therapist.  Your therapy session is merely a starting point; the practise time (repetition) in between sessions is when you strengthen that newly established pathways and hard wire the new connections in your brain. This is how we move from conscious movement to unconscious (automatic) movement.

Our job as the therapy team is to assess and prescribe the right treatment for you - it is your job to do your programme (for those that are able).  For most stroke survivors, the power to recover lies with you. We can guide, advise and educate but ultimately the person in charge is you. 

Unfortunately the patient/therapist power ratio in the early stages after a stroke (e.g. in hospital) is often tipped towards the therapists, and patients forget how much control they have over their own lives. Once back home, it can be difficult for stroke survivors to regain this control, perhaps waiting for community services to pick them up before making any steps towards recovery. 

This may be more difficult if your stroke was severe and you are reliant on other people for everything you need. We can still offer treatment that is personalised to your needs and will work with you to set realistic goals. 

We want to give you the tools to be able to take your recovery forwards.