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  • The Importance of Golden Period in Stroke Rehabilitation

    Published on June 19, 2018

    Dr Vijay Janagama,

    Director- New Initiatives, SuVitas Holistic Healthcare

    Stroke can hit anyone at any age. With India reporting more than 1.8 million stroke cases every year, of which almost 15% affect people in their 30s and 40s, there is enough reason to learn more about this disease. Stroke or a Cerebro Vascular Accident (CVA) results from a sudden blood loss to the brain or bleeding within the brain resulting in the impairment of neurological function. Obesity, smoking, hypertension, alcohol consumption, diabetes and family history are considered some of the common factors leading to stroke. While effective treatment for stroke is evolving in the country, a largely neglected area is the ‘golden period of stroke rehabilitation.’

    The first 90 days after recovery of a stroke is referred to as the golden period. This phase is considered extremely important in the complete rehabilitation of a patient since most of the neurological recovery happens during this time.

    Listed below are few reasons which underline the significance of the ‘Golden Period’:

    1. In the absence of continued monitoring by a team of skilled nurses and doctors, critical signs in a patient could be overlooked consequently leading to a relapse (deterioration of recovery), disability with profound effects on the quality of life or moving to a vegetative state and death.

    Some of the critical signs to watch for after a stroke are,

    • Symptoms of heart disease- chest pain, fatigue , congestion etc
    • Deep Vein thrombosis- swelling, pain or tenderness in legs
    • Pneumonia- fever, shortness of breath
    • Seizures- tingling sensation, partial loss of consciousness
    • Depression- feelings of anxiety, irritability, helplessness
    1. Early rehabilitation in an organized care setting can prevent other common post stroke complications like recurrent stroke, bed sores, aspirations, spasticity and infections.
    2. A reliable prognosis (the likely course of a medical condition) in all patients is madewithin 12 weeksfrom stroke onset. Majority of neurological effects of stroke can be reduced if early, intense and consistent rehabilitation is initiated.
    3. With the right rehabilitation care provided by a multidisciplinary team of doctors, within the first 90 days itself there will be noticeable signs of improved functional outcomes in the activities of daily living in a stroke patient. These interventions will enhance socialization and minimize changes of mood issues like depression.

    The key objective of stroke rehabilitation is to restore health in an individual through neurological recovery (mainly through neuroplasticity), functional recovery with task specific training and improve the quality of life by focusing on emotional wellbeing.

    The Primary steps of rehabilitation care which needs to be initiated within the first 90 days of Golden Period are,

    1. Base assessment & risk profiling– The recovery prognosis of a patient should be made as per the severity of the disease, by taking into account any co-morbidities including High blood pressure, Diabetes, Hypercholesterolemia and preventable risk factors like falls, aspiration, infections etc.

    1. Goal setting– A multidisciplinary team of care providers including physicians, speech therapists, occupational therapists, nurses, physiotherapists and dieticians should work with the family to set realistic and mutually agreeable goals for enhanced recovery.

    1. Regular evaluation– Performance indicators should be rigorously monitored to continue/ modify the care plan. Stroke affects differently in individuals and hence each care plan should be customized as per the individual’s condition.

    1. Empowerment– Soon after discharge from a critical care setting, depending on the intensity of the condition a stroke patient should decide to choose the next care setting. He/she should be advised to handle the disease/risk factors and ideally moved to an organized rehabilitation setting for an empowered and accelerated recuperation.

    As India battles a rising stroke epidemic compared to other developing nations, it is high time we focused on specialized programmes of stroke rehabilitation to effectively overcome the disability.