1. STROKE DEFINITION Stroke is defined as
“rapidly developing clinical signs of focal (or global) disturbance of cerebral function,
with symptoms lasting 24 hours or longer
or leading to death,
with no apparent cause other than of vascular origin”

2. CLASSIFICATION STROKE ISCHEMIC HAEMORRHAGIC THROMBOTIC EMBOLIC SUB
ARACHNOID
INTRA
CEREBRAL

3. TIA (Transient Ischemic Attack)
ISCHEMIC STROKE
Ischemic stroke accounts for about 87 percent of all cases.
Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain
HEMORRHAGIC STROKE
Hemorrhagic stroke accounts for about 13 percent of stroke cases. 
It results from a weakened vessel that ruptures and bleeds into the surrounding brain.
TIA (Transient Ischemic Attack)
 Transient ischemic attack (TIA) is often labeled “Mini-stroke or Warning stroke”.
Most TIAs last less than five minutes; the average is about a minute.
When a TIA is over, it usually causes no permanent injury to the brain.

4. CLASSIFICATION STROKE (BASED ON BLOOD SUPPLY) ANTERIOR
CEREBRAL ARTERY (ACA) STROKE
MIDDLE
CEREBRAL ARTERY (MCA) STROKE
STROKE
INTERNAL
CAROTID ARTERY (ICA) STROKE
POSTERIOR
CEREBRAL ARTERY (PCA) STROKE
BASILAR ARTERY STROKE

5. RISK FACTORS Age Hypertension Diabetes Cardiac disorders
Cigarette smoking
Previous episode of TIA
Elevated Blood cholestrol
Physical inactivity
Obesity
Excessive alcohol consumption

6. CLINICAL FEATURES

7. Clinical Features
Motor deficits – Usually one side of the body is paralysed (Hemiplegia)
Speech disturbances – Broca’s aphasia (Nonfluent) and Wernike’s Aphasia (Fluent)
Cognitive dysfunctions
Bladder and bowel involvement
Seizures

8. KEY POINTS HISTORY Hemorrhagic Stroke
Onset – Sudden onset of severe head ache followed by loss of consciousness (Rapid Coma)
2) Embolic Stroke
Onset – Sudden, Frequently associated with Cardiac diseases
3) Thrombotic Stroke
Onset – Variable or uneven onset

9. NEUROLOGICAL IMAGING CT Scan & MRI
It is used to rule out the brain lesions such as tumors or abscess and to identify hemorrhagic stroke
Greater resolution of brain and its structural details is obtained in MRI than with a CT scan

10. PHYSIOTHERAPY
MANAGEMENT

11. Physical therapy - Acute Stage
Positioning – Supine, sidelying, sitting
Prevention of Pressure sores – Skin inspection on bony prominences, Frequent change in positioning (Once in 2 hours) & use of pressure relieving devices (Eg- Water bed)
Maintainence of Range of motion – ROM exercises
Training functional activities -like rolling, bridging (Useful for bed pan)
Respiratory management – Breathing exercises
Facial exercises
Bridging

12. POST ACUTE
REHABILITATION

13. MANAGEMENT OF SPASTICITY
Slow icing
Slow icing – Origin to Insertion
2) Stretching
Slow sustained stretching
Maintained for 30 sec
3) Slow stroking
Alternative strokes with flat hands in the paraspinal areas at 3 – 5 times per minute
4) Weight bearing
Promotes stabilization and reduction in Spasticity

14. MAT EXERCISES Rolling to Prone Prone on Elbows Quadrupod Kneel sitting
Kneel standing
Half Kneeling
Standing
Prone on Elbows
Quadrupod

15. BALANCE TRAINING GAIT REHABILITATION Sitting balance
Sit to Stand transition
In case of postural hypotension – Tilt table should be used for vertical progression
Standing balance
GAIT REHABILITATION
Emphasize on Knee flexion and heel Strike
Discourage Circumduction gait (Seen in Stroke patients)
Provide foot marks – Visual cues
ASSISTANCE
Ankle Foot Orthosis (AFO)
Quadrupod in the normal side
FUNCTIONAL ELECTRICAL STIMULATION
Electrical stimulation for performing a functional activity
In case of foot drop – prevents foot dragging in swing phase