Is Walking Considered Rehabilitation After a Stroke? - Neurology

Dr. Hong Weibin reply Neurology

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Hello: Ischemic stroke is caused by the occlusion of blood vessels supplying brain tissue, leading to hypoxia and necrosis of normal brain tissue.
The acute phase of an ischemic stroke lasts approximately 5-7 days from the onset of symptoms.
Risk factors for stroke include age (the older you are, the higher the risk), chronic hypertension, diabetes, hyperlipidemia (high cholesterol and triglycerides), atrial fibrillation, family history of stroke, and long-term smoking, among others.
To prevent the occurrence of a stroke, it is essential to reduce the impact of these risk factors.
While age is an unavoidable factor, it is crucial to manage hypertension, diabetes, and hyperlipidemia, as well as to quit smoking, maintain a balanced diet to avoid dehydration, and engage in regular exercise.
If atrial fibrillation is present, it is advisable to consult a neurologist or cardiologist to assess the need for anticoagulant medication.

For patients who have experienced multiple strokes, the body's ability to recover diminishes, so active rehabilitation is necessary after the acute phase of the stroke.
For elderly patients, simply walking in a park may be considered rehabilitation, but the intensity is relatively low, and the effectiveness may be limited.
It is recommended to seek evaluation from a rehabilitation specialist to arrange appropriate rehabilitation exercises.
Rehabilitation exercises, like fitness training, should be progressive and consider the patient's load capacity.
Typically, in addition to aerobic exercises, strength training is incorporated (though the intensity will not be as heavy as in regular fitness training) to enhance muscle strength, along with balance training based on the patient's stability.
Rehabilitation is a specialized field.
If a patient has a history of ischemic stroke and no contraindications (such as bleeding disorders, hemophilia, liver cirrhosis, or thrombocytopenia), long-term use of antiplatelet medications, such as aspirin or clopidogrel (known as Plavix), is usually recommended to protect blood vessels and prevent future strokes.
If the patient has atrial fibrillation (a type of arrhythmia), it is important to check the pulse for regularity; if irregular, caution is warranted for potential arrhythmias.
Due to the higher risk of stroke associated with this arrhythmia, long-term anticoagulant therapy is advised.
There are many effective new-generation oral anticoagulants available, which can be discussed with a neurologist or cardiologist.
The physiological mechanisms of atherosclerosis are quite complex and can be caused by multiple factors, including hypertension, diabetes, age, hyperlipidemia, and smoking.
Exercise enhances cardiovascular endurance, reduces free radicals in the body, lowers insulin resistance, and indirectly slows the progression of atherosclerosis.
Therefore, exercise should be performed regularly over the long term, rather than sporadically.
Aerobic exercises are recommended (such as brisk walking, swimming, or cycling that raises the heart rate; leisurely walking in the park does not count).
Ideally, one should aim for at least three sessions per week, with each session lasting at least 30 minutes, achieving a heart rate of at least 130 beats per minute.
Additionally, incorporating strength training to increase muscle strength and mass is beneficial.
Patients who suffer from acute strokes often experience a drastic decline in functional ability, dropping from 100 to 10-20 points.
However, with treatment and rehabilitation, the patient's condition gradually stabilizes and may improve to 40-50 points, or even 70-80 points, depending on individual circumstances.
The recovery process takes time, often exceeding six months, and can take 1-2 years, so family members need to patiently support the patient through this long journey.
Wishing you and your loved ones health and happiness.

Department of Neurology, Tainan Hospital, Ministry of Health and Welfare, Hong Wei-bin.

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Reply Date: 2017/12/07