Following a stroke, hemiplegia, hemiparesis: what is the treatment in rehabilitation?

Read an article written by Anne-Laure Chatain, MKDE and Allyane-certified practitioner, on rehabilitative care following a stroke.

Stroke, a few reminders

Stroke is one of the most common forms of damage to the central nervous system (brain, brain stem, cerebellum, spinal cord). It is a failure of vascularization of a part of the brain, often resulting in neurological deficits. With 140,000 new cases per year in France, it is the leading cause of disability.

There are two types of stroke: haemorrhagic stroke (about 20%) and ischemic stroke (about 80%).

Stroke due to cerebral haemorrhage is mainly caused by ruptured aneurysms, arteriovenous malformations (usually young people) or high blood pressure (usually older people).

Stroke due to cerebral ischaemia has various aetiologies: the most common is atherosclerosis/thrombus of the aorta (with migration of the clot to the brain), or of the carotid or intracerebral arteries (middle or sylvian cerebral, anterior cerebral, posterior cerebral, basilar trunk). The origin can also be cardio embolic (cardiac arrhythmia, myocardial infarction, heart failure), tumoral...

Paralysis or numbness of the face, a limb or a side, speech or comprehension problems, sudden alteration of vision, sudden loss of balance, sudden and intense headaches are signs that indicate a suspected stroke and require an emergency call to 15.

Stroke, which clinical pictures?

There are as many clinical pictures as there are strokes.
Brain damage leads to hemiplegia or hemiparesis contralateral to the damaged hemisphere (right hemisphere damage: left hemiplegia and vice versa).

This hemiplegia/paresis may sometimes be transient and spontaneously reversible (in the case of transient ischemic attacks: TIAs).
Clinical involvement involves sensory and/or motor impairment of all or part of a hemibody. This corresponds to paralysis/paresis of the limb(s), which may be complemented by tonus alteration (specific to these disorders of the so-called "pyramidal" pathway): flaccidity/spasticity.
These impairments may have a daily functional impact on walking, balance, grasping, washing, dressing and eating.
They may be associated with impairments in cognitive functions: aphasia (language and communication: written, oral), apraxia (gestural sequence), hemineglect, visual field (e.g. Homonymous Lateral Hemianopsia), memory (memory disorders), attention, concentration, fatigue...

Stroke, what rehabilitation?

Rehabilitation after a stroke is often slow, long and incomplete. On the cerebral level, it is achieved thanks to the mechanisms of cerebral plasticity (cerebral reorganisation and redesign). Rehabilitation professionals indirectly "direct" this plasticity by stimulating the patient on the motor, sensory and cognitive levels.

The Allyane method is a relevant complement to motor rehabilitation. For this purpose, the patient's proprioceptive sensations are integrated into motor imagery (a particular form of mental imagery), coupled with low frequency sounds. These specific sounds generated by a medical device will increase the emission of alpha brainwaves allowing the hyperactivation of motor areas. By this means, it is the image of the gesture that we are trying to correct or recreate.

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