Stroke, which is damage to the brain from interruption of its blood supply, is normally referred to as a ‘cerebral vascular accident’, which means that it is very fast and sudden, and can happen to anyone. Medics say if someone with a stroke is taken to hospital early, there are high possibilities of getting the help needed in time, and possibly, resuming normal activities eventually. Jacques Nshimiyimana, a physiotherapist at Deus Est Neuro-Rehabilitation Center and Clinics in Kigali, says although stroke is first treated by neurologists, there is another phase after this which is also part of the treatment known as physiotherapy. For people to resume their daily physical activities after a stroke, Nshimiyimana says physiotherapy is required as it plays a big role in rehabilitation. Medically, there is a concept known as neuroplasticity, meaning that the brain can be formed even if it has an injury; there is some ability to recover because the brain does some rearrangement to try to recover the function. “By doing intensive rehabilitation, we are trying to influence that neural plasticity or brain plasticity to occur very fast because if we don’t do the rehab, it (the (rearrangement of the brain) will still occur but in a fatal way,” says Nshimiyimana. Also, if the patient seeks treatment late, it’s hard for them to be helped to recover from a particular function that will be targeted, or sometimes be impossible because the brain would have already rearranged itself. “We start by helping out when it comes to turning or changing their positions in bed,” he says. The physiotherapist goes on to explain that this is so because after a stroke has occurred, one is normally left with one side of the body weakened or paralysed. Aiding them turn in bed helps in avoiding the risk of developing bedsores, which if not helped, one might need to stay in hospital longer. Also with physiotherapy, patients are trained on how to sit as well as stand with use of support. Such mobility exercises, Celestine Karangwa, a physiotherapist at Technology Clinic in Remera-Kigali, says, are normally done on a mat as it’s safer. Stroke rehabilitation under physiotherapy, Karangwa says, also includes what is known as transfer, which simply means moving from one place to another, helped from the bed to the chair and vice versa. “The main aim of physiotherapy is to restore functional independence to carry out daily activities self-sufficiently,” says Nshimiyimana. He explains that rehabilitation should be very intense for better outcomes. “Starting treatment early and doing it intensively is important to help patients recover. The recommendation is that patients should do rehabilitation five days a week and 45 minutes of exercise daily for a period of six months. It can even go beyond depending on the patient,” adds Nshimiyimana. Understanding stroke Stroke is a brain attack, when blood supply to the brain is reduced or halted. Due to the inadequate supply of oxygen and nutrients to the brain, brain cells die in this state. It can happen to anybody at any moment and its manifestations are haemorrhagic, ischemic, and ischemic transient assaults. Blockage of arteries linked to the brain is the main cause of ischemic stroke, while haemorrhagic stroke is caused by brain arteries bursting open or leaking blood. Dr Alain Sayinzoga, a medical director and neuro-disability specialist, says during the diagnostic, the first thing is to carry out computed tomography (CT) scan to find out exactly what type a stroke one is suffering from. He explains that this is so because when it comes to the treatment, these two (haemorrhagic and ischemic stroke) differ in terms of treatment. He says stroke has phases including acute and subacute phases. At the acute phase, it is always considered an emergency case where the medics try to remove the blood by the surgery, or thrombolysis—a treatment to dissolve dangerous clots in blood vessels, and improve blood flow. The initial phase, called the acute phase, lasts for about two weeks after the onset of the lesion. The second phase is the subacute phase, and this usually lasts up to six months after onset. Finally, the chronic phase begins months to years after stroke, and it may continue for the remainder of the person’s life. Here, depending on the patient’s status, the physiotherapist helps with rehabilitation treatment. Signs During a stroke, Sayinzoga says every minute counts and that when one seeks medical attention as soon as possible, there are possibilities of getting the help needed and avoiding further complications, and even death. He says that in knowing the signs and symptoms of stroke, one can take quick action and perhaps save a life. There are three main signs, including sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. There is also sudden confusion, trouble speaking, or difficulty understanding speech.
