A stroke, or cerebrovascular accident, or “brain attack,” is the most common disease of the nervous system. It occurs when a blood vessel bringing oxygen to the brain is hindered by an obstruction. Because the brain is deprived of blood, its neurons begin dying. Severe strokes may cause serious disorders such as paralysis, loss of speech, and even death. Stroke is the third greatest cause of death in the United States. However, between four to seven million people have survived stroke. For them, brain stroke recovery is critical to living without impairment.
The cerebrum is the largest portion of the brain, consisting of about 80 percent of the brain’s mass. It is divided into a right and left hemisphere that are separated by a longitudinal cerebral fissure. In most people the left hemisphere primarily controls analytical and verbal functions like reading, writing, and math while the right hemisphere controls spatial and artistic functions. Some portions of the two hemispheres are connected by a large chunk of gray matter known as the corpus callosum. Patients undergoing left-brain stroke recovery may experience personality changes, trouble communicating, and paralysis on the right sides of their bodies, while patients undergoing right-brain stroke recovery may experience poor concentration, impaired reasoning, and short-term memory loss. The patient may also be unable to recognize the extent of impairment and think he can perform tasks at the same level of quality he employed before the stroke. This is known as anosognosia, or a lack of awareness of the existence of a disability.
Within the cerebrum are five paired lobes. The frontal lobe forms the anterior portion of the cerebral hemispheres and plays a major role in analyzing sensory experiences, assisting in the movement of skeletal muscles, and mediating responses related to memory, emotion, reasoning, and verbal communication. When a patient suffers a stroke in the frontal lobe, he or she may experience apraxia (altered voluntary movements), disorganized thinking, poor reasoning, hemiplegia (one-sided paralysis), depression, and Broca’s aphasia (difficulty communicating ideas).
The parietal lobe is instrumental in understanding speech and articulating one’s own thoughts and emotions. It also aids in the body’s sensitivity to stimuli like pain and pressure and helps interpret the textures and shapes of objects. Strokes in the parietal lobe may lead to paresthesia (tingling and loss of sensation), difficulty reading and writing, hemineglect (inability to respond to stimuli on one side of the body), and trouble distinguishing between left and right.
The temporal lobe is located below the back part of the frontal lobe. In addition to receiving sensory fibers from the ear, the temporal lobe helps interpret sensory experiences and stores memories of things seen and heard. Strokes in the temporal lobe may induce trouble hearing, memory deficit, and difficulty comprehending language.
The occipital lobe is in the back part of the cerebrum, above the cerebellum and separated from it by an infolding of the meningeal layer. As its name suggests, the occipital lobe aids in vision by directing and focusing the eye. Stroke in the occipital lobe may result in visual field deficit (VFD), total blindness, or visual agnosia in which a patient can still see things but no longer retains the ability to comprehend what he or she is looking at.
Some form of structured exercise program is recommended for recovery after a stroke. There are a number of different exercise modalities that have been shown to improve cardiovascular fitness in stroke survivors and lower the risk of having another stroke. Moreover, exercises that incorporate task-repetitive straining can improve both motor learning, and thereby improve function in both the upper and lower extremities. Inactivity, on the other hand, can worsen disability and increase the likelihood of a second or third stroke. For this reason it’s important that a patient engage in a repetitive daily program of habitual activities as part of a long-term health regimen.
The formulation of an exercise program for recovering patients may begin in a stroke recovery center where physicians perform a thorough medical history, physical, and cardiopulmonary examination. Low-intensity aerobic exercise may not be advisable for patients who, in addition to suffering stroke, also have chronic pain symptoms, dementia, severe aphasia, peripheral arterial occlusive disease (clogging or blocking of the peripheral artery), or symptomatic heart failure. Proper clinical discernment should be used in evaluating whether a stroke survivor can participate in exercise without impairment.
However, research indicates that certain aerobic exercises are beneficial for a select number of stroke victims, if undertaken with the evaluation and supervision of a trained physician. Structured exercise programs can improve bone health and lower cardiovascular-metabolic risk. Recent studies also suggest that exercise improves cognitive function, alleviates depression, and mediates brain plasticity, which has been linked to motor learning.
Because two-thirds of those undergoing stroke-victim recovery are suffering from motor deficits, virtual reality has become an ideal form of brain recovery after stroke. Virtual reality activates neurons in the brain that induce a therapeutic effect, thereby reducing pain and increasing function. According to the American Stroke Association in 2011, 11 out of 12 previous studies showed significant improvement in motor impairment after rehabilitation with virtual-reality programming.
At the NYDNRehab we employ Computer Assisted Rehabilitation Environment (CAREN) to treat patients who are suffering the repercussions of traumatic brain injuries, strokes, and concussions. While CAREN has been used to treat a wide range of neurological disorders, it aids and rehabilitates stroke victims primarily by helping to restore balance, gait stability, and motor control. Consisting of a motion base, motion-capture software, and a projection screen, CAREN is an immersive, multi-sensory virtual reality system designed to facilitate neeuroplastic recovery by allowing patient to use unique multi-sensory feedback while being immersed. These effects can’t be produced by any methods of conventional physical therapy; its proven success in initiating and reinforcing new neuronal connections in recovering stroke victims brain. This type of new therapy is a missing link in stroke victims’ recovery.
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