The common sites of brain damage found to be; Occlusion of the internal carotid, middle cereberal, anterior cereberal, posterior cereberal, and the vertebral arteries are well known.
The severity of the stroke depends upon five factors:
1. The cause of the stroke and its permanence.
2. The location of the stroke. The locations and extent of the brain damage determine the symptoms and physical findings in the patient.
3. The quantity of the brain tissue involved. The lesser damaged brain cells, the faster is the recovery.
4. The health status of the patient before the stroke. For example incompliant diabetic patient may be able to be much slower in their progress and their response to the care.
5. The number and type of complications that occurred after the stroke. Patient with severely spastic paralysis may become harder to be treated.
To comprehend the therapeutic exercise treatment of hemiplegia (stroke) fully, one must have a thorough knowledge of the whole range of therapeutic exercise and an appreciation of the pathophysiology of stroke and its evolution.
Hemiplegia (stroke) is characterized by a variable collection of neurological impairments only one of which is motor paralysis, mostly on one side of the body and in many cases are to include the facial muscles as well. This is suggest that a variety of therapeutic techniques must be introduced to the patient by experienced physical therapist.
The careful evaluation of each stroke patient is the first priority of treatment and the careful formation of an appropriate exercise program is the second priority. The initial evaluation of the patient rarely given all the information needed concerning patient’s deficits. More often the therapeutic team needs to carefully observe the patient for several days or weeks before all of the impairments are detected and understood. Changes in impairments occur as a result of the evolution of hemiplegia and in response to the treatment program. This makes continuing evaluation by qualified therapist, so modification of the exercise program can assist development of plan of care that suit the patient immediate condition and his progression.