WHAT IS A STROKE AND WHAT CAUSES IT?
A stroke is an acute brain injury of vascular origin that requires immediate medical treatment.
It occurs when:
- blood flow to an area of the brain is suddenly reduced or interrupted, usually because a blood vessel becomes blocked (ischaemic stroke), or
- a blood vessel ruptures, causing bleeding within and/or around the brain (haemorrhagic stroke).
In an ischaemic stroke, the sudden reduction or interruption of blood flow deprives brain cells of oxygen and nutrients and can cause irreversible damage within minutes.
TIME IS BRAIN!
For this reason, every stroke is a medical emergency and requires immediate diagnosis and treatment.
In ischaemic stroke, emergency treatment in appropriately selected patients may include intravenous thrombolysis to dissolve the clot and, when a large blood vessel is blocked, mechanical thrombectomy to remove it.
Whether these treatments can be used depends on the time that has elapsed since the onset of symptoms, the clinical and imaging findings, and the individual characteristics of each patient.
When the time of onset is unknown, the last time the patient was known to be free of symptoms of the stroke is taken into account.
In subarachnoid haemorrhage caused by rupture of a cerebral aneurysm, the aneurysm must be identified and secured urgently by endovascular embolisation or microsurgical clipping in order to prevent rebleeding.
Appropriate follow-up imaging is required after treatment, particularly following endovascular embolisation, where recurrence or recanalisation may occur.
In intracerebral haemorrhage, which is often associated with chronic arterial hypertension, immediate and careful control of blood pressure is required. When a clotting disorder is present, or the patient is taking anticoagulant medication, appropriate treatment is given to restore normal blood clotting.
In selected patients, neurosurgical or other specialist intervention may also be required.
Stroke is one of the most common and serious neurological conditions worldwide and remains a major cause of death and long-term loss of function.
In Greece, an estimated 30,000–35,000 new strokes occur each year.
The risk of recurrence also remains significant, with approximately one in ten patients experiencing another stroke within the first year.
WHAT ARE THE SYMPTOMS OF A STROKE?
Symptoms usually develop suddenly. The most common are:
- weakness or numbness of the face, arm or leg, particularly on one side of the body,
- difficulty speaking or understanding speech,
- disturbance or loss of vision,
- unsteadiness, dizziness, loss of balance or coordination,
- a very severe headache with no obvious cause.
In Greece, the appearance of any of these symptoms requires an immediate call to 166 or 112, even if they improve quickly.
Depending on the area and extent of the brain injury, a stroke may cause motor, sensory and visual problems, difficulties with speech, communication or swallowing, as well as disturbances of memory, attention, perception, behaviour and emotion.
Recovery varies considerably from one patient to another. Part of the improvement is due to spontaneous neurological recovery, meaning the body’s natural recovery mechanisms, and to neuroplasticity, the ability of neural networks in the brain to change their organisation and function.
Structured rehabilitation makes use of this capacity through systematic and repetitive practice of functional activities with specific treatment goals.
WHY IS EARLY REHABILITATION IMPORTANT?
After a stroke, secondary complications may develop, including respiratory infections, deep vein thrombosis, pressure ulcers, contractures, pain, falls, malnutrition and depression.
Immobility, dysphagia, muscle weakness, spasticity and other functional problems can increase the risk of these complications if they are not recognised and managed promptly and effectively.
Rehabilitation is an integral part of the overall treatment after stroke. It begins once the patient is medically stable and is adapted to their general and neurological condition, as well as to their needs and abilities.
HOW DO WE MANAGE STROKE AT ANAPLASI?
At ANAPLASI, the Multidisciplinary Rehabilitation Team systematically assesses the patient’s neurological and functional condition and develops an individualised rehabilitation programme with specific, measurable treatment goals and regular reassessment of progress.
The intensity, duration and combination of therapeutic interventions are adapted to the needs and abilities of each patient.
Information, education and guidance are also provided to the patient and their family about what to expect after stroke, the Rehabilitation process and the safe management of functional difficulties.
The programme includes:
- physiotherapy,
- specialised aquatic therapy in the Hydrotherapy Pool,
- occupational therapy and training in activities of daily living,
- speech and language therapy for disorders of speech, communication and swallowing,
- dietetic assessment and follow-up, with feeding adapted to each patient’s needs and clinical condition,
- neuropsychological assessment and therapeutic intervention for memory, attention, executive, visuospatial and other cognitive functions, as well as
- psychological support for the patient and their family.
Modern rehabilitation systems are also used for standing, balance and gait training, assisted mobilisation and active exercise.
When indicated, the programme includes aerobic exercise, with gradual increases in intensity and duration, using specialised equipment, to improve endurance.
For inpatients, respiratory physiotherapy is provided from the time of admission, with the aim of maintaining and improving respiratory function, promoting better lung expansion and facilitating the mobilisation and clearance of bronchial secretions.
DIGITAL COGNITIVE REHABILITATION SYSTEM RehaCom
At ANAPLASI, when indicated, the cognitive Rehabilitation programme after stroke is supported by the specialised digital cognitive Rehabilitation system RehaCom.
Specially designed exercises are used to train functions such as attention, memory, information-processing speed, executive functions and visuospatial abilities. The level of difficulty is adjusted to each patient’s needs and performance, allowing individualised and systematic training and monitoring of progress.
RehaCom is used as part of the overall Rehabilitation programme and does not replace neuropsychological assessment and individualised therapeutic intervention.
SPECIALISED AQUATIC THERAPY IN THE HYDROTHERAPY POOL
When indicated after stroke, specialised aquatic therapy in the Hydrotherapy Pool uses the physical properties of water to facilitate movement.
It may contribute to improvements in balance, mobility and walking, while also promoting muscle relaxation.
MANAGEMENT OF SPASTICITY
Spasticity after stroke is treated when it causes pain, restricts movement and function, interferes with care or contributes to the development of contractures and deformities.
Spasticity is always assessed in relation to the patient’s functional ability and specific treatment goals.
Management is tailored to individual needs and may include physiotherapy, appropriate positioning and mobilisation, the use of suitable aids and orthoses, specialised aquatic therapy in the Hydrotherapy Pool and medication.
In selected patients with focal spasticity, botulinum toxin type A may be injected under electromyographic guidance as part of the overall Rehabilitation programme.
This is followed, according to individual needs and treatment goals, by physiotherapy, occupational therapy and, when indicated, the use of appropriate aids and orthoses.
SWALLOWING DISORDERS – DYSPHAGIA
Dysphagia after stroke requires particular attention because it can lead to aspiration, pneumonia, dehydration and malnutrition.
At the ANAPLASI Dysphagia Unit, when clinically indicated, Flexible Endoscopic Evaluation of Swallowing – FEES is performed.
The examination uses a thin, flexible endoscope introduced through the nose, allowing direct assessment of swallowing function, secretion management and airway protection.
This enables assessment of the safety and efficiency of swallowing, and the findings are used to guide the individualised planning of treatment, feeding and hydration.
MANAGEMENT OF SIALORRHOEA
Following stroke, some patients may develop sialorrhoea, usually because of impaired oromotor control and difficulty swallowing saliva rather than excessive saliva production. Posterior flow of saliva towards the pharynx is particularly important because it may increase the risk of aspiration.
Management is individualised and may include therapeutic interventions to improve oromotor control and swallowing, medication and, in selected patients, botulinum toxin type A injections into the salivary glands, usually under ultrasound guidance.
Botulinum toxin injections into the salivary glands require careful patient selection and close monitoring because, in rare cases, they may cause or worsen difficulties with chewing or swallowing and increase the risk of aspiration.
MODERN ROBOTIC REHABILITATION TECHNOLOGY
At ANAPLASI, modern robotic rehabilitation technology is also used in patients after stroke, allowing intensive, repetitive and controlled practice of movement and walking as part of the individualised treatment programme and always under the guidance of the Multidisciplinary Rehabilitation Team.
In appropriately selected patients, a robotic exoskeleton may be used for standing and gait training, with the level of assistance adjusted to the patient’s abilities.
For functional retraining of the upper limb, and particularly the hand, a robotic system – a robotic glove – is also used. It enables a large number of controlled and repetitive movements and may be combined with occupational therapy to improve specific functions of the upper limb and hand.
Robotic technology is used as an adjunct and does not replace active therapeutic exercise.
NEUROMODULATION WITH nTMS / navigated rTMS
Navigated Transcranial Magnetic Stimulation (nTMS) allows precise and individualised identification of the target area of the brain.
For therapeutic neuromodulation, Navigated Repetitive Transcranial Magnetic Stimulation – navigated rTMS is used.
In appropriately selected patients after stroke, navigated rTMS may be incorporated into the rehabilitation programme as an adjunct to motor rehabilitation.
rTMS has also been studied in aphasia rehabilitation, although its effectiveness in this area is still being investigated.
At ANAPLASI, in appropriately selected patients with severe dysfunction of the hand, navigated rTMS may be combined with functional retraining using a robotic system – a robotic glove – and with occupational therapy directed towards specific functional goals.
CARE OF THE SEVERELY AFFECTED PATIENT
In patients with severe stroke and significant limitations in mobility, Rehabilitation and the prevention of complications begin early, as soon as the patient’s medical condition permits, even before the patient is able to get out of bed.
In the Inpatient Rehabilitation Unit at ANAPLASI, advanced therapeutic beds are used. These allow controlled and programmed changes of position, alternating lateral rotation, specialised pressure management, full-chair positioning and, when indicated, gradual progression towards a more upright position.
These functions also contribute to both the prevention and management of pressure ulcers.
They also provide percussion and vibration functions which, when clinically indicated, can be incorporated into the patient’s respiratory care.
These functions form part of the overall medical, nursing and therapeutic management and do not replace active mobilisation or a structured rehabilitation programme.
In patients with a high level of physical dependence, electrically powered patient hoists may also be used for safer transfer from the bed to the wheelchair and to treatment areas.
SEXUAL FUNCTION AND REHABILITATION
After a stroke, changes may occur in sexual desire, arousal, erectile function, lubrication or orgasm. Sexual life may also be affected by motor or sensory problems, spasticity, fatigue, pain, mood disorders, fear of another stroke or certain medications.
Sexual rehabilitation may include appropriate information and practical guidance, management of factors that interfere with sexual activity, psychological support or counselling and, where necessary, specialist medical treatment.
The involvement of the patient’s partner may be helpful if the patient wishes.
RETURNING HOME AND TO EVERYDAY LIFE
Rehabilitation may be provided through Inpatient Rehabilitation, Day Rehabilitation or Rehabilitation at Home, depending on the patient’s clinical, neurological and functional condition.
Before returning home, the patient’s needs and living conditions are assessed. Appropriate adaptations to the home environment and any necessary assistive devices are recommended and, where required, the family is trained so that the return home can take place with greater safety and independence.
CREATIVE ACTIVITIES, SPORT AND SOCIAL PARTICIPATION
At ANAPLASI, creative activities, sport and social participation complement the Rehabilitation programme and are adapted to each patient’s abilities, interests and therapeutic goals.
Activities include painting, arts and crafts, cooking, music and theatre activities, group activities and sport, as well as participation in cultural and social activities both within and outside ANAPLASI.
These activities provide opportunities for active participation, social interaction, taking initiative and using the patient’s functional abilities in everyday life.
PREVENTING ANOTHER STROKE
After a stroke, particular attention must also be given to preventing another stroke.
Management of risk factors, including arterial hypertension, dyslipidaemia, diabetes mellitus, smoking, obesity and physical inactivity, together with appropriate medication and assessment for atrial fibrillation and other cardiac or vascular causes, according to the type and cause of the stroke, are fundamental parts of the patient’s long-term care.
Regular exercise, a healthy diet and the patient’s active involvement in managing their own health complement the rehabilitation programme and help reduce future cardiovascular risk.
WHAT IS THE AIM OF THE REHABILITATION PROGRAMME?
At ANAPLASI, the aim is to achieve the greatest possible recovery of the patient’s functional ability and independence and to support their active return to personal, family, social and working life.
