Brain damage or stroke patients tend to have longer recovery period, often with residual function impairment because unfortunately, not many patients reach a hospital in time due to various factors to initiate immediate treatment but it is important to note that emergency treatment within the golden hour, which is the first 60 minutes after an attack, is important to prevent long-term brain damage. Stroke, also known as paralysis, is an attack on the brain and is caused by reduced oxygen supply (due to a clot) or bleeding where the symptoms of stroke depend on the portion of the brain affected.
Rehabilitation does not reverse or undo the damage caused by brain disease or trauma but rather helps restore the individual to optimal health, functioning and well-being and with rehabilitation a lot of lost function can be taken over by other cells in the brain and this phenomenon is called neuroplasticity. With these, good results can be seen in children as well as adults.
In an interview with HT Lifestyle, Dr VP Singh, Chairman, Institute of Neurosciences at Medanta- The Medicity in Gurugram, revealed that the causes of brain damage that need intensive rehabilitation are –
- Trauma: The trauma to the brain and spinal cord occurs after road traffic accidents, fall from heights and assaults. They typically affect young people in the prime of their lives. This may lead to severe disability resulting in loss of many productive man-hours for the individual and country. Spinal cord injuries often lead to severe disability in the patients, and they need continuous care. Often the patient loses control of the bladder and bowel. Traumatic events can occur at any age and have long-term effects.
- Stroke: A stroke occurs when there is a loss of blood flow to a part of a brain. This could be the result of a blood clot formed inside the blood vessel or there may be rupture of a blood vessel resulting in bleeding in the brain. Common stroke symptoms include numbness, weakness or paralysis in the face, arm or leg and blurred vision in one or both eyes. This can result in brain damage and necessitates extensive rehabilitation.
- A brain tumor is a growth of abnormal cells in a specific area of the brain that causes damage to the brain. These patients usually need surgery. However depending upon the location of the tumor, there may be resultant disability and intensive rehabilitation is necessary for a good functional outcome.
- The most common type of brain damage in newborn babies is hypoxic-ischemic encephalopathy (HIE). It occurs when the baby’s brain does not receive enough oxygen or blood flow for an extended period of time. HIE can occur prior to, during, or following childbirth. It can be caused by maternal conditions such as high blood pressure (preeclampsia) or birth complications such as prolonged labor, umbilical cord complications and respiratory (breathing) failure.
- Brain infections like Meningitis and Encephalitis can cause brain damage and strokes and can again leave a patient disabled.
Highlighting the challenges in the rehabilitation of patients, he shared, “Whenever brain damages occur it causes disability and depending on the area of damage this could lead to symptoms like- weakness in the arm or leg or problems with speech. All these things cause severe disability to the patient, and this affects the quality of life. They may not be able to communicate or express themselves freely or they may be handicapped and not able to move. This creates a situation where the patient is unable to perform basic functions.”
He added, “It is believed that once the brain is damaged there is nothing much that can be done because the brain cells die and do not regenerate. However, now it is believed that with help of training and good rehabilitation some of the patients can be made functionally better. Even if you are not able to restore function, the aim is to make some improvements, so that at least the patient is able to function and perform basic activities and be independent.”
Talking about how does neurological rehabilitation benefit the patients, Dr VP Singh said, “Fortunately, Neuro Rehabilitation serves as a ray of hope for patients suffering from mild to severe neurological challenges. When there is a lack of function of an arm or leg, then over time the arm and leg become rigid and there is resistance to movement and over a period of time, this leads to severe contractures, where the arm gets permanently deformed in a particular posture and this we often see in patients. If proper therapy is not given in time, this results in permanent contracture.”
He insisted, “In situations like this, rehabilitation can really help. The aim is to improve the balance and walking of the patient and make the arm useful for day-to-day functions. Similarly, speech rehabilitation and therapy help the patient communicate better. The benefits are maximum if the rehabilitation is started at an early stage. A neurological rehabilitation program aims to improve physical, emotional, and social well-being while returning you to the highest level of function and independence. In most cases, patients can get back to living independently, making them happier and more satisfied with their lives.”
Throwing light on robotic rehabilitation, Dr VP Singh said, “In most patients with common neurological diseases like stroke, severe brain injury, spasticity due to other diseases, and cognitive disorders, traditional neurorehabilitation techniques seem to be less effective. New technologies have been proposed in recent years to improve the efficacy of rehabilitation techniques in these circumstances. They include methods like assistive technology as well as robotic-assisted training and virtual reality to improve the scope and effectiveness of neuro-rehabilitation and to manipulate brain excitability and plasticity. With manual physiotherapy both active and passive movements may be restricted due to spasticity and the desired benefit is not achieved. Rehabilitation becomes easier with the robots which helps to achieve a full range of motion which is physiological and simulates normal walking.”
As per him, a simple formula to check if it’s a stroke is FAST –
- F – Face: Ask the patient to smile and look for any asymmetry of the face
- A – Arm: Ask the patient to outstretch both hands and one arm may gradually drift down
- S- Speech: While speaking, the speech may not clear, or may not make sense or may not be able to name objects and people. The patient may use inappropriate words or may make only sounds
- T- Time: The emphasis is that if any of the above symptoms are there the patient must immediately be referred to a good center with modern facilities of stroke management so that effective therapy can be given. The longer one waits, the more damage can occur to the brain. And therefore, time lost is brain lost.
He asserted, “Some of the causes behind the rise of neuro conditions at a younger age are hypertension, high cholesterol, diabetes, smoking and obesity which act as the major risk factors for stroke at younger age.” He elaborated:
- Sedentary or inactive lifestyle- a lifestyle with a lot of sitting and lying down, with very little to no exercise.
- Smoking
- Stress
- Genetic factors
- The lifestyle factors are a major cause of the rise of neuro conditions at the younger age.