Pelvic bridge: Stand next to the patient, hold his knee and support his bottom as he tries to lift his hip off the floor. — SHAARI CHEMAT/The Star
Getting a stroke is no joke.
For every minute that a stroke patient goes untreated, he loses roughly two million neurons (i.e. nerve cells in the brain) that transmit information to other neurons, muscles and tissues throughout the body.
Some may take days or weeks to recover, while others can take months or years to regain full functionality ... if they start rehabilitation promptly.
By acting quickly and/or calling 999 at the earliest signs of stroke, you can get the patient to the hospital in time to receive treatment that clears the blockage and restores blood flow to their brain.
This treatment can only be administered within four hours from the moment the first symptoms appear.
These symptoms include sudden numbness, weakness, blurred vision and drooping of the face, arm or leg, especially on one side of the body.
“But how many people are fortunate enough to get to the hospital in time so they don’t get disabled?” asks Universiti Kebangsaan Malaysia consultant neurologist Associate Professor Dr Khoo Ching Soong.
“A lot of hospitals are also not equipped to treat acute stroke patients.
“Sadly, many people lack awareness and don’t know about stroke or rehabilitation.”
Once the stroke patient is stabilised, she is discharged from hospital and goes home.
He says: “I see them months later, but in between, the patient has not gone for stroke rehabilitation, even though I’ve prescribed it.
“Due to several limitations such as finances, inaccessibility, transportation, long waiting time at public hospitals, etc, they don’t go.
“Besides, stroke rehabilitation services are not available everywhere.
“Imagine if the stroke patient lives in Cheras and the rehabilitation hospital is in Sungai Buloh (about 30km away) – it’s difficult for the patient to get to, especially if he has no family support.
“So physiotherapy becomes a problem as he doesn’t attend the sessions; hence, he doesn’t regain full functionality.”
A rehabilitation programme should ideally involve nurses; physiotherapists, occupational and speech therapists; audiologists; nutritionists; counsellors; social workers; and psychiatrists for young patients who might go into depression from losing their jobs and being dependent on others.
Making changes
Globally, 15 million people suffer from stroke each year. 
Trunk rotation: Stand behind the patient, who should be holding towel or stick in front of them, and help them twist their torso from left to right to work their core muscles, balance and mobility. — Photos: Filepic
In Malaysia, it ranks as the third most common cause of death with an estimated 50,000 new stroke cases annually.
The first 90 days post-stroke are critical for recovery and engaging in rehabilitation during this period cannot be emphasised enough.
“This is the best window period to regenerate, rewire and reconnect the brain cells to improve neuroplasticity,” says Assoc Prof Khoo.
Neuroplasticity is the brain’s ability to form new connections and pathways, and change how its circuits are wired.
Unfortunately, many stroke patients miss this crucial time frame, resulting in lasting physical impairments.
They can still begin rehabilitation after the 90 days, but the results may not be as good.
As adverse as it may seem, stroke doesn’t have to be the beginning of the end.
About 80% of strokes can be prevented with lifestyle changes such as losing weight, cutting back on salt, exercising and sleeping well.
Uncontrolled long-term stress is another risk factor.
Inflammation can come from increased cortisol – a stress hormone – which changes when you’re sleep-deprived.
The inflammation raises your risk for hypertension (high blood pressure), heart disease and stroke.
Lack of sleep also increases your heart rate and blood pressure, putting you at an even higher risk for stroke.
Therefore, quality sleep is key to repairing and regenerating the body, which can then lessen the risk of developing heart and degenerative diseases.
Loneliness kills
With older people, other than the physical limitations from stroke, they also become very lonely, and even depressed.
“When they get a stroke, the older person loses access to going out and their children have no time to take them out either as they have to work and take care of their own families.
“Also, the car seat needs to be adjusted, and getting the patient in and out of the car is difficult,” says Dr Choo Hao Jian, whose interest lies in regenerative medicine and geriatric wellness.
In the past, the focus has always been on lifespan, but now, the buzzword is healthspan.
ALSO READ: Adding life to years, not years to life
He says: “A long lifespan is a curse without a good quality of life.
“If the senior person cannot recover fully from a stroke and lives until a ripe old age, think of the consequences.
“We want to prevent these kinds of things so that we spend a shorter lifespan in disease.”
Keeping mobile and active can prevent many heart and muscle loss issues.
Dr Choo adds: “Even for those dealing with old injuries, physiotherapy and rehabilitation are essential, helping them regain mobility and return to an active lifestyle.”
Move those muscles
A decade-long study involving over 16,000 healthy men revealed that those with higher levels of cardiorespiratory fitness had a 68% lower risk of stroke and stroke-related deaths, compared to their less fit peers.
Trunk rotation: Stand behind the patient, who should be holding a towel or stick in front of them, and help them twist their torso from left to right to work their core muscles, balance and mobility.According to physiotherapist Houston Tee, skeletal muscles start shrinking in just 14 days from inactivity.
“So, imagine a stoke patient who is in bed for the first one month after a stroke.
“His family – out of love – is asking him to rest and not get up, but in actuality, we are slowly killing the patient.
“It takes more time to retrain shrinking muscles,” he says.
The biggest issue among stroke patients is balance.
Even standing up from a sitting position, or getting up to sit on the edge of the bed from a lying position, can be a challenge.
“They have no control over some of their movements, so we set rehabilitation goals for them.
“They might say ‘I want to climb the stairs’.
“That is an unrealistic goal at that point so we do it step by step and start with walking first,” says Tee.
For home exercises, he recommends caregivers help patients with the following three exercises to help improve their balance and regain strength in their torso and leg/hip muscles:
- Pelvic bridging
- Sit to stand
- Trunk rotation.
Assoc Prof Khoo, Dr Choo and Tee were speaking at the recent launch of AmHope, a regenerative and rehabilitation centre designed to help seniors overcome the challenges of stroke and other physical health issues.
Located in Puchong, Selangor, the centre also offers substantial financial aid to assist stroke patients facing multiple challenges.
Patients only need to present a hospital medical report of their stroke diagnosis and pay a discounted fee of RM30 per rehabilitation session (market rate is RM150).
“We recognise the challenges some patients face in accessing rehabilitation services, so we currently provide a shuttle service for customer transportation at a fee of RM1 per kilometre.
“Soon, we plan to roll out a mobile truck equipped with various rehabilitation tools to serve local communities, ensuring that essential services reach those in need,” says Lew Mun Yee, founder and president of AmLife International, the parent company of AmHope.
