Therapy after Stroke or TIA
by Alec Martinez, DPT
Unlike the typical orthopedic injuries that we often associate with physical therapy, issues that arise after a stroke or a TIA do not involve a direct muscle or tendon issue, but rather a communication problem between the brain and the muscles it is trying to activate. Depending on the location and size of the affected area of nervous tissue, different areas of the body may need to relearn tasks that were once second nature, or may not respond entirely.
What Does __ Mean?
In healthcare, we often have a language of our own, and sometimes we may forget to translate for you. Here are some of the common words you may hear.
Spasticity- while we may think of a muscle randomly turning on or off in a spasm, spasticity relates to muscles that have high tone, similar to a severely inflexible muscle. The difference in spasticity is that this increase in “tightness” is caused by a nervous system response, and increases most with higher speed movements.
Ataxia- this refers usually to how you walk. An “ataxic gait” means that the limbs are moving in an uncoordinated pattern that may seem almost random.
Dysdiadochokinesia- while a large and scary word, this simply refers to difficulty performing alternating movements, like extending and flexing your arm in succession, and again relates to coordination problems.
What is the Plan?
Each area of neural recovery has different stages, and will be very dependent on your specific presentation. Spasticity management, for example, will be often addressed by a combination of medication to help with the nervous response we discussed earlier, as well as positioning and mobility management.
When movements “don’t look quite right” like with ataxia and dysdiadochokinesia, you will work with your therapist on relearning the patterns of movement that your body uses, sometimes by mimicking the other body part, with the therapist guiding your motions manually, or by working with a variety of tools that may assist you in moving in the “right” pattern.
Depending on severity of the condition, there may be some different muscle groups that are not listening to what your brain is telling them by moving in the “wrong way,” or perhaps not listening at all. Whether this is temporary or lifelong is difficult to predict, but in the short term your doctors and therapists may also assist you in finding the right tools to compensate for issues like drop foot by teaching you to more easily use different gait devices or orthotics to help you feel more natural in the meantime.
Regardless, because your body is learning skills it perceives as new, repetition matters! Often your therapist will ask you to perform any activities possible, even if you have a very difficult time with them, with the affected side to force your brain to practice over and over, just like when your body first learned these skills in childhood.
Like with all physical therapy, practice and repetition outside of the clinic have the biggest impact on recovery. Performing even the smallest movements over and over can help he brain re-establish the connections it is having difficulty with. Be very forgiving with your body, there is no “wrong” version of a movement so long as your body is trying to take that step. Missteps are how the brain learned everything the first time, and it will be how it learns again!